SC_16-14_ Jeffreys (2)

Issued by WiRO SC16-14
Surf City Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT Coastal Management
ENVIRONMENTAL QUALITY
as authorized by the State of North Carolina, Department of 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 Giles Jeffreys Jr. authorizing development in the Ocean Hazard (AEC) at 145 Atkinson Road, in Surf City,
Pender County as requested in the permittee's application, dated June 1, 2016, and received by DCM on July 5, 2016.
This permit, issued on July 18, 2016, is subject to compliance with the application and drawing dated and received by
DCM on July 5, 2016 (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: Construction of a single family residence.
(1) All proposed development and associated construction must be done in accordance with the permitted site drawing dated
received by DCM on June 29, 2016.
(2) All construction must 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
within twenty (20)days of the issuing date. This permit must be on the project
site and accessible to the permit officer when the project is inspected for Jason Dail
compliance. Any maintenance work or project modification not covered under C MA LOCAL PERMIT OFFICIAL
this permit,require further written permit approval.All work must cease when this
permit expires on: 127 Cardinal Drive Extension
December31,2019 Wilmington, NC 28405-3845
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 CoastaRECEIVED
Management. DCM WILt'.�INUTC MITTEE
(Signature required if conditions above apply to permit)
n r

Name: Giles Jeffreys Jr
Minor Permit#SC16-14
Date: June 18, 2016
Page 2 of 3
(5) 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.
(6) • Any proposed for grading within the 30' buffer from the Normal High Water level must be contoured to prevent
additional stormwater runoff to the adjacent marsh and/or canal. This area shall be immediately vegetatively
stabilized, and must remain in a vegetated state.
(7) With exception of 200 sq. ft. or less of elevated, slatted uncovered wood decking, no structure(s) shall be located
within the 30' Coastal Shoreline buffer, including but not limited to concrete slabs, stepping stones, roof covers,
accessory buildings,etc.
(8) All buildings shall comply with the NC Building Code, including the Coastal and Flood Plain Construction Standards
of the N. C. Building Code, and the Local Flood Damage Prevention Ordinance as required by the National Flood
Insurance Program. If any provisions of the building code or a flood damage prevention ordinance are inconsistent
with any of the following AEC standards, the more restrictive provision shall control.
(9) Pursuant to 15A NCAC, Subchapter 7J.0406(b), this permit may not be assigned, transferred, sold or otherwise
disposed of to a third-party.
SIGNATURE: - 4Z---;2fr-92 DATE:
PERMITTEE
RECEIVED
DCM WILMINGTON, NC
JUL 2 5 2016

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GENERAL INFORMATION
LAND OWNER
Name I[f,S )Q-Pf U'l S Jr
Address SO 9 1,9,e4o0 kL 9tr 9(ace Gt
City ,.?,(A.. e.,0 State• I..)L Zip 42151 Phone ` (9 c t c — U/16
Email
AUTHORIZED� AGENT 1 ,(,
Name \�101 1,9 D A (k, c (AtV2! ') (.I C..
Address Q O 1joX p2oS
City ,SA(FG l'Ci State MC, Zip a2cf`t`((Phone q(o 9r2 Z — 2 5 V
Email o(V\-\ ( \v;A c ) L C L C Oo. C o 1
LOCATION OF PROJECT:(Address,street name and/or directions to site.If not oceanfront,what is the name of the
adjacent waterbody.) L,U 1 S- Q(A,i\s w\ . a c \-- Togs CAN(
1
DESCRIPTION OF PROJECT:(List all proposed construction and land disthrbance.) e_ PrA✓c
VL,j
d rye AS' G
SIZE OF LOT/PARCEL: (e`'`O D square feet acres
PROPOSED USE: Residential (Single-family 0 Multi-family ❑ ) Commercial/Industrial 0Other
COMPLETE EITHER(1)OR(2)BELOW(Contact your Local Permit Officer if you are not sure which AEC applies
to your property):
(I) OCEAN HAZARD AECs:TOTAL FLOOR AREA OF PROPOSED STRUCTURE: square feet(includes
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: square feet(includes the area of the roof/drip line of all buildings,driveways,covered decks,
concrete or masonry patios,etc.that are 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 Stormwater
Manage ent Permit issued by the NC Division of Water Quality?
YES NO
If yes,list the total built upon area/impervious surface allowed for your lot or parcel: 1 3 0 • square feet.
RECEIVED
)CM VVILMIINGTCN, NC
n u A i. oriole

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,FIA
Certification,Sand Dune,Sediment Control,Subdivision Approval,Mobile Home Park Approval,Highway Connection,and
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 a
person authorized to act as an agent for purposes of applying for a CAMA minor development permit,certify that the person
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 ,see Deed Book g yp ge c0 in the Q-e".&e.-( County Registry of Deeds.
an owner by virtue of inheritance.Applicant is an heir to the estate of ,
probate was in County.
if other interest,such as written contract or lease,explain below or use a separate sheet&attach to this application.
NOTIFICATION OF ADJACENT PROPERTY OWNERS:
I furthermore certify that the following persons are 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)
(1) j, ---Cu1/4(\AJAI 1,rt PrtV-tnS it-
(2) 9A`mac- +vv,(*ovis4 l�3 kV—t a5ap) tl_.A
(3)
(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 staff,
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 l day of ,"Towc. ,20 ((,
Lan t o' , .: 1 tho :: to act as is/her agent filing a CAMA permit application
This application includes:general information(this form), a site drawing as described on the back of this application, the
ownership statement, the Ocean Hazard AEC Notice where necessary,a check for$100.00 made payable to the locality, and
any information as may be provided orally by the applicant. The details of the application as described by these sources are
incorporated without reference in any permit which may be issued.Deviation from these details will constitute a violation of
any permit.Any person developing in an AEC without permit is subject to civil, criminal and administrative action. _D
DCM VVIL`I:!iIN. TCIN, iyIL
II II n K onir

Issued by WiRO SC16.14
Surf City Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT Coastal Management
ENVIRONMENTAL QUALITY
as authorized by the State of North Carolina, Department of 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 Giles Jeffreys Jr. authorizing development in the Estuarine Shoreline (AEC) at 145 Atkinson Road, in Surf
City, Pender County as requested in the permittee's application, dated June 1, 2016, and received by DCM on July 5,
2016. This permit, modified on September 27, 2016, is subject to compliance with the application and drawing dated
and received by DCM on September 27, 2016 (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 retaining wall.
(1) All proposed development and associated construction must be done in accordance with the permitted site drawing dated
received by DCM on September 27, 2016.
(2) All construction must 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)
r
This permit action may be appealed by the permittee or other qualified persons (11-j21
within twenty (20) days of the issuing date. This permit must be on the project
site and accessible to the permit officer when the project is inspected for Jason Dail
compliance. Any maintenance work or project modification not covered under CAMA LOCAL PERMIT OFFICIAL
this permit,require further written permit approval.All work must cease when this
permit expires on: 127 Cardinal Drive Extension
December3l,2019 Wilmington, NC 28405-3845
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: Giles Jeffreys Jr
Minor Permit#SC16-14—Permit
Modification
Date: September 27, 2016
Page 2 of 3
(5) The permit conditions of CAMA Minor Permit SC16-14, issued on June 18, 2016, remain active until permit
expiration.
(6) Any proposed for grading within the 30' buffer from the Normal High Water level must be contoured to prevent
additional stormwater runoff to the adjacent marsh. This area shall be immediately vegetatively stabilized, and must
remain in a vegetated state.
(7) This permit does not authorize the excavation or filling of any wetlands or open water areas.
(8) With exception of 200 sq. ft. or less of elevated, slatted uncovered wood decking, no structure(s) shall be located
within the 30' Coastal Shoreline buffer, including but not limited to concrete slabs, stepping stones, roof covers,
accessory buildings, etc.
(9) All buildings shall comply with the NC Building Code, including the Coastal and Flood Plain Construction Standards
of the N. C. Building Code, and the Local Flood Damage Prevention Ordinance as required by the National Flood
Insurance Program. If any provisions of the building code or a flood damage prevention ordinance are inconsistent
with any of the following AEC standards,the more restrictive provision shall control.
(10) Pursuant to 15A NCAC, Subchapter 7J.0406(b), this permit may not be assigned, transferred, sold or otherwise
disposed of to a third-party.
SIGNATURE: DATE:
PERMITTEE

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT/AT
I hereby certify that I own property adjacent to (�%i//�5 �l rJC 6 's
(
NamA of Prop Owner)
(45 property located at � 'o ' `� )tom, Kt) VPM 15 Li la
(Address,
(Address, Lot, BlocIjeRo 4 tc.) 4, ' -
(Waterbody)on ��(City/Tow and/or County)
The app. ant has described to me, as shown below, the development proposed at the above
locati .
have no objection to this proposal.
v
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.
4 I do not wish to waive the 15' setback requirement.
n (Pr- erty Ow -r Info m-tibn) (Adj ent Property ner Information)
cn a '� . G� '._I�� i
-r' mv : .' ' i(;
) ZZ e'
1 or Type Name Print or Type Name
G1 o [-
` 3` ,eV120 P� i Y Pi II(`6 Z/�/ —i—> 7C
Q, P . ling res M n At ddr ss
.? ling
i ( , , 751/ y/,� ec Z76f2
City/Sta aryls r( ip )-[ y 10 y9lg A �'27Z
p
Teleph ne umber email address Teleph e umber/email address
Date Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 6 c 6��j �� �i�3 's
y me of operty Owner)
1 L(6 property located at t0�/ 5 '45� r 15 if/
(Address, Lot, Block, Road, etc.)
on , in , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
ocati
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.
not wish to waive the 15' setback requirement.
(Pro erty Owner Information) (Adjacent Property Owner Information)
rn
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42Sirtat re Sin ure
�I r' L gb/'"'e<" , �U�r►�b�r
0 Q' ritrinlpr Typ9 Name n Print or Type Name
�� Mailing%.° sn9 mtr )(4, (Ict /97 -e-/fc 1-4177
Add ess �l Mailing Address
1A i✓v fes Y /"r . -7 i I f'c,ric c, �f. 28Y4'r"
Cit S ate/Zip City/State/Zip
Teleph4ie Numbe /email address Telephone Number/email address
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Date Date*

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PAT MCCRORY
(iu vemor
DONALD R. VAN DER VAART
`'e creto:
BRAXTON DAVIS
Coastal Management iiic4,or
ENVIRONMENTAL QUALITY
July 19, 2016
Mr. Giles Jeffreys, Jr.
509 Lemon Pepper Place
Wendell, NC 27591
Dear Mr. Jeffreys:
Attached is Amended CAMA Minor Development Permit#SC 16-14, for work to be done at
145 Atkinson Road, in Surf City, Pender County. A copy of the permit has been sent to your
agent and to the Town's Inspections Department.
In order to validate this permit, please sign both copies of the permit as indicated for our
records. Please retain the orange copy for your files and both pages of the white copy then
return 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.
Sincerely,
Shaun K. Simpson
Permit Support Technician
Enclosures
Cc: WiRO files
Town of Surf City Inspections Dept.
Thornton Builders, Agent
State of North Carolina I Environmental Quality I Coastal Management
127 Cardinal Drive Ext.,Wilmington,NC 28405

„ ,‘ ,
NOTIC
CAMA PERMIT
APPLIED FOR
PROJECT: _ If • • . ing
at Lot 5, Peninsula at Topsail (145 Atkinson Rd.),
as ” - - • ITallt.1:J.:7111/ IIiT r - • er
County
COMMENTS ACCEPTD TH1 N/A
APPLICANT: FOR MORE DETAILS CONTACT
THE LOCAL PERMIT OFFICER BELOW:
Giles Jeffreys Jr. NC Div. of Coastal Management
633 Blue Point Road 127 Cardinal Dr. Extension
Wilmington, NC 28411 Wilmington, NC 28405
Jason Dail, Field Representative
Agent: Thornton Builders [phone] 910-796-7266

I.CH w rct FRAHOS Rlds PROFESSIONAL •o.. u. 7 >ms.�s0uo
SURVEYOR. DO HEREBY CERTIFY THAT III 'f ,..cr% 'rz
SURVEYED THE PROPERTY AS SHOWN HEREON '� = IR
ACCORDANCE WIER THE STANDARDS OF P191C SEAL
FOR LAND SURVEYING IN NORTH CAROLINFQ L-2981
THE RATIO OF PREd ON AS CALOUUIFI) t WM
um" 0 RES 15: owls
I7FS �..' R (19 ___ 'IkilL,. \......
I —illlB L
LLJ-
CONCRETE
I ii
La PEN.
M,Oe�Nam. BAN
THIS IS TO CERTIFY THAT THE SUBJECT PROPERTY IS LOCATED 2111
IN FLOOD ZONE 'AL"'IEL-&0') WHICH IS A 18i NONITY SKETCH
SPEEMERGENCY FLOOD MANAGEMENT AGENCY,DETERMINED
THE BY VIAL FLOOD THE �
INSURANCE PROGRAM. COMMUNITY PANEL NUMBER 1 I�II�,I.II�I , GENORETE B d
C.
370186 3720423400J,FEBRUARY 16 2007 A L
y SV BGIE
2t BENCHMARK:DIN
FRmLc
ROTEI PROPOSED
Ra 1p ELEVATION:VERTICAL DATUM:TUM:
NAND 88
LAND DISTURBANCE FROM R/W TO 30'CAMA BUFFER 4455 Sq.FL OF UNCOVERED DECK(TOTAL OF 3 LEVELS) R/W t R/W' VERTICAL DATUM OBTAJNED WITH TOPCON GRS
Sq. USING N.C.GEODETIC CONTINUOUS OPERATING
PIUNG DEPTH AS PER ENGNEER RESTS WITHIN 30'CAMA BUFFER 3' REFERENCE STATORS
LANDSCAPING AS PER TOWN OF SURF CITY ORDINANCES
, 4
Dom.. BEF�FHCES
ROILROILp i� DIES R.Jtr FRtTS,Jr. D.B.214.P.78
N &WIFE D.B.3133,P.368
GROUND:
62.5 Sq.Ft 01 A JEANNE C.JEFFREYS D.B.473,P.189
Sq.Ft I 6eE LOT 7 cy D.B.613,P.87
I OFT.SECOND FLOOR: 28 1 va R I it THE PENINSULA gI <li TITLE RnIIRCE DEL.10005.P.333
TOTAL FLOOR AREA:2224.2 Sq.FL i AT TOPSAIL &F .- D.B.1281,P.340
AS PER HOUSE PLANS I I M.B. 56,P. 39 I y D.B.4428.P.50 D.B.1419,P.146
I }(! kI!hl D.B.1867,P.210
D.B.2429,P.264
I MM�EAIIUN WWF/IO \ I I I ; ..ass
4234-14-4732-0000 D.B.3868,P.145
1 IC AC® 1 I BEN MARK D.B.4110.P.291
D.B.4262.P.336
ZONED R FT D.B.4428.P.50
r \— -i �`1 7RFRONT SFIRAhRC D.B.4496.P.169
UNE TABLE `, REART 130'CAMA M.B.4 P.90
NYP N57'00'00'E 12308' _ I 1M.B.36.P.44
27.54' 24.08' .EIR 42.00' 7. WEIR 15.31' EMN SIDE -7.5' Y.B.37,P.139
LIFE/ LENGTH DIRECTION 7 1�1 — .1 I 1 SDE =12.5'(3 STORY) Y.B.58.P.39
LI 36.27' N2618'54'W NOW OR FORMERLY jL to•IMAM
tt
JAMES BATTS g 6. I \IS,
BDgL2 5.2e' N7417'52'w D.B.1281,P. 340 A k CANAL o LOT 5 .N, r3 iar itLk i B A 7.5'DRAMAGE t UTILITY
LOT 14 'n 6408 Sq.Ft I 1 EASEMENT E19515 ALONG THE
L7 10.01' N31OS70'W 1LYSTATE NPES OF LOT 01-24$NAE'$LANDING W 0.147 ACRE$ I tl I 1 1 SIDE UPER OF 88 1012L4 1128' 54215'NPE M.B.31,P.1 (4979 Sq.Ft as 1 $¢ rn
L5 &83' S6011'45'E M20NED R-57 8ABOVE HIGH - j j, -- +,EOU 1&OS' S2356'I?E �,, WATER) r } LFCdtlG
n EEE ' I � 1I''''. �=T� 1 CC -CONTROL CORNER
L7 11.02' SIR12'1YE 'n f I I tY •/ , :H EON=E105TING CONCRETE MONUMENT(FOUNDXCONIROL CORNER)
+ \ J OP -COSTING IRON PIPE(FOUND)
M 7.6'.lRAat•..,, TP ER -EXISTING IRON ROD(FOUNT)
26.45' 13.49'j 21.72' OR 43,82 I 17.4W DR 15.3 EMN-EXISTING MAGNETC NAIL(FO1ND)(CONTROC CORNER)
NYPS 557100'00•W 133.25' \ EMN EPK-EOSTING PARKER-KALON NAIL(FOUNDXO OL COR NIRNER)
- ..�� 1 F 1 ERRS-EXISTING RAILROAD SPIKE(FOUND)
MBL-MINIMUM BUILDING UNE
yD� NAP-NON MONUMENTED PINT
PROPOSED DWELLING WITHIN 75'AEC -938 Sq.Ft 'R'E'I'Nw pWn LINE i r60 H6 DIM txoes. 8 9 R/W-RIGHT OF WAY
PROPOSED DRIVE WITHIN 75'AEC -0 Sq.Ft MINIMS 6 MITT EASEMENT SCM-SET CONCRETE MONUMENT(CONTROL CORNER)
*MMHG C(NCRF1E WAI K W THIN 75'AVE -0 en Ft IV CWMIIAS• SIP =SET IRON PIPE
MITT MOW MOOT SR -SET IRON ROD
El PROPOSED IMPERVIOUS SURFACE WITHIN 75'AEC-938 Sq.Ft. I tp WOOER(WW) SRN-SET MAGNETIC NAIL(CONTROL CORNER)
TOTAL LOT AREA WITHIN 75'AEC -3R01 SO.Ft I LOT 3 SPX-SET PARKER-KALON NAIL(CONTROL CORNER)
PROPOSED IMPERVIOUS AREA WITHIN 75'AEC -24.7% THE PENINSULA u ERN I Q -CENTERLINE
'�
IMI-WATER METER
ATTOPSAIL
M.B.. 56,P. 39 7` 4-FIRE HYDRANT
ME I I DO-WATER VALVE
PROPOSED DWEl11NG -938 Sq.Ft. I (I-SANITARY SEWER MANHOLE
PROPOSED RAISED WOOD DRIVE -0 Sq.Ft
I ®-CLEAN OUT
FORTING TONCRFIE WAIN -750 qn Ft
PROPOSED TOTAL IMPERVIOUS SURFACE-1188$q.Ft R/W R/W ®-TELEPHONE PEDESTAL
TOTAL LOT ARFA -6406 NA Ft
PROPOSED IMPERVIOUS AREA -1&59 ® TELEVISOR PEDESTAL
E ®-FIBER OPTIC CABLE MARKER
>O -UGHT POLE
WOE '0.-POWER POLE
STATE PERMIT SWB 060128Y00 ALLOWS I330 Sq.Ft OF KER UNE
OD-EELLECTRIC TRANSFORMER
IIMPERVIOUS SURFACE BOUNDARY SURVEY & PRELIMINARY PLOT PLAN xrwY-E STNO SPOT ELEVATOR
FOR
GILES R. JEFFREYS, Jr. GRAPHIC SCALE
I
CHARLES F. RIGGS & ASSOCIATES, INC.(c-730) JEANNE C. JEFFREYS h - V
LAND SURVEYING - CONVENTIONAL & GLOBAL POSITIONING SYSTEMS, (D)R1)
LAND PLANNING COMPUTER MAPPING LOT 5, PENINSULA AT TOPSAIL M.B. 56, P. 39 1 Tees-20 It
502 NEW BRIDGE STREET LANDFALL EXECUTIVE SUITE 217 TOPSAIL TOWNSHIP, PENDER COUNTY, NORTH CAROUNA ACTUAL FIELD SURVEY DATE DECEMBER 2, 2014
P.O. BOX 1570 1213 CULBRETH DRIVE GILES R. JEFFREYS, Jr. & WIFE JEANNE C. JEFFREYS, OWNERS, D.B. 4428, P. 50 MAPPING DATE: JUNE 21, 2016
JACKSONVILLE,NC 28540-1570 NILMINGTON,NC 28405 FIELD BOOK: 7898 PAGE: 71
s TELEPHONE [phone] TELEPHONE [phone] 145 ATKINSON ROAD
'6y E-MAIL riggAlondOrfggelandnc.com PROJECT NUMBER: 13-05-26 I

From: Lee Thornton [e-mail]
Subject: CAMA agent form
Date. Today at 11:01 PM
To: Giles Eileffrevsl @nc,r?.corT
Giles,
good morning. Please fill out this form and send it back to me. It will allow me to pull the necessary CAMA permits for your house.
Once I get it back and the Survey from charles riggs I can submit it to Jason Dail. I want to get ahead as much as we can. THANKS!
LEE
AVA
. b E Wk.
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue Braxton C.Davis Dee Freeman
Governor Director Secretary
AGENT AUTHORIZATION FORM
Date:
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
C-ct.1,<s ,(;c SNe'. Ti'vorA.A- or\ v(Artivs
/
Owner's Mailing Address: Agent's Mailing Address:
5 41 tY100N ?t.fr.v- 'Pk ace P 0 PDX 6I0F)
N% Sei cvtrf-- (Arv' (-LC
Phone Number('.el) ;1-,t Phone Number(PO) /2 2-2.0,5S
I certify that I have authorized the agent listed above to act on my behalf,for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following(activity):
S7A5(C i;40^'111 rev. de^cc
For my property located at k-ok 6 r P - ut (AA e Sa.,
This certification is valid thru(date) t •
,71 .2-o IL.
Propeitv Qvnr Sig ture Date
RECEIVED
DCM WILMINGTON, NC
JUL 0 5 2016

I. . 'os a ervice
CERTIFIED MAIL® RECEIPT
o Domestic Mail Only
r
U For delivery information,visit our website at www.usps.corn
RA .,_". ,f 216C I A L U S E
U Certified Mail Fee $3.30 0482
O Extra Services&Fees(checkbox,add fee -..f atftECEIVED 02
❑Return Receipt(hardco )
❑Return Receipt(electronic) $$$ ri�t7` ,ILMINGT91,111C
j ❑Certified Mail Restricted Delivery $ $!0.00 Ware
0 Adult Signature Required $
7 16
❑Adult Signature Restricted Delivery$ iQ a Vv v L 0 O
7 Postage
n $0.47
✓ $ 07/05/2016
rl Total Postage and Fees
s $3.77
n Sent
Street and Apt.No Pb Box b.
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City ate1e , N C. c2
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Receipts for
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ate
811411—
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Adjacent Property Owners
a k,k ��S�a 5(1
Mailing kc4—. NL 0f1,4
City,State,Zip Code
Dear Adjacent Property;
this letter is to inform you that I, G'%\tS J1`cc i' 5 have applied for a CAMA Minor
Property Owner \\
Permit on my property at . k S \CMS%a �o ,in Pender/Onslow
Property Address
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 1 �0) L'L— Los q ,or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the Surf City CAMA Minor Permit Program,you may submit
them to:
Jason Dail,Field Representative
NC Division of Coastal Management
Town of Surf City Local Permit Program
127 Cardinal Drive Extension
Wilmington,NC 28405
Sincerely,
Property Owner
Mailing Address •
City,State,Zip Code •
RECEIVED
. DOM WILMINIGTI- ,v;
JUL 052016

•. . •os a ervice
CERTIFIED MAIL° RECEIPT
D
Domestic Mail Only
1-1• For delivery information,visit our website at www.usps.com°.
How IUD yrit21414,
7
LI Certified Mail Fee $3.30 0482
$Extra Services&Fees(check box,add feeate.o` e) RECEIVED 02
❑Return Receipt(hardcopy) $
❑Return Receipt(electronic) $ In.IiG.IVI WILMIN4iihTuON,NC
❑Certified Mail Restricted Delivery $ $') 00 Here
Adult Signature Required
❑Adult Signature Restricted Delivery$ •°° J U L 0 5 ?016
Postage 17
✓ $ 07/05/2016
rl Total Postage and FOy•77
$ i3
n SentTp�
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A_4AofG In_
Street d t.No o xNo
1 /4VJ
`"S; c tij Z '('if

Receipts for
Certified Mail
(Staple Here)
\ VL (
Date 1
1!)t .&CC, CUTA'n r1�\\c
Adjacent Property Owner
(A3 NIY r�S+vJ
Mailing Address
\-v) INL �-4 4.M.3/
City,State,Zip Code
Dear Adjacent Property: ��
This letter is to inform you that I, Gk\�.S —5eStC es'4-'"l5 ...._have applied for a CAMA Minor
Property Owner
Permit on my property at OAS \.-M5n \n moo , in Pender/Onslow
Property Address
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 \0) 1 Zti" Los ,or by mail at the address listed below. If you wish to
Applicants Telephone
file written comments or objections with the Surf City CAMA Minor Permit Program,you may submit
them to:
Jason Dail,Field Representative
NC Division of Coastal Management
Town of Surf City Local Permit Program
127 Cardinal Drive Extension
Wilmington,NC 28405
Sincerely,
Property Owner
Mailing Address
City,State,Zip Code
•
RECEIVED
DCM WILMINGTON, NC
JUL 0 5 2016

DENR CAMA Daily Check Log for WIRO
Date
Date Deposite Check Receipt or
Received d Check From(Name) Name of Permit Holder Vendor Check Number amount Permit Number/Comments Refund/Realloce
7/5/2016 Giles R.Jeffreys Jr same State Employees CU 1014 $100.00'minor fee,Lot 5,Penninsula at Topsail,Pender ',JD rct.2323D