77753D - Forrest

0 4.CAMA / DREDGE & FILL N9 77753 A B C OD
GENERAL PERMIT_ Previous permit#
> C New �M diif ato.. Complete Reissue C Partial Reissue Date previous permit issued
As auth rized by the S -o No . olina,Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC l7-4- , j 2-d 0
rr-- ( I❑Rules attached.
Applicant Name V V\� �,' 1\ ^n �t;Y/. St Project Location: County
Address 2 1 v E. \ .,;-1. ;- . Street Address/State Road/Lot#(s) ILISy M‘11 1CJt c.n
i
City))ctc,,. \sl4 ��r•ar h State NC ZIP 2 `AGrr1 —_ ' r.,- SW
Phone#(7A-)'-/L} 70' Z E-Mail (Awtt(96r" i.1 co— Subdivision
Authorized Agent Lies Tkuy Li.,.., �a,„�SiA. )-v.,.,..t. City ;)kAA\c V'kC ZIP 2 S'
CW VIEW PTA ❑ES ❑PTS Phone# ( ) River Basin
Affected P.AEC(s): ❑OEA ❑HHF IDIH ElUBA ❑WA Adj.Wtr. Body .`1 vA� v�``v` ��t-man /unkn)
❑ PWS:
ORW: yes I no PNA yes / no Closest Maj.Wtr. Body
ORW: °�`' `��
r1 rr
\�,-,' \ (1y-.� Lc\r �^a Cr., ,\,41, w' 3�;z.e ,00 cee-zs 0Ic,-�kz,.,. c;
Type of Project/ActivityJ i
• i .� uc 4� `� (Scale: N 7 S )
Pier(dock)length lY I lc 12.01
• i i 1 1 1 _ ! i
Fixed Platforms)rl l u r its! x,I�' N,_
„``V„ QI.�t, ( > r
Floating Platform(s) 0' X 1 I i
cit5,.5
Finger piers) I Groin len h
number - ,—
�� 1 I 4 I I
Bulkhead/Riprap length
avg distance offshore
i j
max distance offshore
Basin,channel , f b'
hr
I I
cubic yards i I �� ! 1
Boat ramp � 1 _,_ j If �Ika �
Boathouse/Boatlift �.__I10.
_.. _...._ ._-..._..._ .__._o' �'
Beach Bulldozing Y 1 e 4
Other 4 1 I t ' .i
.,.,, - \
V v o-
Shoreline Length 1 S 0
w 4
SAV: not sure yes no
046 Vt.Moratorium: ilia yes ;n o ��" �- i—
Photos: Yes ss vi 94 \t R L„,..c. 5,,1 „4,,,v Pt o
Waiver Attached: M`'•� an J I I f i ' (a f• i M a s.+n
A building permit may beYAquired by: \S A Sw, c,� rQ�,,\ . I ,See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions � -1-.. ciCV.k^'` C.-c r.\.L) `,.,�\\ ' pt (p1CC i I A��� c.
I,. I-.cz-AA- S`el k
2 � ��- _A P
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Cdti mb 21,i/2 f 0,]
S.34/2_ A-4t.c 1,4 re, .,,,,Ac--, -----\S/0 cA4
Agent or Applicant Printed Name Permit r ted Name
\ c_ ` C----
Signature *` lease read compliance statement on back cf permit" Signature
200 °CUJ -�i{}-- U ) /zz f Lo Z 1 /7-2 /2.02,i
Application Fee(s Check# Issuing Dake Z I31zj $a Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I)prior to undertaking any activities authorized by this permit,the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief,certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar-Pamlico River Basin Buffer Rules Other:
Neuse River Basin Buffer Rules
If indicated on front of permit,your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office(9 I 0-796-7215)for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ 1-888-4RCOAST 252-946-648 I
Fax: [phone] Fax: [phone]
(Serves:Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden, Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

i CAMA/❑DREDGE& FILL N9 77753 A B C
E N ERAL PERMIT Previous permit#—
New ❑Modification OComplete Reissue DPartial Reissue Date previous permit issued
As aut ed by the State of North Carolina.Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to IsA NCAC Qi-�� (v _
r(� n t 4 Project Location: County -
Applicant Name 17V , � �Yh' t t I�{S� M.��,
4- S4_ Street Address/State Road/Lot#(s) - �.nt—_
Address 2�� E. (-.�s / SWv
Cityoci ,,� ls�c. aL.cr State_N_4 ZIP?5i(A_
Phone#(7o±1)`I1,3 to`I.E-mail Ul6. 1��^ co2.� Subdivision '
Authorized Agent �j/r3 !Ail(1.-,..14OSI )' i•r`t A City S• O 1-4-
pew ZIP 2 h7
w jfEW 7.PTA Ois OPTS Phone# (_) River Basin
Affected !
AEC(s): OOEA OHHF O1H OUBA ON/A Adj.Wtr.Body 51VAko `-t�.v-c./ n unkn
O PWS: goVdi stir-iL ..fe...e'
ORW: yes IC) PNA yes C 9 Closest Maj.Wtr Body
Type of ProjecdActivity ( ')I( :la-,.) cti.0cAc•.3 ar(i,-1- r w y rA i -rI- l?
Pi (Scale: Z S )
v� -� or:k
Peer(dock)length I It I7-1j1 -
C.+c. • * • ' I_- ] I I 1-1- I ! 1 I I-1. I I l i t L L� i I _
Feed 1'ladorm(:} xf - — 1 I I _ �_- .T __ I `\�j �:_.K-�V e�t1 ^-'-� I 't. ,, i
Fioadnz om-0) -O- X pc- I• j i + I i I� i --I_ _ 1 1
Rnger pl t) -' -
Groin length •
I I :�T ,.•. i I _.'�� I 'f i 1 1 I +n 1 I
number — 1 I i _I- ,1- I �-� --1--��t 4'i_ I 1-.�-1_7_7__ --.A__I-
Bulkheadl Riprap length • _ !`�""("I Ij I �` _ 1-L •• - - I 1 j 1
av` _ �1 1 I I I---� I i I ' tit I j ` _��-1
distance offshore j_ i _ ' _
MIX distance offshore I I i 1 _ I • L'i I—1 I I I ii I I
1 I I ICJ_ 1 I 1 11 I I I
Bain.channel •1-T I I j ( Ib' I-J j i j
cubic
,1 I II .�_ l i 1 it-
I I I , i _
Boat ramp r -'ii 1 1 1 _ 11 I 1 _j 14 1 1 , ,iv• ! i l
BoadatndBoadih {—I— I I t.•S-1...0 I_ _I V�1t0 ' i !�11 -- ,e_,._
Beach Bulldozing itti
�•_t-_ _�_I 1 I I 1_ _ I—,-- I `.. 1 i _ j7 +-
i l i I j � I I I I �, �I t l c I I !
Other Ill __I _HIV -
I {- i l I kT v I I !JJ tj- l ----!-
IM ' I_►_1__
Shoreline Length `i S O i�-�J-'j_ {_ I J_ j r4` • _.•-i' I I I ��—� _•'11
SAY: not sure yes vte 1_ .!_l `--tom- - ,— _i- _ _-1 -- 1 _ w. I
Moratorium: Nis yes Q tl 11 _ 1 4_ 1 �friLST_ P-.eQ_ _f__I .I 1.. ��- _- -i r - - 1- 1--IS -
Photor: yes� no iN5 b..1._j.._ IyS� (eiltjsewl t+h r i- �: 1Waiver Attached: yes rA► ' Gn' I I I 1 l 1 • I I .� ._E_.I_I I. i _I.. 1 p b PA g.I�N
A building permit may�%b r qutred by: \ !..,0.tw•k SC. , i ❑See note on back regarding River Basin rules.
(Note Local Planning Jurisdialon
Notes/Special`Conditions �od ^• l ,.1t ws`\,,, N., n� P �t:1✓L ] Gc�t4Le .ir 1e"
-tZ��n,- ( ,., r.�,�sn f�.m ..e'1' Yr+GYpc.4L ...10 4C.,�G s.A.6ct �
-'C'7" I.G..
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;Agent � ddtP need A y�l{ W rC'IL.-, 1 •roC.
Signature ease rcad c pllu,ce statement on back permit
>•• Signature /
�� -o --�V ,,��2 L(ZO L I App1'c3t1°
App/ieaden Feet Check I Issuing trne ( Expit tIon D�~!
ate
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner. 620 d' a4n, frorres-
YT
Address of Property: /�5y •p'•11 7s4 Little $ .) , SJs6/d l AG /&. swt tIc
(Lot or Street#,Street or Road,City&County) /
Agent's Name#: .mod t2 nJ S F tA- h "-' Mailing Address: /3 (b994u! 1,--
Agent's phone#: 9 to- a&3. 'PLO, ferA r- re v
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing.A description or drawing,with dimensions,must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed,you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available athitpj/www.nccoastalmanagementnet/web/cm/staff-listinq or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock,mooring pilings,boat ramp,breakwater, boathouse,or lift must
be set back a minimum distance of 15'from my area of riparian access unless waived by me. (If
you wish to waive the setback,you must initial the appropriate blank below.).
I do wish to waive the 15'setback requirement. -�_, -n
- a/- zg-.Zoe/
1 do not wish to waive the 15'setback requirement.
(Prop Owner Information) (Riparian Property Owner Information)
„tOr, 4.
Signature • Signature -
6-.07 A-arre gi2ln �sA-IQ-/Qa�a 77
Print 6r Type Name Print or Type Name
y5I/ /Yd! 4 5,141 I r1.. iA 1 f XAIl i F}n! AJ6W DA:
Mailing Address Mailing/ Address
$4f/o 4/VC 2 ' 7 S' ) �T�E�XSga.r2o sic .274I L
City/State/Bp City/State/Zip
76f y 7-7°Y-?/D/BGu/BeINW;•<0rti .334 467 , and/n 624,-re677.
Telephone Number/Email Address Telephone Number/Email Address -f-2tre •rza-des''"
30 —20 /i/E .20
•
Date Date
(Revised Aug.201.4)

• AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ( � v y to/ S-/
Mailing Address: /4/5 / /W i`r G h L . .mow s h*
Phone Number:
Email Address:
I certify that I have authorized So O ri d S/i� /24ctr n e <IS ite.,c
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: /J O .1' Pi-e r 4 /( Y •9
t( �1 6�C�• /( /K/6/ auItr-ee/• / Y/ / /`/oc 7in� �c. .
at my property located at /5/SY Ali //sail LA_ .sw 4 //6,7Ve- n
in Rruvis w«/_ County.
I furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
l _//
Signature
Print or Type Name
DLhcer
Title
// l a o
Date
This certification is valid through I /

•
•
NC Division of Coastal Management 13506 A >3
Cashier's Official Receipt tiP
Date:._/2''7" •
•
Received From: . • - _ (, S 2oo 00
Permit No.: Check N
Applicant's Name:. County: rvn 5•..... c —
Project Address: ILI S� qk-. � S"v ket I16
Please retain receipt for your records a proof of payment for permit issued. •
Signature of Agent or Applicant: -- Date; /�"/�J
Signature of Field Representatim_ n" " Date: / Z-/z.1?f
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Check
Date Received Date Deposited Check From(Name) Name of Permit Nolder Vendor 11/ amount Permit Number/Comments Redrpt or.Rerund/Roalloceled
Column'? _Column2 Cakrmn9 Column4 I Cdumnb Gbha.M Calmar Column! _ Calumn9
1/29/2021 Restoration Systems,LLC Howard Malpass Towne Bank 177330 $ 200.00 GP#77764D JD rot.13616 __
129(2021 Restoration Systems,LLC Town of Topsail Beach Towne Bank 17329 $ 200.00 GP#77531 D JD rct.13615 _
1/29/2021 Chnstopher Reid 1005 Ocean Boulevard LLC The Bank of New York Mellon 1038 $ 100.00 minor fee,1005 Ocean Boulevard,Topsail Beach, �JD rct.13614 _
1/29/2021 Eddie Wood same 8B&T 1819 8 200.00 GP#77739D JO rut.12383 _
1/29/2021 Shelby Lawrence James Lawrence Wells Fargo 6087 $ 200.00 GP#77529D JD rd.13613 _
1/27/2021_ B and B Construction Money Order - Mctendon Beach House LLC Wells Fargo 19-088347331 $ 400.00 GP#77658D trnac rel.13587
1/27/2021 Delta Dock and Boallift 7Jason Johnson FCB 9015 $ 200.00 GP#735880 JO mt.12378
1272021 t Maritime Coastal Construction.LLC (Kirk Fox CresCom Bank 3329 $ _ 200.00 GP#71900D _ tmac rut.13586
1272021 B and B Construction Money Order Robert and Julianne Hurst Wells Fargo 19-088347338 $ 400.00 GP#77651D _ tmac rot 13580 _
_ 1272021 Backwater Manna of NC LLC David Brady BB&T 12141$ 200.00 GP#77571D _ BB rct.13514 _
127/2021 Delta Dock and Boallift John and Pamela Hultin FCB 9026 $ 200.00 GP#77738D __ ,JD rel.13611 —
1/27/2021 Sound Side Marine Construiction LLC Guy&Ann Forrest FCB 103 $ 200.00 GP#777530 IBB rct.13506 _
1/27/2021 Steven Michael Greif same Piedmont Advantage CU 445 $ 200.00 GP#777622D _ ,BB rot.13512 _
1/27/2021 Welbome White&Schmidt Dentistry Partnership Martin and Shannon While FCB 29232 $ 200.00 GP#777600 _IBB rd.13511 _-
1/27/2021. J Banks Garrison Jr. Banks and Susan Garrison Wells Fargo 13700 3 600.00 GP#777610 _ 'BB rct.13510 __
1/27/2021 Gregory Gage Greg&Alita Gage Wells Fargo _ 4262 $ 200,00 GP#777520 _ 43B met.13513 __
1/27/2021 Holden Docks and Bulkheads Tracie Hams Rice CresCom Bank _ 3651 $ 400.00 GP#777230 __45B rd.13507 __
1/27/2021 Holden Docks and Bulkheads Gracie and Daniel Hands CresCom Bank _j 3649 $ 400.00 GP#77727D iBB rat.13504
1/27/2021 Landon Funsten same Bank of Amenca_ i 1569 8 200.00 GP#77751D BB rd.13509
1/27/2021 B and B Manna Construction Money Order Sand Dwellers II,UOA Wells Fargo _ 19-088347330 $ 400.00 GP#77750D BB rct.13508
1/27/2021 Bledsoe Enterpnses Inc. Ocean Dunes HOA BB&T - 1 20023 S 400.00 GP#76181 D SPA rd.11577