80138D - West

0❑CAMA/ ❑DREDGE & FILL No 80138 A B C
GENERAL PERMIT Previous permit#
>�% 61New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina,Department of Environmental Quality 7 0 . / T�
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 7
�,, �i j j / ❑Rules `hed.
Applicant Name f� y 1'�1��G/7 �L ' VV " ' Project Location: County (! ()A)
Address 1 03—! ' $1 Street Address/State Road/Lot#(s)
City ✓ ( - State N'✓ ZIP 7�4 4-c- -7 0 -1 7 �F�
Phone#1 l D 7 ID I 07 Subdivision '
-Mail �'^
Authorized Agent #3 / � )City V 1 *4-- ZIP ZI ti LI
❑CW
AffectedW ` PTA ❑ES ❑PTS Phone# ( ) River Basin 0
❑OEA ❑HHF ❑IH ❑UBA ❑N/A / AL az S G (nat Adj.Wtr. Body c� {J''�s 40 /unk
❑ PWS:
ORW: yes / no° PNA yes / no Closest Maj.Wtr. Body r `IPt ,(0h i�
Type of Project/Activity `�
(Scale: N 7S )
Pier(dock)length
Fixed Platform(s) j I j
Floating P13tform(s)
Finger pier(s)\ I ........ ,.. ligir —
Groin length , , ' j
I '
number —_ i -- - . :,
Bulkhead/Riprap length, - — I.....-.. jJj
� ,,, :4,
—...I
avg distance offshore\ I ;
max distance offshore\, i
Basin,channel ! i
\ ' I 1 r I
i
cubic yards1 , A
Boat ramp Ill( • ! /*
Boath B 1 G j 1 __ —
e/ oatlif< Y _.._. Ii
' .....•BeachBulldozi _ iIHI
OtherQ / ; 1 /�i
• / ,- ,'IMO Shoreline Length / ) i 1
I _
I •
SAV: not sure yes
Moratorium: n/a yes o f
Photos: Yes ., �(
Waiver Attached: ' yes 1
I
A building permit may be required by: <� . ❑See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions
'61ill GUG Uv �4"-- IcrIn..._.7)Gt-;,e
Agent or Applicant Printed Named\.---- ,/
Permit Officer's Printed Name
y,L... ..._._.__„—•-
Signature **P ease read com statement on back of permit*�` Si ure
P

From: Dail.Jason Jason dail@ncdenr gov 6'PO
Subject: =W:Send data from MFP13734211 06/23/2021 09:21
Date: June 23.2021 at 9:22 AM
To: Gatti James [e-mail]
Ms.West.
Please find attached a copy of your CAMA permit for boatlift install. Please sign and return a signed copy of the permit to
""alidate.
Thank you,
Jason
Jason Dati
Field Representative
NC Department of Environmental Quality
NC Division of Coastal Management
127 Cardinal Drive Ext.
Wilmington,NC 28405
Phone:[phone],Fax:[phone]
[e-mail]
*E-mail correspondence to and from this address
may be subject to the North Carolina Public RECEIVEDRecords Law and may be disclosed to third parties.
virginal Message J U L O l 1.0 21
From:[e-mail][mailto:[e-mail]]
Sent:Wednesday,June 23,2021 9:21 AM
To:Dail,Jason<[e-mail]> DCM WILMINGTON, NC
Subject:Send data from MFP13734211 06/23/2021 09:21
Scanned from MFP13734211
Date:06/23/2021 09:21
Pages:1
Resolution:200x200 DPI
HAVE A GREAT DAY!!!
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed
to third parties.
DREDGE• FILL N° HO I.�KABC6
ICAMAE/
RAL PERMIT Previous permit M.
aN
u
ew Mod.l.cN.o•t Complete Reissue Prr,tirl Re ssue DM*previous perm:quadd �
At a 'Jed try die Stasis ln't Dapv.»
of North Cat o1 E.rv✓onn.a.na1 Qwluy /Z0�
and the Coastal Resourc Commissars in an area of anwon real concern poi Want to I SA NCAC j�7 t
N.rrs alba rid
Applicant Name 14 Rti U/41 P.otcct Location County (00
Address .7 01/ 7.1(1' cl4- • Street Address:State Road/Lot 0(s)
City S✓Il 4 M5.N.... State NGtLIP 44 6 7 0 3 -
Phone a I0)2Ma,1'� !Nr II, Subdw.sion / /' t
Aulhon:ed Agent N f fr City 5V L 4 `mil ZIP tC I -/
CW j4W N[TA ES PTS Phone 0 ( ) � �� River Bata+ �` 0
Affected OEA HE* IN USA PEA `r .�ALt
AEC(s;'. Ad) Wlr Body ��/irsit __ SG (matZunkro
�S Sy ON
Closest Mat.Wtr Body
ORW yes 425 PNA yes re,
Type or Project/Activity t
fl _.__� _ ---- N Ts '
(Scale:
Vrrl a)4..Eth
feed Itl
Roatr% m(t)
frier parts
Gain Iwrjeh - -

ft
&A ntaN RV*k'^JS (10. lute
(77i
maa dictum*u(htror.
Law (Kunnas
crop(.a L
.. y ,��,
Beach 11
5 . ptiltir
Shemin*Length"tilL"Cri
SAY moll w* Yrs in
M " 'le/
Mormonism Na rot 5?
WarwrAnacMd / 1
A buatdtn6 permit may b.r.ar+ed try �I l 4.5.-- _. Ste role on back(etarde%Raver Baarn rurct
(Note local Plannn')trrtsdcaon)
Notes,'Special Conditions -----------------------
t
U✓14IJ44aA
wR wA NNNaa'ly�!/ tit) .
R ••('Itn.+rr.Nl�nnrpirar„c slat tr+�cnl crl arUd,r ��I" N r� r�/
"the;
76� 6.l3 r z/ lo
MOk at b.r(te t 1
t rr.ri I 'ttirx Date iapar stun Date
RECEIVED
JUL 0
DCM WILMINGTON, NC

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: -Bay bares e 54-
Mailing Address: r70 3 7 '7'4 S-1-ree+
Surf C i-1-.' , N G ;:?A''Pi 5
Phone Number: ctIQ - aqO - )t17S6
Email Address: -{'o p I be,I ( 3 m a i . C D vv
certify that: have authorized CQ.SS;ctj
Agent/Contractor
to act on my behalf, for the purpose of applying for ana obtaining an CAMA permits
necessary for the following proposed development:
t►n 5- A I ( GL ye I- s 4 i l (-1- 10 " sfl► %hir
at my property located at '1 O?'7 '1 �' 1 V �' c7t,�t%� C. i Al ge-/4S
in ( rt Ib 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:
&J4ah4d
Signature
Barbetrzk '. J" 4
Print or Type Name
O1 tf '1-e
Title
(p 1 21
Date
This certification is valid through / RECEIVED
JUN 21 2021
DCM WILMINGTON, NC

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT_
hereby ceniry mat i own property adjacent to Vc' r bl1 y1z. 6, ,VN e64- '`
(Name of Property Owner
property located at 3/ '144 S YPe
t-
on
C}} �
Jh 1 eAfvAI (Address, Lot, Block,lock, Road, c
, in �UY-F C ,/ AIL m15ID t,t/, N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
/W4)14)
I have no objection to this proposal.
1 nave objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
CaMI,WOvter
ei
k
Vie 3g�I t�Jaocl Deccmn
v\ 6 ea- A-1 t
r Q, ("I + •1. 5) -4'.s Nis ill.. Q i 1 pets toe- C.cL-\-
1-ev�\ uJ i h eci5-ir•k
iyi.
Tr ,,i,Ii. . n eecls 1 r
e-101-ewc{
y,4,<< 0iG it t c'L„r to 1•�
gOtt r Carat I a bO / \e FlO4vAy N& Ff- et%ry '' �t�ps
` ? WAIVER SECTION
I understand that a pier; dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back
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.)
c ;=,_i I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
,6444/1RJIA/264t /6/ • _I .
SirSignature,
Si at�1 Y4 5. 1 PS� f e, iii,o j/l -Sach tit S. f;1/1'15 S.
Print or Type Name Flint or Type Name
`7D 3'7 r14.4 r tae� fi0 A 9 'j Zit r-• e-t
Mailing Address Mailing dr ss
Mailing
Cd-t NC ey4 r Scar L-t I o? 17V6
City/State/Zip / City/State/Zip y '
q1 f7 - .1 ..- ir5 S 3Us- 33 8 —iGO-4
Telephone Number Telephone Number
tp ji 1a8z1 G-is-adai
Date Dc.r,,
(Revised 61 t E I V E D
JUN 21 2021

ADJACENT RIPARIAN PROPERTY OWNER STAT�E`MENT+
I hereby certify that I own property adjacent to 43C.rkC k � S. VN e 4 's
(Name of Property Owner)
property located at 3/ `14`' E-iYeF
rµhCC,, � /� (Address, Lot, Block, Road,ptc.)
on / .)i'1' � (G1 rvd , in e--,00,-P , AIL- ©(1 L /, N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
T 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)
Co -,hik
A
1�'� (o weal cteck,v26
-pi `(%'53 t - - .; need ,1-
$o 1-eve iA/.1 wdc.43,
fawr
o'' 5cl,rwrk--p. .�,� Irenn�✓.vcjlfee1 tt' s; I
ire o ! ( Bar bat, \n,L,st- Pray ti Fiehr
�`� WAIVER SECTION �- PO P` —�
I unArstand 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.)
SeJtlC__ I do wish to waive the 15'setback requirement.
I do not wish to waive the 15'setback requirement.
(Property Owner Information) (Adjacent roperty Owner Information)
jiALd
Si ature Si ure 6 /
POI' If} y4 S. �PSt
Print or Type Name Print or Type Name
'7D 3 7 14-4 SEree:1- 0- -Z f3 V Fte.O W a v t
Mailing Address Mailing Address
urP C;�y NC a�yy5 I �OLJ Spi ii 6 &1 ( Z 731 .
City/State/Zip City/State/Zip
!TSs
Telephone Numb / Telephone Number
i1S MDa J �!/,
Dare D^
(RevisedfctitstIVED
JUN 21 2021

Check
Data Rece ved Dee Danoslted Cheek From(Nana) Name of Permit Holler Vendor Check number amount Permit Number/Comments Receipt or Rdund,Raellocand
Column.' Column2 Column] ColumM Column5 Column6 Column7 Column! Column')
7/2/2021 AWM Docks&Marine Ronal and Loretta Elliott BB&T 6028 $ 200.00 GP#79951D BB rct.14060
7/2/2021 Doris Hatley same Pinnacle 3589 $ 200.00 GP#80192D BB rct.14056
7/2/2021 Southern NC Marine LLC Diana Kennedy First Bank 1447 $ 200.00 GP#80142D JD rct.14348
7/2/2021 Riverbrook LLC First St James Inc. Wells Fargo 1255 $ 400.00 GP#80119D PA rct.12839
7/2/2021 Barbara West same Fidelity Bank 3765 $ 200.00 GP#80138D JD rd.14340