80214D - Jacobus

0 CAMA/ ❑DREDGE & FILL N° 80217
LI A B C C
GENERAL PERMIT Previous permit#��—= /
- i New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina,Department of Environmental Quality .y
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 1 . \ t 0
� El Rules attached.
Applicant Name 3oTe--ph 30,Co bLA S Project Location: County RI(AN Hh(Nit tV
Address ,. 2-Z A ')eet o C Mi V-C_ Street Address/State Road/Lot#(s)
City W i I Vh 1.0 1`f 1,v‘ State/U. ZIP 0 I I '' MA M E
Phone#(110)(o 30-14 3 4 E-Mail Subdivision
Authorized Agent `, I.Avii IAA40 f 411Wr4..÷LL /j i vIvr-/ City ZIP
Affected P CW ❑EW ❑PTA SS ❑PTS // R 0U3 ohone# ,( ) River Basin 1-k OA k
AEC(s): OEA ❑HHF ❑IH ❑UBA O WA Adj.Wtr. Body PG r,,� CV L V/man /u
❑ PWS: (
ORW: yes / no PNA yes /ono r �, G µ_ Closest Maj.Wtr. Body A t W w ' Vv i d C1 I A S�SIM
C 114/
Type of Project/Activity ,v S'4'G I I A Y '? 0 e t - :. f'.a— r OC S I v vti tat d
A -•C{kV J }-)( v yln . (Scale: 1 5.) )
Pier(dock)length J
Fixed Platform(s) PA(IC C 4 ' I
1, l i ' 'T�_ I I
1
Floating Platform(s) jj 1.
Finger pier(s)
I `�E�� lJ�Q ` — \A
Groin length I �� ; •
number - -- 1/_ ._+-1j I___.__._.. ---..._1
Bulkhead(Ripra. length it-40 '��{ o ._._.i
avg dls�ee offshore PA A S rt Z's \f/ • 1
max distance offshore j
Basin,channel i V I
cubic yards V _1/ 1 t. . i I
Boat ramp } yr f { {
Boathouse/Boatlift irlir &R,,=a.•.
Beach Bulldozin PP"'" ��- I �� � C
Other VIM t4 rr (I13fi(kbA f / �� — li
-�� V v�I
4.
'/- do' IGw i‘rh-tf c.(' 11. i r( 1
Shoreline Length I l o 0 I ') 0 I i 1p(0 U g ! /'�,.
SAV: not sure yes ticil j I!L
.
•
Moratorium: , n/a yes no ) i
Photos: (Deli no ►Vf14-
--� --
Waiver Attached: — _ i
A building permit may be re ,red by: a (�OAi J liA h ae V C O J ❑See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)Notes/Special Conditions • Ali R-N . t i U 0 a I3L. l S 1 . ' Q 'c (lt tva` vkla-tonc-
0 .Ci1�ve,"
N� coo(S 1 WeA- Iat4 -�i W'11 Gu- tA rQ -
Y__c i-Va1,Ntc (1 7-0-2I
Agent or Applicant Printed Name PermitOfficer's Printed Name
.(.. Aitr cka j4A- .4-le- iy 11'1421
Signature **Please read compliance statement on back of permit** Signature

'y 'CA MA / ,(DREDGE & FILL >V° O7 1 7 A B
ENERAL PERMIT Previous permit# _
New Modification [ (Complete Reissue L.Partial 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 I5A NCAC 'l't 4
ii JRules attached.
_Applicant Name T( �- 1 _J Cl CO` %.A S Project Location: County iv Qi1,J k Ltvi/4l/
Address L(2.-'Z 14,`eJi N D 1 i V i- Street Address/State Road/Lot #(s)
City \1_t i W(lNi'f j,v1 State(J. ZIP 0 ill 1 1 SP W E
Phone # ('110)(p)Q-• ICE 34 E-Mail Subdivis,on
Authorized Agent 12 S LAJ UtAGOOldej'j'C4 t Cityll...L/J(Vtivvq ZIP
l-)CW LJ EW Li PTA 4s I •PTS n`attk, hone # ( ) River Basin t-V
Affected 11 OEA U HHF L:IH I UBA I I N/A ,
AEC(s): Adj.Wtr. Body PCl i- CV C- at
PWS: 1
ORW: yes no PNA yes ! no �GI Oy.C��s Closest Maj.Wtr. Body k W W( k�t d IA
Type of Project/Activity ,V\S'+U I1 0% ote ,`7 V-,..v,.4 LGt, ' IC1k^c vvtV U4 Ca Sdli i IN,
to ,5-irtbi I LT Q eiVIct 1n D b e,V hn . (Scale: 1 t
Pier(dock)length
Fixed Platforms) i j-1.AT�1, C ,
EZTm5,7L"
\\ (/ •(
Bulkheat41111;length it 40 % U
avg•1 e offshore 0 A S 0 (4. ' V/
max distance offshore •
Basin,channel
cubic yards 1f� 1/
Boat ramp V.
Boathouse/Boadift I i .
i • I
Beach Bulldozin fi }i_`1111 �,� ` t i 1 cj
7
Other�{Vb1 11 ,?rT C1ut1/vkl1 `1V I
1
�, WCL.LS
�d{
btY_im__ice b�- s6t I
I to22. '-11iettiA pv . i
Shoreline Length+/_ 10.0 J -'Z C(6(15 I L
SAV: not sure yes �o . /l
Moratorium: CI yes no i
Photos: no
Waiver Attached: 0 /J�jy, t L V.r
A building permit may be r+g irreedby: t i ON hlitler 4f CO- n See note on back regarding River Bas
(Note Local Planning Jurisdiction) I
Notes/Special Conditions kU •1I4 . 1100 CA_Cik IO(P.i t,S'`att j c '. /d e4 t Q 'a bon 1
NO CoCtS,IT,\ Vie A-lch-e9 -6AI Cu-16x(1,t-t..ttQ .
J II m wA Y _go 6' 0/\)- arc-} s_ uL__el It-{
Agent pplaant Prince ame Permit Officer's Printed Name
Sig a re **Plea ea co lia tater ent on back of permit'"" Signature
ou, i� i

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ( 04,,,,,‘ �01�Jlis
Mailing Address: Ga ,,eJ i ..p e,r/'
4.44h,#Vy'.1 /d e__
Phone Number: y/v// G Ao . /01
Email Address: JJak 6,$ P/l<,„e :
I certify that I have authorized oZ 3 V AOACk
Agent/Contractor
� ic��.—f�
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at 6, /57, z/ec>,,.) ,<2 , / 2 a 7' ,
in /121ei i /4,ijodfounty.
I furthermore certify that f 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:
Signature• ur
Print or Type Name
Title
O"7 1 /O / c?l2. '
Date
This certification is valid through O'7 I I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
j-5 3 of h 6 74-600)
hereby certify that I own property adjacent to-296 ,2 -A#
4 22 (Name of'.operty Owner)
property located at 472red/e.are.) Z V e 40 7 5
Address, Lot, lock, Road etc.'
on gii.. S" (idegiere r Ai/4".4.0.) ,S:.,/ azeiXJ0cAtie . N C
(Waterbodyl (Cftyr13 r and/or County)
The appli/ant has described. o -le as shown below the develocrreit proposed at the above location.
nave no opection to this proposal
-1a\,e objections to this proposai.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
'Individual proposing development must fill in description below or attach a site drawing)
i
WAIVER SECTION
erstand tnat 3 bier occ ik nloonrg F.,:11 ,-,gs breakwater bca:-.:Lse :.f• cc g,c1- --,..,st ce set tack 3
- - r-i...r- Pistarce :!' '5 '-or- --/ area P' -caner access ..niesi Aa,„e,-.! ::f ' e 4 1 0... N'S::' :C, Aia,,e
the setback y:. must initial tne aborconate biank below
VI cc wisn 'o waive the 15 setback re:pi-en-en,.
I dc not'mist,to waive the 15' settack reouirerrert
,Property Owner nformatior`, (A "acent P! derti Owner Information
`:,,,!,:::7!,?•-' 61e,-.4'116411'Sit 10414 ti(rel 4C vi/t A
G126¢,94' '-'4iLa-C-cse <- eiriVUNIA Mai itO,A
--..'), --.,-
,?,2 fee...-i 4erde (00)..rtrItatiA W\te,
',',.. - -:•.:-.: . _ '.-: .--; .2•:. :--- .
-C—R2e--/-2-•
_
9:AeL ,S 7 ---- 6i-{ - P— LO
-,,,:-.-:--1, ,,..,----:•.i--
7-?,oi - ____71[UV 2-0 2 A

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to t10s N4pii ‹ 's
/J ff / (Name of Property Owner)
oroperty located at Gfir7,y,Qs 4P,A/ J v f S
(Address,
`Lot, Block, Road, c.)
on !Q QS e,Q�.,�- in4 G C.
(Waterbody) , Citylt'own and/or County)
The applicant has described to me as shown below, the development proposed at the above location.
1 have no objection to this proposal
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. breakwater. boathocse. 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
k/ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) ( cent Property Owner Information)
tf� dl, `t' tt�rl \4
J Ce'.�.n, S - t ,
Nar m Addrw = it r ocr�s
/, ', 0,/ I' PAIACA: �
�It' /Stn• , :.i :'St6"7t5I q t
Telephone Number Telephone N.." e
7—fv - t92/,,217lat - I - 2
Date
p
Revrser+ 5' 4,2012)

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Check
red Date aposked Check From(Name) Named Permit Holler Vendor Check number amount Permit Number/Comments Receipt or Refund/Reallocated
1 CoWmn2 Column., Column Column5 Column Column7 Columns ColurnnD
2021 _ Charles Poindexter same Wells Fargo 1372 $ 200.00 GP#80221D BH rot 14112
2021 _ North End Builders NC LLC Scott and Teresa Browning SunTrust 1010 $ 400.00 GP#80214D BH rot.14110
2021__ Joseph Jacobus same Wells Fargo 2949 $ 200.00 GP#802170 KE rot.12873
2021 _Arjean by the Sound Ext HOA same First Citizens Bank 1014 $ 200.00 GP#80219D KE rot.12874 _
2021 Village of Balh Head Island same PNC Bank 67238 $ 100.00 minor fee,328 S Bald Head Wynd(Lot 1319),BHI BrCo RM rot.15501
2021 IS.Mitchell,Inc. Clarice Willoughby Bank of America 1094 $ 200.00 GP#803060 BH rot.14108
2021 i i Christopher Gaddy same Suntrust 16472 $ 200.00 GP#80141D JD rct.14346
2021 i Karen K.Sanders same UBS Financial Services 1097 $ 100.00 minor fee..405 N Anderson,Topsail Beach PnCo JD rct.14904
NOV#21-140,Lot 19-8N N King Fisher Ln,Hamp/Pnco
2021 Tim Lewis Money Order Germain Nadaud BOFK,NA R20997218832 $ 448.00 $200/$200/$48 JD rct.14905