HomeMy WebLinkAbout77794D - Riverview 0 .'CAMA / DREDGE & FILL N. 77794 A B C Cii)
GENERAL PERMIT Previous permit#
)C New Modification LComplete Reissue ❑Partial Reissue Date previous permit issued
As aut rized by the State of North Carolina,Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to I5A NCAC 01-+ 11
�. (2 Uo
',Rules attached.
Applicant Name k_.wcrvi-c-.r (Y)Ps (4:-) \'•, 0C \ Project Location: County (-,^Jv.. tCrc-
Address O O U 53 Street Address/State Road/Lot#(s) I27-1
City -'),.✓(,_ 6, State N (.. ZIP? -.5-7-l �. c, ,<--, '),.
Phone#l tll )Sp"70 1(2`, E-Mail / �.
Subdivision �/�
AuthorizedAgent1 AA.- U�15 f PC, �e.. City �H���o -� ZIP SI 1`-'
Affected ❑cw EW X.PTA ❑ES CIPTS Phone# ( ) `` River Basin L " .... f
AEC(s): ElOEA HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body `1 G�``U ` {{ /(na r)an /unkn)
❑ PWS: �� ��-A4e
ORW: yes / PNA yes no
Type of Project/Activity .� 5 , 1� fly -.� b x (c,v Closest Maj.Wtr. Body ci,u c..� , A. ,'.C1L Utt- e ICc \1-j c
( ,)C kt_- �1 P 1 (Scale: .i ''S )
Pier(dock)length
Fixed Platform(s) {{
Q� �' F i j
Floating Platform(s) (71t (Q I ` _ . _
Finger pier(s) nfuti N_U/... I , r — — .401� C s.Sh� — " - —,
Groin length - �' . M I ,.
number i
--- —_..— ,
CIO
Bulkhead/Riprap length ----I I
1
avg distance offshore i i c( O a4c4ss
max distance offshore f { {
I '
Basin,channel ': 1 i
cubic yards C V-1 L A C Sre
11
Boat ramp j IZ'MOO pa$ /are
Boathouse/Boatlift I i
i
-i
. i i
Beach Bulldozing
1
Other \r\.. .� N,. W
f! f- I , ± I
Shoreline Length+ J�, i i. Lk. p,., •
SAV: not sure yes /vet..) p UAj , Q Jt/��
. r,
Moratorium: n/a yes 0 _ 024�
Photos: yes ip L-To e
\d t JJ,t {
Waiver Attached: yes no ! l l I I
A building permit may be required by: (.1d ,r 4 a9. . ❑See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction (. 63,-, -,)—
Notes/Special Conditions n 41�n-1 k i , r.oic -c1S.c2.c e Stz`ln<<She.ill c I-c tisk j •AP.
r.----
..': 1) -.k".:C ki. k \ ,...._ ( e .,-,c. a,... \ 2,- 0 ck,
Agent or Applicant Printed Name PermitOfficer's P • ame
\ ,_ — ----.-1-------\ _,\C___
Signature Please read compliance statement on back of permit** Signature
- 200°° '--+3s" -zl‘\ zoz, C, ( Ii(z0zt
Application eels} Check# Issuing Date 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/ I-888-4RCOAST 252-946-6481
Fax: 252-247-3330 Fax: 252-948-0478
(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
40I S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: 910-395-3964
Fax: 252-264-3723 (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
,
pfcAnnA/o DREDGE Be FILL PERMITENERAL N9 77794 A B C (;)
Previous permit#_- - -
M .iNew IDModification DComplete Reissue 'OPartial Reissue Date previous permit issued________
_
As aut rized by the State of North Carolina,Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 0-1-1A t ZOO •
• 0 Rules attached. %
hi-...A C/0"--1 il t t
Applicant Name 1/4uce-utt....1 run _. ‘,1 .7.•--0 0 04:e5A Project Location: County , /.../ --- 7'de-
_
Address _0 _ 6 1C. c3 _ - -- Street Addre.ss/State Road/Lot#(s) rill _
State IC 21P-2-a-5.7 ( Z•34..ev I t:-../ 167'.)i. S V%.1. . —
Phone#falA)fsaClit2A__ .
Subdivision
E-Mail '
. .."-
Authonzed Agent i••••ov.i•l_ cag.S.S PeA_Ar....t (..t.,4:6..\
. City li‘e.\ke.14C-- _ ZIP_ (2,8q 310
Affected
D CW KEW PTA DES OPTS Phone# ( ) _ _ Nal-Basin Lk) "••••••19'jd... •
AEC(s): 0 OEA 0 HHF CI Ili 0 UBA 0 N/A
. Adj.Wtr.Body 7:Ike-a() C--' - ri-F7.3tari Anilg0,
0 PWS:
ORW: yes PNA yes •
- Closest Maj.Wtr.Body ..•.C.if,\-, akk•iitAe" . '
/CO yes (n ) -
.6.
.,,,,..
Type of Project/Activity i.r..' • .76-:.f.',-")""'" t),X ((47 Az,e.,4%-A- . lattC._ • ir3A- elci-s-1-vie_
_ Ce,............,-,,,, - _ _ (A.•,...k, ... , k _ - ' s (Scale: W , S- )
Pier(dOck)length --
---r-7
Fixed Platfonn(s) sil • " ` ''. " j-- Y 1 / - I 1 i
in li 1 I ilia kk i 1 1 1 I
sul 1 I.
Floating Platforrn(s)'FA t(0 editi
_ Ea. • tt -- R 11 if .....ggr
Fitter pier(s) ° ..!'ll— 11111 I 1-1 . f.7" 7111=•
Groin length ; . ,
number . _LI r.1 ',1__;1_,_; I ,Rs . -; 11111111111111111111011
• _ imp ii,, 7 — 111111•111111111111111
Bulkhead/Riprap length '• 1 i NMM-, ,i-111111111111111111111111111M1111111111
ang distance offshore- I - III- 1 : 1 1 1111 • ;.1..,ii- Mg1 ; _ I 11111M1111111111111M
max distance offshore MINIMPERMIMMI _ I I t • IIIMINIIIIIIIIIM111111111111111111
IIIIIIIMMEMINIMIll i i 1 plimmarmmuiumutamminuns
Bashi,channel _ -
RIIIIIIIIIIIIIIMIll A t - or.11 i Niugirmrun
NI Ill -_ um
cubic yards •4,.......).ev.s.L.,1^e7_ 1 ' 1 ail t,-43.1_1 I Mill I
Boat taint,- ; _t , , ; 1 . ._I ,- -'..12."410.0 %ibikk-to-Li II
- I _is ill MI — - I Boathouse/Boadift
I
1111 ———- I =1-111 'in --
.
Emshiamasp.E.. -_
Beach Bulldozing • Imo iummil
—:C./
Other - - " ingligunummi 1.111— ,,,_ _ . ...___, , 1 MIIIIII- 11111M11
EMU : • ' i 1 Ili - EMI MIRMIE .4..: 1010111=11
- - 1- f ' 1 1 1 MIN ii
Shoreline Length:- V3 •-1 = - -
- 1 Kiiiiii Eriniiin _II AMU "MI
I 1 IIII 1111filM •IN- .ti-Ji -k- °,13(C.741
ii s,e,,Itirimi til w 1--- -vi
Moratorium: n/a yet . 7' 1.1k1r::::„-vizi) -.- ---1- 1 •
-i--1 i 1- • Ili
Waiver Attached: yes ,no _ . ,
A building permit may be required by: 1 fuo."-Nr 4C '- k ,..,:- ' 0 See note on back regarding River Basin rules.
(Note LoCal Planning jurisdiction . Ill .
Notes/Special Conditions .
it ,._ A-,i' . .0 erAus4
. ,
_ - -
•
Agent or l,- Prmtelithme am
Permit Opic a __.....--
V -,--.7
...-. a...--.—_.
5gria'terb "Please read corn lance statementon back of permit...15 • Signature
-
.__4
Application ee(s) 1
..,... n...1.%‘A r 1.:112—%
Check# ''/,... Issuing Date I in_
Expiration Date- -'---
SrannAri with r:AmSrannpr
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: r- kve..,,r•
•
Address of Property: g:774
(Lot or Street#,Street or Road, City&County)
Agents Name#:
mg/Paidress 941)._cALck_ (CI
Agent's phone#: 9 I 0-aub 810
n c
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 drawler°,with dinienSionS, must be Drovided with this letter.
/\ I have no Objections to this proposal. I have objections to this proposal.
If you have objections to what is being propose4 you must notify the Division of Coastal Management PPM in
writing within fa-0;re Of receipt of this tiefloO. Correspondence etiti iildb#mailed 0127 Cardinal Drive Evi,
Wiliningem,NC, 28405484 DCM representetivee 040 also be 001000 at 010)796.72g.No response is-
coneideted the same as no objedtion If you have been notified by Certified klall,
WAIVER SMICA
I understand that a pier, dock,mooring pilings,breakater,boathouse, lift, or groin 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 ck, you must Waif the:appropriate blank belPW4
I do wish to waive the 15'setback requirement.
I do not wish to waive the 15'setback requirement.
(Property4 er Informed° ) (Acrecent Property Owner Information)
ir 41/
k4; 2-r/q4
Signature Si: e
Vie u) PrevecS QtiN.Q.6
Print or Type Name if Pint or T NrPner 6
Po E2) .52) I7 La + f_3
Mailing Address Mailing Address
c)6L(krbr\ nc aa37/-0af.53 ek(1-).e_ n 7 765-Ve.ns—
city/3tateaip City/State/Zip
Telephone Number Telephone Number
• .-3
1 —14
-- —
Date Date
Revised 6/184012
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: V t --1- a►n t"S
Address of Property: l D_'7 y- Q.�ve ,e V„ -i_
(Lot or Street#, Street or Road, City&County)
Agent's Name#: 1Je i�.� 1(?4,4j_(,A � Mailing Address: .21lnC( cw�(\c a,�
Agent's phone#: 9)O , 0c I AL:, S; 'f il (\ C Istt(4
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.
/? 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. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at(910) 796-7215. 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, breakwater, boathouse, lift, or groin 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.
c�1(7. I do not wish to waive the 15' setback requirement.
(Pro arty w r Information) (Ad)ace t Property Owner Information)
i U/C7D-ZZ-,..----\__ , /
Signature ignature
�v lL'iN�x' Q`0 �1(1V�1 !S t-� < t in lA) ('; �vt
Print or Type Name 11 Print or Type Name (J
yC' 'X 1S2 I21$ t2‘ 16( Vi-Gy3 74
Mailing Address Mailing Address
(k x, nc (.3-.11-aot-3 c3( o 4e • nc. �q-7c)
City/State/Zip City/State/Zip
1 i c (7(_, ► 1akt qJL - `I5 - ill%95.
Telephone Number Telephone Number
Date Date
•
/ 2S 202/
Date
Revised 6/18/2012
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 'KU it AA) PcT-e-t-b) O O vLc
Mailing Address: 1 0 `i3 v
V (1C aR31 - cc)s3
Phone Number: t 1 () c -7 C I I ay-
Email Address: Woo-1-er\' 6-on @ n b cu( m c4 , C
I certify that I have authorized rmmu,i ? S
A ent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: -Pc X IC
c,_;1ck .5 X DC"C ('r ccct-
at my property located at I a-PA R „it{e{ k f► e i &)
in `ilnk\SWi C V -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:
ta
Signature
/
Print or Type Name
RCS
Title
I I
Date
This certification is valid through / I `-( I
...ENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3. A. Signature
• Print your name and address on the reverse X (/-
gent
so that we can return the card to you. V —
■ Attach this card to the back of the mailpiece, B. Received byinted Name) gate of Deliver
or on the front if space permits. C /`/ y
1. Article Addressed to: D. Is delivery address different from item 1? ■ Yes
I (` If YES,enter delivery address below: El No
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[III
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n I^—'di Mail 0 Signature Confirmation
7018 0680 0000 7025 3915 I Mail Restricted Delivery Restricted Delivery
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PS Fnrm a81 1 .lulu 2015 PSN 75an-n2-nnn-9nsa Domestic Return Recei
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CERTIFIED MAIL° RECEIPT
q Domestic Mail Only
1 For delivery information,visit our website at www.u:ps,com'.
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3 Total Postage and Fees 01/11/2021
s $6.95
1 Sent To 111 /5
met. I.No or P e(+ R cL
�;�Bata,Zl i 5 c oe NC a id-C9
ICI 1111CU MQII bet VIGC FAruVIUCS LIIC IUIIVWII1lJ. UCIICIIIti:
A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail
A unique identifier for your mailpiece. associate for assistance.To receive a duplicate
Electronic verification of delivery or attempted return receipt for no additional tee,present this
delivery. USPS®-postmarked Certified Mail receipt to the
A record of delivery(Iny!uding t h recipient's retail associate.
signature)that Is retaired by the Postal Service'" -Restricted delivery service,which provides
for a specified period. delivery to the addressee specified by name,or
to the addressee's authorized agent
warrant Reminders: -Adult signature service,which requires the
You may purchase Certified Mail service with signee to be at least 21 years of age(not
First-Class Mail®,First-Class Package Service®, available at retail).
or Priority Mails service. -Adult signature restricted delivery service,which
Certified Mail service is not available for requires the signee to be at least 21 years of ag
international mail. and provides delivery to the addressee specified
Insurance coverage is not available for purchase by name,or to the addressee's authorized agent
with Certified Mail service.However,the purchase (not available at retail).
of Certified Mail service does not change the ■To ensure that your Certified Mail receipt Is
insurance coverage automatically included with accepted as legal proof of mailing,it should bear a
certain Priority Mail items. USPS postmark.If you would like a postmark on
For an additional fee,and with a proper this Certified Mail receipt,please present your
endorsement on the mailpiece,you may request Certified Mail item at a Post Office—for
the following services: postmarking.If you don't need a postmark on this
-Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion
of delivery(including the recipient's signature). of this label,affix It to the mailpiece,apply
You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.
electronic version.For a hardcopy return receipt,
complete PS Form 3811,Domestic Return
Receipt;attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records.
__
CERTIFIED MAIL • RETURN RECEIPT REQUESTED r
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner �s(
{ Address of Property: 1 1,Y7y ? /e{V i e tD 11K
(Lot or Street#, Street or Road, City&County)
Agent's Name#: 65-> —r-t�' l Mailing Address: `'l—s�'
Agent's phone#: 4Io-;;c.c I Rglo SL, ,e(. (l( IL, ,.
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. Correspondence should be mailed to 127 Cardinal Drive&t.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at(910) 796-7215. 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, breakwater, boathouse, lift, or groin 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.
I do not wish to waive the 15' setback requirement.
(Property ;, er Information) (Adjacent Property Owner Information)
•l E z(,- -
7n
Signature Signature
N,vefVie u) Prtree*5. () S m ers
Print or Type Name Print or Ty Name
PO c-ix 5=2 ,. I 1 rn 0)2-r+
Mailing Address Mailing Address
Vce_ k y, nL 02 - 7J-cos3 3-->K ne n( .7705.-.7or5S
City/State/Zip City/State/Zip
(If ' Im _ , - _iiaq
Telephone Number Telephone Number
1 - 4-�I
Date Date
Revised 6/18/2012
I. •
CERTIFIED MAIL® RECEIPT
• Domestic Mail Only
• For delivery information,visit our website at www.usps.comn.
o el NC 28470
U Certified Mail Fee $3.
3 0462
Extra Services&Fees(check box,edd fee elliffite) 04
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Li Return Receipt(electronic) $ $0_00 Postmark
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0 Adult Signature Required $ $0.00
El Adult Signature Restricted Delve),$
Postage
$0.55
n $
Total Postage and FAeS95 01/11/2021
3 $6.
O Sent To ititi yri
StroandApt.No., rIq-Efoi-fifo..
bi-
- -11
,errrneu man service provuoes xne ronowing oenenrs;
A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail
A unique identifier for your mailpiece. ' associate for assistance.To receive a duplicate
Electronic verification of delivery or dttemptee return receipt for no additional fee,present this
delivery. USPS®-postmarked Certified Mail receipt to the
A record of delivery(including the recipient's retail associate.
signature)that•is retained by the Postal Service— -Restricted delivery service,which provides
for a specified period. delivery to the addressee specified by name,or
to the addressee's authorized agent.
nportant Reminders: -Adult signature service,which requires the
You may purchase Certified Mail service with signee to be at least 21 years of age(not
First-Class Mail',Rrst-Class Package Service®, available at retail).
or Priority Mail'service. -Adult signature restricted delivery service,whict
Certified Mail service Is not available for requires the signee to be at least 21 years of ag
international mall. and provides delivery to the addressee specified
Insurance coverage is not available for purchase by name,or to the addressee's authorized agent
with Certified Mail service.However,the purchase (not available at retail).
of Certified Mail service does not change the •To ensure that your Certified Mail receipt is
insurance coverage automatically included with accepted as legal proof of mailing,it should bear E
certain Priority Mail items. LISPS postmark.It you would like a postmark on
For an additional fee,and with a proper this Certified Mail receipt,please present your
endorsement on the mailpiece,you may request Certified Mail item at a Post Office"for
the following services: postmarking.If you don't need a postmark on this
-Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion
of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply
You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.
electronic version.For a hardcopy return receipt,
complete PS Form 3811,Domestic Return
Receipt.attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records.
c s/Da,.a.cai ccu 7snn-nosrvione7
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
P y .J?,.r-Y1 P.0 Cr ��-E C�wc i C.(
Address of Property: !)-'1 Lk ✓Q V‘ et F_
(Lot or Street#, re Street or Road, City&County)
Agent's Name#:—Dc,,r\( � X;� f laud j, A 0VP\ VI 'ia ling Address: Zl 1�,�1 C�rr cw�(le e
Agent's phone#: 1)O c%0 1 MC(c, I (\ L lsu((e
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. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at(910) 796-7215. 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, breakwater, boathouse, lift, or groin 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.
I do not wish to waive the 15' setback requirement.
(Pro erty , wn r Information) (Adjacent Property Owner Information)
Signature Signature
et v'i 1!1,, (1/4)i c i/1W`nsa S C a-tr ) r� Lit
Print or Type Name Print or Type Name
PC) 6DX Je{ V i-CAA) TX<
Mailing Address Mailing Address
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City/State/Zip City/State/Zip
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Telephone Number Telephone Number
Date Date
Revised 6/18/2012
Check
Date Received Date Deposited Check From(Name) Nam.of Permit Holder Vendor 11/ amount Permit Number/Comment. Receipt or Refund/Reallocated
Columnl Colulted Column3 Columns Column6 • Column6 Column? Cok/mne Column9
2/18/2021 Richard Penny Construction,LLC Wendy Mack Navy Federal CU 1567 $ 200.00 GP#775960 i KE mfr.13874
2/18/2021. 'John Dunkle Suzanne Dunkle Fulton Bank 568 $ 200.00 GP#78820D Tmac rct.12912
2/18l2021 Barry Golob Jeff Laver Layefelte FCU 179 $ 400.00 GP#77709D Ttnac rct.12915
2118/2021 Barry Golob same _ Layalette FCU _ 177 $ 400.00 GP#77710D •Tmac rot.12917
2/18/2021 Augustus Paul Davenport Mark Davenport BB&T 555 $ 400.00 OP#77707D Trnec rct 12918 _
2118/2021 Michael J Ouimet Loncille Litz _ Wells Fargo 2150 $_ 400.00 GP#77706D n tet rot.12919
2l1812021 Barry Golob Cathy Lovejoy Layafette FCU 178 $ 400.00 OP#777080 time rot.12916 _
2/18/2021. Michael Ouimet same Welts Fargo 2149 $ 400.00 GP 0777110 _-_ __. Imam rct.12920
2/18/2021 B a B Marine Money Order BSB Resod Properties Wells Fargo 17-979411642 $ 400.00 OP S776570 tmac rot.12913
2/18/2021 Fire Mechanical Scott McCaffrey Wells Fargo 2074 $ 200.00 GP#77639D tmac rct.12911
2/18/2021 Michael Leone Kathleen end Michael Leone FCB _ _ 5136 $ 200.00 GPS77771D PA rct.11587
2/18/2021 Roland C Lingle same Lumbee Guaranty Bank 507 $ 600.00 OP#77763D tmac rct 13596
2/18/2021 Carolus Building Company Alfred Stewed First Bank 1463 $ 200.00 OP 077767D JD rct.13552
2/78R021 Richard Penny Construction,LLC Thomas Simpson NavyFCU 1565 $ 200.00 OP 4177793D IKE rct 13670
2/18/2021 Jill P Ansley same First National Bank i 5520 $ 200.00 13P980114D JD rat 13563
2/18/2021 Permit Pals Riverview POA •CresCom Bank 3735 $ 200.00 GP 677794D BB rat.13525
2/18/2021 i McPherson Marine Services.LLC Tim Poirier FCB 3963 L 5 200.00 GP#77798D BB rct 12984
2/18/2021 McPherson Marine Services.LLC Chadd Smith FCB 3962 $ 200.00 OP#777970 BB rat 12965
2/18/2021 Jeffrey Skidmore same Peoples Bank 1018�3 200.00 GP 177788D BB rct.13524
2/16/2021 Town of Wrightsville Beach same FCB 1180991$ 400.00 GP 0745920 PA fcL 13675