79969D - Donat

0❑F„AMA / 11 DREDGE & FILL N° 79969 A BCI
GENERAL PERMIT Previous permit#
>' li New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina,Department of Environmental Quality �— C I • 2(Dorf)and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
�_\ ❑Rules attached.
Applicant Name 4'e { - ,, Project Location: County
Address <', ( i•(•>r-ILL Le -ck,--0) Street Address/State Road/Lot#(s)
City i I«. .,,S C State‘'`- C ZIP L>'I i C q ,.
Phone# ( ) - tit. 7 Z E-Mail Subdivision
Is -\. l
Authorized Agent (,'''! .Jn, City ()& 7)i l IA,'k`4'\ ZIP 2.E'�''Q9
Affected O CW ElEW iZrPTA El ES ❑PTS Phone# ( ) J River Basin
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
AEC(s): ❑ PWS: Adj.Wtr. Body Jqn� (nat / /un
ORW: yes / no PNA yes / no Closest Maj.Wtr. Body�:`(\j1-U- 1iCr're- `c"-I d\
�rr (
Type of Project/Activity I - T` fN �.Q 75+ .\11 <l 1 P
(Scale: f ._ y ,
Pier(dock)length
Fix Platform(s) i ' I I '
Floats Platform(s) i-4,
cL II
Finger pi (s) I;
Groin lengt 1
number`. i l l
Bulkhead/Riprap lecigth i T '-
avg distance off` ore I
max distance offsh e '
b
Basin,channelkwl if!:
{ i
Boat ramp
' � i
BoathouseABoatl' I cat +( t ..__....----- 4 ._^�. e ,_ -.__'
i
Beach Bulldozing i )j ,___p, -0
Other (\ : H
k.1d �dl, +� �1
V I
Shoreline Length 41/00 `� V
y ®�`
SAV: not sure yes , i l f I
Moratorium: n/a yes n — —._..
Photos: es n __ ..._ _ _.. rt_
Waiver Attached: ' q " I 1, J SZI +1 ) 1-
A buildingpermit maybe required b u.� vv.,i.�C,f
9 Y �� �G CC7 I I See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) , % (-
Notes/Special Conditions NJO f X�-Cv. .u-� >A lk`.-t` C*rZA,. (..__,,t,/
Agent or Applicant Printed Name Permit•' - 's Prin Name
l/,, i.I' A , i013\2.1
Signature **Please read compliance statement on back of permit Signatyre
. ,� .."-- /_ / . \ .. /

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
--DName of Property Owner Requesting Permit: E""fE QV1a4T
Mailing Address: I5;15 1-1 l�/4-y 1-AV,Dit
11vtnv1 j4 Yi NG Li0
Phone Number: (31Q) 5tr4
Email Address: ?e,\-t. © \A GWAVIAS�es1-A--ut-r)-14- ev)
1 certify that I have authorized .J; rnrrty K)ac'An
Agent/ Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: ( ---Entrzci Li Cr
at my property located at 15 a5 SA t}ypx y ( ,t,,,;,,,s
in 1,4e'w A,nov¢-,t" 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.
Pro•erty Owner Information:
Signature
E21QMAIT
Print or Type Name
4)r,perry J YNe-r
Title
Date
This certification is valid through _i_ „

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 2T 2TZ. QNIAT 's
(Name of roperty Owner)
property located at 13 5 3}p1A y , .y Lt,r;v1�
(Address, Lot,/1Block, Road,,'etc.)
►
on t\Satn—cD R.a t,,r� , in 1k\E+.o tw\ oveA C i1. , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
(11 I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock. mooring pilings, boat ramp, 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.)
yo
V I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
A Owner Info 'on (Adjactent Property Owner Information)
/l
Z2512ieriA,t.y/LZ/
Sin ure Signature*
0717)6,AA-E- .V/4-Af.0 >PA n c,-er WA"/
Print or Type Name Print or Type Name
IS(9-5 SAI 4 y Icy %hamD.5 )61D ,i}vx
Mailin Address n' ^�q M ling Address / p//
„ �Y1l1 Goa✓1,!V 1.1U 1 �(�1QOi//vAt A:5,54 y.."r /ue Yr2,'
City/State/Zip v Cit�yy,/State/Zip _t
9 so - 5-4 - - 6ZZ Yi0 /7-:s'79S' /Y/.%,AQP.,bc 9 ;/
Telephone Number/email address Telephone Number/email address
/kVich ( .6,2.OZ) "972c'Fr
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature'

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
c t �
I hereby certify that I own property adjacent to CTE(L , 1)>"Ar-" 's
(Name of Property Owner)
property located at 152.5 5_A14--y —gA L.-AvrO+v
n^ (Address, Lot, Block, Road, c.)
,
on 1 v`PSSO rt1 tSo20 St ) , in NEtA1A4 v (..(uv , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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.
(Pe Owner Infor n) (Adjacent Property inter-Information)
St natut.e St nature
Vitt i.-i. ov1AT � _._ C,erT , /-1,d ci-%
Print or Type Name Print or Type Name
15z.s S9)ty ► Ay vay, -z in 7 � f;sd► 1_c.,d ,
Mailing Address 4
Mailing
Address
t- / Ale
ae,VD 9,
4 0LA.) S I V
City/State tp City/State/Zip
�1 - Asa-54786
4 i D-s4�-y bZZ ?Ace���tsr'c��-iron� 0
Telephone Number/email address • Cov^" Telephone Number/email address
hrCtiI I ) t 20 '} e res a kv rn o n C r S
1 �1 /it I
Date Date" ti,LS -a f
(Revised Aug. 2014)
`Valid for one calendar year after signature* a°-t°'t a n�

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Cheek
e Rived Data Deposited Cheek From(Mama) Name ofPenrdt Holder Vendor Check number amount Permit Number/Comment. Raoell:t or *R. 48t datated
n7 Colwnn2 Column! CokamM Coaamra Column. Column? Columns Column!
02021 H Hilton Yacht&Ship hunter and Susan Britt TD Bank 185 $ 200.00 GP#80179D __ BB rd.14950
I2021 Grice Construction Theodore&Krista Modell BBBT 14872 $ 200.00:GP#801260 BB rd.14947
V2021 Grim Construction Cape Fear Transport LLC BB&T 14873 $ 200.00 GP#80127D BB rcL 14948
V2021 David Heilig same Wells Fargo 1552 $ 400.00 GP#80000D BB rot.14949
02021 Sound Side Marine Construiction LLC Trent and Molly Woodcock First Citizens Bank 118 $ 200.00'GP#80103D ,BB rcL 14942
02021 Backwater Marine of NC LLC William and Jenna Cox BB&T 1326 $ 200.00 IGP#80159D BB rot 14948
12021 Shelby Lawrence James Lawrence Wells Fargo 6175 $ 200.00 GP#80134D JD rCL 14327
V2021 Allied Marine Contractors LLC Michael Lautenbach First Citizens Bank 10170 $ 800.00 GP#71878D JD rot.14077
12021 Delta Dock and Boatlift Justin Struble First __
Citizens Bank 9101 S 200.00 GP#74824D JD rcl.14080
02021 Carding Marine Construction,Inc. Martha 8 James Chaffins First Bank 12688 $ 400.00 GP#80184D KE rd.13447
112021 Coastal Manse Piers Bulkheads John Spencer :Wells Fargo 23817 $ 200.00 GP#12397 JD rcL 12397
02021 Town of Surf City lame First Citizens Bank 85235 $ 200.00 GP#79918D ,JD rot.14143
--- —_. a
#2021 Coastal Marine Piers Bulkheads _ Peter Donal Wells Fargo _ 23882 $ 200.00 GP#79969D 'BH rcL 12898
42021 Thomas Cruz same iWells Fargo 171 $ 200.00 GP#79970D _ BH rot.12897 _
__. --__.1
1/2021 McAdams '.New Hanover County ,SunTrust 1817 $ 400.00 GP#80130D IKE rct.12852