75853D - Mason

Chock
Date Received Dab Deposited Check From(Name) Name of Permit Holder Vendor Check Number amount Permit Number/Comments Receipt or Refund/Reallocated
Columnl Cotonnl Column3 Column4 Column5 Columns Column7 _ Columns _ Cdumn9
10/19/2020 10/20/2020 Ricky Hewett Construction Annetta Cobb BB&T 4855 $ 200.00 GP#77644D BB rot,12485 __
10/19/2020 10/20/2020.Big D's Home Improvements Darrell Saccheri CresCom Bank 1011 $ 200.00 GP#77861 D BB rct.12486 _
10/19/2020' 10/20/2020 AMW Docks and Marine Construction LLC Thomas and Dianna Mason 'BB&T 5980 $ 200.00 GP#75853D BB rot.12479 __
10/19/2020 10/20/2020 Bruce W Quaintance same CresCom Bank 2195 $ 200.00 GP#77647D BB rd.12487 __
10/19/2020 10/20/2020 Grim Construction ,Michael and Bettery Williams BB&T 14148 $ 400.00 GP#77645D BB rot.12483
10/19/2020 10/20/2020 Grim Construction Charles Bradley BB&T 14147 $ 200.00 GP#77646D BB rct.12484 _
10/19/2020 10/20/2020 Susan Brami same BB&T 719 $ 200.00 GP#77648D BB rot.12488
10/19/2020 10/20/2020 Bledsoe Enterprises Inc. Ocean Dunes HOA BB&T 14122 $ 400.00 OP#76491D _ PA rot.10265
10/19/2020 10/20/2020 Southern NC Marine LLC Charles and Kelly Batts First Bank 1341 $ 200.00 GP#77831D JD Rd.11760

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AgSNT AUTHORIZATION FOR CAMA PERMIT APPLICATION
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Name of Property Owner Requesting Permit: #h\5o4 t1'1( ��1�`'Llr-21'I el_u c.
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I certify that I have authorized __ V I C*. 1.1 C } Ae^y1��6LK„
Agent i Gont(dctrr
to act on my behalf,for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development _14.4c42-1&+'kilt---_PAAb
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at my property located at 10 S C !}t 1 _CL`_ 6 ,
in='-i.,?141S i.1 t Cr—_County.
1 furthermore certify that 1 am authorized to grant. and do in fact grant permission to
av,Ision of Coastal Management staff, the Local Permit Officer and their agents to enter
or the aforementioned lands in connection with evaluating information related to this
permit application.
Properly Owner Information:
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This rertncuatron is valid through (2 f 3 I 1 2-0

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A / n DREDGE & FILL " No. 75853 A B C
EI.V ERAL PERMIT Previous permit# (4- 1
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued -.2.. 1 9 1 it-
•As authorized by the State of North Carolina,Department of Environmental Quality �T '��
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC o .
❑Rules attached.
Applicant Name k ,0r,ca. S �
t ti, .,in4, SC)^ Project Location: County f ^S �-i ck..
Address ( 9 2 U-4- ,-t dole cp,(1 C.v, Street Address/State Road/Lot#(s) r,dS-
City Co✓64_(i S state N C...zIP 2 c3 I C(,{o rk ( 1>
Phone#(-}0/ (i`. - G d 9 E-Mail f A14 1-7 Sc y,r,C,,/, ce— Subdivision
Authorized Agent t c t L U c S+'_ City :.. s.d A c t4 e< s• C (/' ZIP 2 .?'`I(P
Aff ted icw jA EW 'g'PTA ❑ES El PTS Phone# ( ) River Basin C ---1c./
AE (s): ❑OEA ❑HHF ❑IH ❑USA ❑N/A Adj.Wtr. Body ( lc."A ( (n man nkn)
❑ PWS:
ORW: yes no PNA yes /"�."� Closest Maj.Wtr. Body . ",k S C Vc-c-\'<..-
Type of Project/Activity ‘,..✓:),4,‘c:,_ - , , �-c,< < (t T` `;�r 0,- `-�)i (lc, , _ , ,-,.c
. g V;r . , ,,�z. 'o., C)t ( o'T1 c ax I (Scale: ► ) t -S )
Pier(dock)length() G y3O
b'
Fixed Platform(s) t 2'x i ttr' . i
Floating Platform(s) i y Z O' V' .- ' �` I Finger pier(s) ,� O
4
Groin length
1 number .1 i °l
Bulkhead/Riprap length C
avg distance offshore _ r
max distance offshore A.
Vyra,Hc I 1' + I
G
Basin,channel \ I I j 1 k . /_t f'
I
cubic yards j<,:
1
Boat ramp }
Boathouse/Boatlift
i Id,'Yt
Beach Bulldozing 1
Other �� ,J�J
1 - � 1
Shoreline Length Sv �1 (}
SAV: not sure yes �',\-t.(, (-- 4`�' -- M C^�`0 1'r U`) r-- �+( T
Moratorium: n/a yes ai 5 0 Can A 1
r
Photos: yes
i f
Waiver Attached: yes no : i
A building permit may be required by: S1/4) iN 3&/r 'co h See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions �. ( c ) t ,,\, ,\, not Q&cc ram° ` r
r'i
%. k"----
Age rAppli t Printed Name Permit int Name
Signature **Please read comp lance statement on back of permit** ; Signature
'`pry 2C0`o j 9 60 Iv i ?.t�2U t ZQ z0z
Application Fee Check# Issuing Date pirati n Date
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