PN_20-07_ Davis

IC ,
Issued by WiRO PN20-07
Pender County Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT r
NORTH CAROLINA
as authorized by the State of North Carolina, Department of Environmental Quality Environmental Quality
and the Coastal Resources Commission for development in an area of environment
concern pursuant to Section 113A-118 of the General Statutes, "Coastal Area
Management"
Issued to Matt and Kelli Davis authorizing development in the Estuarine Shoreline (AECs) at 95 Seahawk Lane,
Hampstead, Pender County as requested in the permittee's application, dated March 20, 2020, and received complete
by DCM on March 20, 2020. This permit, issued on April 9, 2020, is subject to compliance with the application and
drawing dated and received by DCM on March 20, 2020 (where consistent with the permit), all applicable regulations
and special conditions and notes set forth below. Any violation of these terms may subject the permittee to a fine,
imprisonment or civil action, or may cause the permit to be null and void.
This permit authorizes: Installation of a swimming pool with landscaping.
(1) All proposed development and associated construction must be done in accordance with the permitted site drawing,
received by DCM on March 20, 2020.
(2) All construction shall conform to the N.C. Building Code requirements and all other local, State and Federal regulations,
applicable local ordinances and FEMA Flood Regulations.
(3) Any change or changes in the plans for development, construction, and/or land use activities will require re-evaluation and
modification of this permit.
(4) A copy of this permit shall be posted or available on site throughout the construction process. Contact this office at(910)
766-7221 for a final inspection at completion of work.
(Additional Permit Conditions on Page 2)
This permit action may be appealed by the permittee or other qualified persons o
within twenty (20) days of the issuing date. This permit must be on the project o 0
site and accessible to the permit officer when the project is inspected for Jason Dail j
compliance. Any maintenance work or project modification not covered under CAMA OCAL PERMIT OFFI�U4L c.1 Z
this permit,require further written permit approval.All work must cease when this
permit expires on: 127 Cardinal Drive ExtensiE
December31,2023 Wilmington, NC 28405-384X `c
In issuing this permit it is agreed that this project is consistent with the local Land
Use Plan and all applicable ordinances. This permit may not be transferred to
another party without the written approval of the Division of Coastal PERMITTEE
Management.
(Signature required if conditions above apply to permit)

Name: Matt and Kelli Davis
Minor Permit#PN20-07
Date: April 9, 2020
Page 2 of 2
(5) This permit does not authorize the excavation or filling of any wetlands or open water area(s).
(6) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Disturbed areas shall be vegetated and stabilized (planted and
mulched)within 14 days of construction completion.
(7) This permit does not authorize any development activities within 30 feet of the normal/mean high water line.
(8) Pursuant to 15A NCAC, Subchapter 7J.0406(b), this permit may not be assigned, transferred, sold or otherwise
disposed of to a third-party.
(9) All construction shall conform to the N.C. Building Code requirements and all other local, State and Federal
Regulations, applicable local ordinances and FEMA Flood Regulations.
SIGNATURE: DATE: tk, l Z� Z�ZG
PERMITTEE
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,. ;°;,. `• ROY COOPER
i. 'i i r MICHAEL S. REGAN
• BRAXTON DAVIS
April 16, 2020
Matt and Kelli Davis
95 Seahawk Lane
Hampstead, NC 28443
Dear Mr. & Mrs. Davis,
Attached is CAMA Minor Development Permit PN 20-07 for work to be done at 95 Seahawk Lane,
Hampstead in Pender County. An electronic copy has been sent to the Pender County Inspections
Department and your Agent.
To validate this permit, please sign both copies as indicated for our records. Retain the orange copy for
your files, and return the white copy to us within 20 days of receipt in the enclosed,self-addressed
envelope.
This is not a valid permit until it is signed and returned to our office.
Thank you for your prompt attention to this matter.
Si erely,
Tanya K. i ila
Permit Support Technician
N.C. Division of Coastal Management
Enclosures
Cc: WiRO files
PN Inspection Dept.
Ocean Blue—Agent
State of North Carolina l Environmental Quality I Coastal Management
127 Cardinal Drive Ext.,Wilmington,NC 28405
919 796 7215

)A-00- V06° 2°
Y Localit rdkA Permit Number
. Ocean Hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other
(For official use only)
GENERAL INFORMATION
LAND OWNER- MAILING ADDRESS
Namc /�-ram —
Address / . .<t' //AI.-s — L✓ _
City Atop sie- State A C- Zip 67 kay3 Phone 9/() /o q
Email / 'L' -y , -D�V S
AUTHORIZED AGENT
Name O Cr/✓ 73 CUE,
Address 3) Cd V,c 4v
City Mt !ln//I/6rreN State NC zip0S9o3 Phone 779- .XJZZ
Email 6 CC` }/ ) 7 UL: I- JLAE /A/‘770r-) 2 67A4A-1L- fir''
LOCATION OF PROJECT: (Address,street name and/or directions to site; name of the adjacent waterbody.)
I< SEA )4' i ii LA) 7-61' cg iL C K
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) FOOL 37X/7
RECEIVED
MAR 2 0 2020
SIZE OF LOT/PARCEL: - 15 4 square feet / • �� acres
❑ Multi-family ❑ ) Y ��"4' TBN. NC❑
PROPOSED USE: Residential� (Single-familyConuncrci i � a they
COMPLETE EITHER (1)OR(2) BELOW(Contact your Local Permit Officer if you are not sure which AEC applie
to your property):
(1) OCEAN HAZARD AECs: TOTAL FLOOR AREA OF PROPOSED STRUCTURE: square feet(includ(
air conditioned living space, parking elevated above ground level, non-conditioned space elevated above ground level but
excluding non-load-bearing attic space)
(2) COASTAL SHORELINE AECs: SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
UPON SURFACES: [306 square feet(includes the area of the foundation of all buildings,driveways, covered decks,
concrete or masonry patios,etc. that arc within the applicable AEC.Attach your calculations with the project drawing.)
STATE STORMWATER MANAGEMENT PERMIT: Is the project located in an area subject to a State NO

ii
OTHER PERMITS MAY BE REQUIRED: The activity you are planning may require permits other than the CAMA
minor development permit, including, but not limited to: Drinking Water Well,Septic Tank (or other sanitary waste
treatment system), Building, Electrical, Plumbing, Heating and Air Conditioning, insulation and Energy Conservation, FI,
Certification, Sand Dune, Sediment Control, Subdivision Approval, Mobile Home Park Approval, Highway Connection,
others. Check with your Local Permit Officer for more information.
STATEMENT OF OWNERSHIP:
I, the undersigned,an applicant for a CAMA minor development permit, being either the owner of property in an AEC or
person authorized to act as an agent for purposes of applying for a CAMA minor development permit,certify that the pers
listed as landowner on this application has a significant interest in the real property described therein. This interest can be
described as: (check one)
an owner or record title,Title is vested in name of /{4A-7--r_1 T'9 VI S
see Deed Book N(aI 9 page 1 LI(03 in the MGvt j2. County Registry of Deeds
an owner by virtue of inheritance.Applicant is an heir to the estate of
; probate was in Count)
if other interest,such as written contract or lease,explain below or use a separate sheet &attach to this application.
NOTIFICATION OF ADJACENT RIPARIAN PROPERTY OWNERS:
I furthermore certify that the following persons arc owners of properties adjoining this property. i affirm that I have given
ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
(Name) (Address)
(I) iZOJJ S FFi-c D 133 I Cc'/ZCU S f -42- f21D. )f4&47 s ivC
(2) X i- )3 gl Co2Cu S r�vn , ,
(3) I" E /4 A,Z1tiELL/ 13 79
(4)
ACKNOWLEDGEMENTS:
I, the undersigned,acknowledge that the land owner is aware that the proposed development is planned for an area which
may be susceptible to erosion and/or flooding. I acknowledge that the Local Permit Officer has explained to me the particu
lar hazard problems associated with this lot.This explanation was accompanied by recommendations concerning stabiliza-
tion and floodproofing techniques.
I furthermore certify that I am authorized to grant,and do in fact grant,permission to Division of Coastal Management sta
the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information
related to this permit application.
This the ZO T1 day of,tt Q 01 , 20 Zo
RECEIVED
Landowner or person authorized to act as his/her agent for purpose of filing a CAMA permit applicatio 2 O 2020
MAK
•
This application includes:general information (this form), a site drawing as described on the back okc faiN�hc
ownership statement, the Ocean Hazard AEC Notice where necessary acheck for$100.00 ma� Cj5 ya a to the locality, an
any information as may be provided orally by the applicant. The details of the application as described by these souses at
incopo•ated without reference in any permit which may be issued. Deviation fio n these details will constitute a violation

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT ,
FOR CAMA MINOR PERMITS
i hereby certify that I own property adjacent"o 4 _ ! I � y t 's
(Name of Property Owner)
property located at .c�4 Qt-3k4
(Address, Lot, Block, Road,etc.)
on ��� ; :_ . it render County. N 0.
5 (Waterbody)
He/She has described to me as shown in the attached application and project drawing(s) the development he is
proposing at that location, and,I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHE
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APR 02 2020
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Dail, Jason
From: Dail, Jason
Sent: Tuesday, March 31, 2020 9:45 AM
To: Matt Davis
Subject: CAMA minor permit application - Incomplete
Mr. Davis,
RE: INCOMPLETE APPLICATION —Matt and Kelly Davis -ADDITIONAL INFORMATION REQUIRED
APPLICATION NUMBER—N/A
PROJECT ADDRESS— 95 Seahawk Lane, Hampstead Pender Co, NC
Mr. Davis,
The Division of Coastal Management's Wilmington Regional office received a CAMA Minor Permit application from you
on March 20, 2020, requesting approval for development activities at unknown address, Pender Co, NC. In reviewing
your application,we have discovered that additional information is needed to complete the review process.Accordingly,
I am requesting that you submit the following additional information to this office:
I am in receipt of letter from Ronald Sheffield, 1331 Corcus Ferry Road, Hampstead, NC, dated received by the NCDCM
on March 25, 2020. Mr. Sheffield's letter stipulates he was not provided a copy of the CAMA minor permit application,
nor was he provided a copy of the project drawing as it relates to the development plan you intend to undertake,which
ultimately will require approval by way of CAMA permitting. Please understand that the burden of proof of providing the
appropriate documentation is the obligation of the applicant. As you indicated by phone today(March 31, 2020),you
did not submit a copy of neither the CAMA minor permit application, nor the project drawing(s). As a result, your
application package is considered incomplete and will be on "pending" status until such notification can be provided to
Mr. Sheffield (your adjacent riparian property owner), and proof of sufficient notification provided to the NCDCM (i.e.
signed mail receipts with copies included).
Once this issue is resolved,your application package will be considered complete for processing.
In accordance with the Department of Environment and Natural Resources regulations, we note that the application, as
received in our office on March 20, 2020, is incomplete for processing. Upon resubmission of a complete application, a
local decision will be made in 25 days, provided this period is not extended as provided by law. Please contact me at
910-796-7221 if you have any questions.
Take care,
Jason
Jason Dail
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]
1

Afal
March 22, 2020 Ir.. 7016C OC6V,1,4
Jason Dail, DCM Field Representative
LPO, County of Pender
NC DEQ / DCM J
127 Cardinal Drive Ext.
Wilmington, NC 28405 1j 0 0t `'�l
RE: Matt & Kelli David I
95 Sea Hawk LN
Hampstead in Pender County N11
1� /�Dear Mr. Dail, "1 q vD
I have received, by certified mail, two pages, which I will include a copy of, concerning
an applied for CAMA minor permit by Matt & Kelli Davis.
One statement from them states that "I have enclosed a copy of my permit application
and project drawing(s) as notification of my proposed project."
These documents were not included in my letter and I therefore can neither sign and
return the enclosed No Objection Form or submit a knowledgeable objection submission
to CAMA.
Thank you so much for your attention to this,
Respectfully yours,
RArk-till 44;2/
Ronald E. Sheffield
1331 Corcus Ferry Road
Hampstead, NC 28443
Cell 910-231-9899
RES/dks
Encl. 2

Receipts for
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(Staple Here)
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Adjacent Property Owner i 1 Cc 'cus raj Qt Ci
griddd kJC, 28u`�3
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City, State, Zip Code
Dear Adjacent Property:
This letter is to inform you that I, //IA `r ' w. 144-7 4:( r /15 have applied for a CAMA Minor
Property Owner
Permit on my property at SG fM /-i, ` ,ik' t-_., i , in ? n j ^f::.
Property Address City/Town
in Pender County. As required by CAMA regulations, I have enclosed a copy of my permit appticabon and
project drawing(s) as notification of my proposed project.No action is required from you or you may sign and return
the enclosed no objection form. If you have any questions or comments about my proposed project, please
contact me at ',1-1-1/5-- WO q ,or by mail at the address listed below. If you wish to
Applicant's Telephone
tile written comments or objections with the CAMA Minor Permit Program,you may submit them to:
Jason Dail, DCM Field Representative
LPO, County of Pender
NC DEQ/DCM
127 Cardinal Drive Ext.
--- ---------- _. _ Wilmington, NC 28405
M Owner
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Mailing Address rr
City, State, Zip Code

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to 's
(Name of Property Owner)
property located at
(Address, Lot, Block, Road, etc.)
on , in Pender County, N.C.
(Waterbody)
He has described to me as shown in the attached application and project drawing(s),the development he is
proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
Signature
Print or Type Name
Telephone Number
Date

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Receipts for
Certified Mail
(Staple Here)
3--I1-21)
Dale
.A►ex NaIl
Adjacent Property Owner
13E 1 cc rcii5 -
Mailing Addres
�d,
City,State,Zip Code
Dear Adjacent Property:
This letter is to inform you that I, /I r ?' ' '``" `` ;DAVIS. have applied for a CAMA Minor
Property Owner
Permit on my property at City/Town
Property Address
in Pender County. As required by CAMA regulations, I have enclosed a copy of my permit application and
project drawing(s)as notification of my proposed project.No action is required from you or you may sign and return
the enclosed no objection form. If you have any questions or comments about my proposed project,please
contact me at " 2'1"-5 ' ,or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the CAMA Minor Permit Program,you may submit them to:
Jason Dail, DCM Field Representative
LPO,County of Pender
NC DEQ/DCM
127 Cardinal Drive Ext.
Wilmington, NC 28405
_
roperty Owner
!> /'-
J
Mailing Address
r_ N_�t f ;t�
City,State,Zip Code
RECEIVED
MAR 2 0 2020
DCM WILMINGTON, NC

g. . •os a ervice
CERTIFIED MAIL® RECEIPT
• Domestic Mail Only - •
1• For delivery information,visit our website at www.usps.com
3 Certified Mail Fee 37 c;c; 0400
- $ $24 08
Extra Services&Fees(check box,add bee eine te)
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3 0 Return Receipt(electronic) $ S(/.Ill Postmark
3 flCectifred Mall Restricted Delivery $ (1.1:1.,0) Here
3 Adult Signature Required $ $0 00
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$ 03/11/2020
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nportant Reminders: -Adult signature service,which requires the
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electronic version.For a hardcopy return receipt,
complete PS Form 3811,Domestic Retum
Receipt;attach PS Form 3811 to your mailpiece; IMPORTANT:Save tlds receipt for your records.
e e......grans n..ai nn.c io..,.......,i DOM 7cnnsosnn_onn,

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to 's
(Name of Property Owner)
property located at
(Address, Lot, Block, Road, etc.)
on , in Pender County, N.C.
(Waterbody)
He has described to me as shown in the attached application and project drawing(s),the development he is
proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED.)
Signature
Print or Type Name
Telephone Number
Date
RECEIVED
MAR 2 0 2020
DCM WILMINGTON, NC

4
Receipts for
Certified Mail
(Staple Here)
3 -20
Laten Ehec l e,td
Adiacent Property Owner r.
gL31 Corcus �er r\I R�d
arg Add ► is 2?gm3
City,State,Zip Code
Dear Adjacent Property:
This letter is to inform you that I, MA- f 5 have applied for a CAMA Minor
Property Owner
Permit on my property at City/Town
Property Address
in Pender County. As required by CAMA regulations, I have enclosed a copy of my permit application and
project drawing(s)as notification of my proposed project.No action is required from you or you may sign and return
the enclosed no objection form.If you have any questions or comments about my proposed project,please
contact me at "� ' 2'1 ,or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the CAMA Minor Permit Program,you may submit them to:
Jason Dail,DCM Field Representative
LPO,County of Pender
NC DEW DCM
127 Cardinal Drive Ext.
__- _ _ Wilmington,NC 28405
roperty Owner
Mailing Address
City,State,Zip Code
RECEIVED
MAR 2 0 2020
DCM WILMINGTON, NC

1. . •os a ervice
CERTIFIED MAIL® RECEIPT
Domestic Mail Only
• For delivery information,visit our website at www.usps.com®.
HA IT ?f249 44s -
D Certified Mail Fee
Extra Services&Fees(check box,add tee a $ Oate) 08
$❑Return Receipt(hardcopy) $ •I.
D ❑Return Receipt(electronic) $ $ 1_I i II Postmark
D ❑Certified Mall Restricted Delivery $ i 1•j l j i Here
7 ❑Adult Signature Required $
❑Adult Signature Restricted Delivery$ !1•f{i t
Postage 5
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Total Postage and Fees Cali 1/2020
$ $6•95
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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.
'portant 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,whict
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. LISPS 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.
...-_—Donn ._�.....�.,.'__'_'......��...................�

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to 's
(Name of Property Owner)
property located at
(Address, Lot, Block, Road, etc.)
on , in Pender County, N.C.
(Waterbody)
He has described to me as shown in the attached application and project drawing(s),the development he is
proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
Signature
Print or Type Name
Telephone Number
Date
RECEIVED
MAR 2 0 2020
DCM WILMINGTON, NC

-i. f' 'Receipts for
Certified Mail
(Staple Here)
3 `1t-2C
Date
W.-e, Mir i r dt
Adjacent Property Owner
1'3--i'1 Coro a s e_r P.
Mgr g Addig4e6A
kc, 74L2
City,State, ip Code
Dear Adjacent Property:
This letter is to inform you that I, "44 7"1- ' I (•(- I /q/-'s have applied for a CAMA Minor
Property Owner
Permit on my property at 7 SEA J1.�.e, _:z ,in *-. -n p', :- ..
Property Address City/Town
in Pender County. As required by CAMA regulations, I have enclosed a copy of my permit application and
project drawing(s)as notification of my proposed project.No action is required from you or you may sign and return
the enclosed no objection form.If you have any questions or comments about my proposed project,please
contact me at ..' .g-`?6 <!3 ,or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the CAMA Minor Permit Program,you may submit them to:
Jason Dail,DCM Field Representative
LPO,County of Pender
NC DEQ/DCM
127 Cardinal Drive Ext.
—_ Wilmington,NC 28405
/ _ ;
erty Owner
?c C ``A' /-f A I,"l;f /
Mailing Address
,r 1..16.. <.
City,State,Zip Code
RECEIVED
MAR 2 0 2020
DCM WILMINGTON, NC

I. . •os a ervice
• CERTIFIED MAIL®RECEIPT
▪ Domestic Mail Only
3
-I For delivery information,visit our website at www.usps.com .
▪ HAre n", pl41 j'A
L Li S E
Certified Mail Fee
$3.55 0400
• $
08
Extra Services&Fees(check box,add fee atOpliefete)
• Return Receipt(nardcoPV) $ II I II
3 0 Return Receipt(electronic) $ $0.00 Postmark
3 DCaitfled Mall Restricted Delivery $ $ Here
3 D Adult Signature Required W.un
Adult Signature Restricted Delivery '
• Postage
$0.55
a s 032020
1 Total Postage and Fees
$6.95
• $
I Sent To Mi Vrinel\ i
3
ccd,

..erllriea man service proviaes me ronowmg aenems:
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,whict
Certified Mail service is not available for requires the signee to beat least 21 years of ag
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 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.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to .s
(Name of Property Owner)
property located at
(Address, Lot, Block, Road,etc.)
on , in Ponder County, N.C.
(Waterbody)
He has described to me as shown in the attached application and project drawing(s),the development he is
proposing at that location, and, I have no objections to his proposal.
LAPPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
Signature
Print or Type Name
Telephone Number
Date
RECEIVED
MAR 2 0 2020
DCM WILMINGTON, NC

Date Date Check From Name of Vendor Check Check Permit Rct. #
Received Deposited Permit Holder Number amount Number/Comments
3/24/2020 David Fence, Inc. Matt& Kelli Davis First Bank 13463 $100.00 minor fee, 95 Seahawk Lane JD rct.
Hampstead PnCo 10397