80128D - Fairlane

0 •CAMA / DREDGE & FILL N° 80128 A B C
GENERAL PERMIT Previous permit#
> -- _'New Modification IIComplete Reissue DPartial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality �� l��
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC .
c io (j... .\6,, lk - ElRules attached.
Applicant Name ‘v j,„�t.c. i n vG Sh r s LLL ,
iv,c cc r1Ar .Project Location: County 15 r .•.•c„x c tr...."
) V2-0 L t, \\;c..,r•S h U<o u(.j In Ct Street Address/State Road/L_
2L� Lot SA
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City l.,{ ,V L�G V\ State ZIP 2`11009 L( J I
Phone# ( 'll f1) 914 IC f 3 E-Mail A.\ 'INN L r,,, 5Of•(',(,coASubdivision
Authorized Agent Li c.• & (f t t.t. City S.1-.S e l C in ZIP Z `t L&
Affected 7Cw itW [ PTA ❑ES ❑PTS Phone# ( ) River Basin t V.-- _r
❑OEA HHF ❑IH ❑UBA ❑N/A �r 1
AEC(s): Adj.Wtr. Body ��U C t/t z C- S 1)man /unkn)
❑ PWS: `
Closest Maj.Wtr. Body `� t,G-" < 0 LA
ORW: yes / no PNA yes ) no t
Type of Project/Activity C1(C( S < r, St< e A O w 11 G,. • ()des t-Ca
. (Scale: Z 5 )
Pier(dock)length 67 x -C) u
Fixed Platform(s) xI Z- _�
Floating Platform(s)
# 7 I — 1
Finger pier(s) j �._,..
Groin length Vr ' — I number
Bulkhead/Riprap length I I r" T �—
t
avg distance offshore 1
max distance offshore I j t i I j -
i i
Basin,channel —� ': —
I i
I
cubic yards k'C1 \y�_ j
t I
Boat ramp ) S� I
Boathouse/Boatlift _. ...--- _—_..__---T. —_._._1 i- I-
1 _a l I l I I
Beach Bulldozing — 1�1 ` '
, % 1 I (o�/l 0III
Other (.4 � OW �` U f I Sk,e &ow w 1 j,
t. A\` I i Y Z , c.o �,. l w .ziLa t
Shoreline Length ` "1 / /A-
: j
SAV: not sure yes fil j t—r I
—
Yr1 efif I Gir U \reJes�-tur f �t\\.9-n,, 6 4 Zi;L,
Moratorium: n/a yes yt1 ,i
Photos: es 1�, I_.._.___.,_-_..._..._..__._._..__
Waiver Attached: yes I ' i I 1
A building permit may be required by: cvf•SCk- Q e 4.C . n See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction `` ` n t
Notes/Special Conditions k V Av^ '- \k. '`C- C\< VG 4-t Cl. M1"‘."..../r".- tzt-(- G hUJe,
k 4, L.J( \-C-) C)i t ' L,-.` n\ --` �X Cat C jci c.., lL-, % [s ., o`t eft G
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Agent or Applicant Printed N al
e PermitOfficer' •ed Name
\ _..,_ `tt
(..____
Signature *' Please read compliance statement on back of permit** Signature
2oQ"�- 44 Iy Sot ''..)1\(kZU2I 1 t6t( 20/1
Application Fee(s) 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: [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

•
AGENT AUTHORIZATION FOR.CAMA PERMIT APPLICATION, . •,•
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Name of, PrOperty Owner Requesting Permit rAlr 1 vl '• 4. % :-., ,L.L.C. 1
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Mailing Address.. 3 L 2 .\A,;,i i Vt..%kl--;1:00(..t%Li.c: Ccii;4,r4
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Phone Number " 6/' -- tif 1 Li — C;41 7 :
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I certify that I have authorized NA/A wt., (.7r 1 i
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Agent
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Age /ConArector, 1 C', •'ei% l' ,)‘:tf, %i :C.(-iv Ai C 2
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to act on my behalf,,for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development ,1. Ana° 4.--
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at my properly located at )1 Z-•—•-Li/Crt 14 V t'E-:t 5 tit 0 t>- PCz A ...V..., :24;:'•Vi,
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:in:13:ii/tztylltounty:
I furthermore certify that I am authorized tb grant, and do in fact grant.permission to [.
DivisiOn of Coastal Managementstaff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating in formation related to this
perMit application.
Property-Owner Information:
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This certification is valid through- / - _./ Z.(. 2,-,1 1.
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CERTIFIED MAIL° RECEIPT
r Domestic Mail Only
u• For delivery information,visit our website at www.usps.com'''.
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Certified Mail Fee
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$ 17 11
` Extra Services&Fees(check box,add fee areenor Mte)
D Return Receipt(hardcopy) $ ,,���1 11
D Return Receipt(electronic) $ $1 ,1 11 1 Postmark
❑Certified Mail Restricted Delivery $ $Ll 0lt,1 Here
❑Adult Signature Required $ $()•Co)
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Postage$
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#GI LIIIGY IvIOII OGI YI4.G 1..11 Y•IYGO YIO I I1y Y IIO.
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 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.
mportant 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 Mail°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
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.
'S Forrn 3800.Aonl 2015(Reverse)PSN 7530-02-000-9047 -

1. . 'os a ervuce
CERTIFIED MAIL° RECEIPT
-1 Domestic Mail Only
U• For delivery information,visit our website at www.usps.com'.
a P erketeta ej
Certified Mail Fees
$ 0470
Extra Services&Fees(check box,add fee s aaloprgvp?fete) 11
0 Return Receipt(hardcopyl $ A I I,IJI 1
M ❑Return Receipt(electronic) $ I),1 i 11 Postmark
M ❑Certified Mall Restncted Delivery $ '#.) [I(I Here
7 ❑Adult Signature Required $
❑Adult Signature Restricted Delivery$
Postage
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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 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.
rnportant 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 Mail'service. -Adult signature restricted delivery service,which
Certified Mail service is not available for requires the signee to be at least 21 years of age
international mail. and provides delivery to the addressee specified
Insurance coverage is notavailable 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 hear 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 Farm 3811 to your mailpiece; IMPORTANT:Save this receipt for your records.
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ENDER:r'OMPLETE THIS SECTION COMPLEI E THIS SECTION ON DELIVERY
• Complete items 1,2,and 3. A. S'gnature
II Print your name and address on the reverse ■ ' - ❑Agent
so that we can return the card to you. .7 . . A • -ssei
• Attach this card to the back of the mailpiece, ceived by(P rnted Name) C. Date if Deliver
or on the front if space permits. 0 Gv1v Ci "Ac c r'n(c.r I y t . _
1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes
If YES,enter delivery address below: 0 No
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❑Adult Signature Restricted Delivery 0 Registered Mail Restrict
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9590 9402 5492 9249 3665 71 ❑Certified Mail Restricted Delivery An-Return Receipt for
❑Collect on Delivery Merchandise
2. Article Number(Transfer from service label) ❑Collect on Delivery Restricted Delivery ❑Signature ConfirmationT
n Incurtxi Mau 0 Signature Confirmation
7 017 0660 0000 7487 1211 .ed Delivery Restricted Delivery
]00-9053 Domestic Return Receipt

USPS TRACKNG# . •
First-Class Mail
MIN „ II r! �' Postage&Fees Paid
��II IIII III . III USPS
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9590 9402 5492 9249 3665 71
United States •Sender:Please print your name,address,and ZIP+4®in this box'
Postal Service
GRICE CONSTRUCTION
6618 BEACH DR. , SW
OCEAN ISLE BEACH, NC 28469
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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 �l II (�i I f U'! CI Agent
so that we can return the card to you. ID Addresse
• Attach this card to the back of the mailpiece, B. Receive.by(Printed N. e) C. Date of Deliver
or on the front if space permits. 1 (11 "I. I I Y
1. Article Addressed to: D:'I delivery address different from item 1? ❑ Yes
L�\Cr ` � If YES,enter delivery address below: ❑ No
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I I I I I III I I I II I I I II I I I I I III 3. Service Type Ll Adult Signature ❑Priority Mail Express®
❑Registered MaiITM
D Adult Signature Restricted Delivery 0 Registered Mail Restrict
9590 9402 5492 9249 3665 88 edified Mail® Delivery
L3 Certified Mail Restricted Delivery t$Return Receipt for
O Collect on Delivery Merchandise
2. Artirlo NItImhPr rTran..cfar from service label) 0 Collect on Delivery Restricted Delivery 0 Signature ConfirmationT
0 Signature Confirmation
7 017 0660 0000 7487 1204 stricted Delivery Restricted Delivery
PS Fnrm RR11 .tut,9rri PAN 7s1n_r9_nnn_oncr flnmactin Pet!irn Ronoin'

USPS TRACKING# •
First-Class`Rail
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tfl ,I III I'' ! 7 USPS
Permit No. G-10
9590 9402 5492 9249 3665 88
United States •Sender: Please print your name,address,and ZIP+4`'in this box
Postal Service
GRICE CONSTRUCTION
6618 BEACH DR. , SW
OCEAN ISLE BEACH, NC 28469
3-471018 IIIMuPIIII IIIPHII,1III1IIIInIuulI1111/1111IIi.l111111 111

•
CERTIFI.EQ MAIL• BURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
•
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner.--.___.._ c) -r,n'C
Address of Property: 312,.__L\V n 31. C t_et 5—t Q CL('1.._._ __ ..--
r (Lot or Street#, Street or'Road, City&County)
Agent's Name#:l� tCQ R'Skett(AIvt) Mailing Address411)1 `(� I.-h Dc` i
Agent's phone#:\\O"-5 IG'gLg5 ( ,C to 01\ N( Z�yGy
I hereby certify that I own property adjacent to the above referenced property. The individual applying for
this permit hes described to me as shown on the attached drawing_the development they are proposing.
osseormetwimiltintlel X I have objections to this proposal.
If you have objections to what Is being proposed, you must notify the Div n of Coastal
Management(DCM) In writing within 10 days of receipt of this notice. C should bs
mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM reprase also be
contacted at(910)798-7215. No response Is considered the same as no objection je#A0rObeen
C notified by Certified Mall.
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.
(Property Owner Information) party •wrier Information)
rvi�Q ba. e4;A> _,..Ilir �
Signature .SI 4nuru
� �
� m� Fa ..t - \1 4k-- r
Print or Type Name Print or Type Name
Mailing Address Meiling Address
City/State'p City/State/Zip
Telephone Number Tele hon Number
! ite Da e
Revised 8/18/2012

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Cheek
Date Racevad Data Dapoe(fad Cheek From(Name) Nam.of Permit Wrier Vendor Chock number amount Permit Number/Commanta Receipt or RerundRtwllocatod
Column1 Column2 Column3 - CWumn4 Columnb CWum,M Column7 Column8 Column9
3/25/2021. Brandon H King same First Bank 148 $1,000.00 GP#80243D JD rct.13460
3/25/2021 Ocean's Edge Ventures.LLC George and Elizabeth Jordan BB&T 11884 $ 200.00 GP#801930 BB mt.12979
3/25/2021 Grice Construction of Brunswick County In Fairlane Investors,LLC BB&T i 14501 $ 200.00 GP#80128D BB rot,12982
3/25/2021 Permit Pals McDaniel&Ava Harris CresCom Bank •
3710 $ 200.00 GP#80189D BB rot.12981
!3/25/2021 B&K Marine Costruction Cindy&Grover Griffie BB&T _•_ 1661 $ 200.00 GP#80207D BB rct.12978
3/25/2021 H5 Construction.LLC Richard&Ashley Schmidt BB&T 2565 $ 200.00 GP#80190D B8 rct.12980
3/25/2021' Nicholas G.Chapis same FCB 1631'$ 200.00 GP#80162D JD rct.12395
3/25/2021 Jerry Ennett Carlton Dail Coastal Bank and Trust 3744 $ 200.00 OP#80160D JD rot.12392
3/25/2021 Land to Sea Construction.LLC Kenneth Blackwelder FCB • 431 $ 200.00 OP#802180 KE rct.12736
3/25/2021 Southeastern Coastal Construction Co. John McAdams South State Bank 12129 $ 400.00 GP 880220D KE rct.12739
3/25/2021 Jerry Ennett Andy Darden Coastal Bank and Trust 3742 $ 200.00 IGP#80159D JD rct.12391
3/25/2021 Jerry Ennett Doris Padgett Coastal Bank and Trust • 3745 $ 200.00 GP#80242D JO rct.12393
1 —
3l25/2021 .Jerry Ennett Howard Malpass Coastal Bank and Trust 3743 $ 200.00'GP#80161D JD rct.12394 __
3/25/2021 Southeastern Coastal Constructon Co. 'Joe Donahue South State Bank 12130'$ 400.00'GP#80221D KE rct.12738 _
3/25/2021 Coastal Marine Piers Bulkheads LLC Kathy and Thomas Dean Wells Fargo 23759 $ 200.00 tGP#76188D PA rct.11597