SC_19-36_ Seabees

Issued by WiRO SC19-36
Surf City Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT
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 Seabees, LLC authorizing development in the Ocean Hazard (AECs) at 1406 South Shore Drive, in Surf City,
Pender County as requested in the permittee's application, dated October 3, 2019, and received by DCM on October 3,
2019. This permit, issued on October 23, 2019, is subject to compliance with the application and drawing dated received by
DCM on October 3, 2019, (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: Re-construction of a street side deck.
(1) All proposed development and associated construction must be done in accordance with the permitted drawing, prepared by
received by DCM on October 3, 2019.
(2) Any change or changes in the plans for development, construction, and/or land use activities will require re-evaluation and
modification of this permit.
(3) A copy of this permit shall be posted or available on site throughout the construction process. Contact this office at(910)796-
7221 for a final inspection at completion of work.
(Additional Permit Conditions on Page 2)
U
This permit action may be appealed by the permittee or other qualified persons Z
within twenty (20) days of the issuing date. This permit must be on the project 0 c ZZ
site and accessible to the permit officer when the project is inspected for Jason Dail o_
compliance. Any maintenance work or project modification not covered under AMA LOCAL PERMIT OFF aIAL ,� 0
this permit,require further written permit approval.All work must cease when this Z
permit expires on: 127 Cardinal Drive Exten• c�
Wilmington, NC 28405-3:5 J
December31,2022 o
In issuing this permit it is agreed that this project is consistent with the local Land W011#•:41
Use Plan and all applicable ordinances. This permit may not be transferred to 7 � )
another party without the written approval of the Division of Coastal PERMITTEE 1--CJ"
Management. (Signature required if conditions above apply to permit))
l o/J8r(°�

Name: Seabees, LLC
Minor Permit#SC19-36
Date: October 23, 2019
Page 2 of 2
(4) The permittee is required to contact the Local Permit Officer [phone], shortly before he plans to begin
construction to arrange a setback measurement that will be effective for sixty (60) days barring a major shoreline
change. Construction must begin within sixty (60) days of the determination or the measurement is void and must
be redone.
(5) Any structure(s) constructed within the Ocean Hazard area 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.
(6) This permit does not authorize the removal of sand or vegetation from/on/in the frontal dune, with exception of that
necessary for piling installation.
(7) The authorized structure(s) must be set back a minimum of 60 feet from the First Line of Stable Natural Vegetation
(FLSNV), as determined by the DCM, the LPO, or another assigned agent of the DCM, and stall be structurally
independent of the existing residence(i.e. deck must be self supported).
(8) 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.
(9) Any structure authorized by this permit shall be relocated or dismantled when it becomes imminently threatened by
changes in shoreline configuration. The structure(s) shall be relocated or dismantled within two years of the time
when it becomes imminently threatened, and in any case upon its collapse or subsidence. However, if natural
shoreline recovery or beach renourishment takes place within two years of the time the structure becomes
imminently threatened, so that the structure is no longer imminently threatened, then it need not be relocated or
dismantled at that time. This condition shall not affect the permit holder's right to seek authorization of temporary
protective measures allowed under CRC rules.
(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.
NOTE: 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.
SIGNATURE: 11A11
DATE: /615
PERMITTEE 2,a,e 6e-Ci
Crv\c L g\,:v\s9/v, , ����1 RECEIVED

11.r Locality CPA( v' y Ni Permit Number SG V 1/ "
Ocean Hazard K Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other
(for official use only)
GENERAL INFORMATION .
LAND OWNER-MAILING ADDRESS
Name S-AiCCS,.._..ttr
Address Zq '✓Loss(,J�r✓ CST41-es- 2
city P�'f'`oDa0 — State N C Zip-ITN—Phone SW - G?c -Yy1'r --
Email flAitrilk>AE 2" f4A--s e 6e`+,q_ G. (o,-,
AUTHORIZED AGENT gr2....-)
Name Mt c )$ C.�� ?2✓ AD--j
G ,L, 6 LCs C/4J6(z_
Address 401 a2 J 6 Ca.,' 44/6....
City /oP.t/Fx L.4 .4GI f State N "Lip 2 d•iNci5hone
Email CC/-LCF4O✓IiJ4,eie 6AAA L_ _(__ /--t
LOCATION OF PROJECT: (Address,street name and/or directions to site;name of the adjacent waterbody.)
I L 6 s srw✓eE Dz, 5,,ar Cam, e ,,..► c 2 F N c
ATT,, z4 occ4,-
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.)
aCeLlie'r,.-G S -ac-e- S f)G-GK
SIZE OF LOT/PARCEL: ca ?v v square feet - acres
PROPOSED USE: Residential (r (Single-family Multi-family ❑ ) Commercial/Industrial ❑ Other 0
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: (cit., square feet(includes the area of the foundation 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 Stat�EC'E1vED
Stormwater Management Permit issued by the NC Division of Energy, Mineral and Land Resources(DEMLR)? ,)�t,g
YES NO / OCZ 0 3 L
_.-�_ _, Ktr'

i
OTHER PERMITS MAY BE REQUIRED:The activity you arc 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, HA
Certification,Sand Dune,Sediment Control,Subdivision Approval,Mobile!Ionic Park Approval,i lighway 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 name of,S(q C4.S� LLC
see Deed Book -I 223 page �2? in the AC-peAC2 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 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) t✓"iLLTAr+ 2 R r' `ID , 6AazC. 1_t , 64/leld 2 , C Z 7SZS
(2)4Ju w4s_. -j ( Pa 4 /os'4 S�r•F.x,c ✓A z? 39
(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 ,3 Ail day of DST ,20 l S
u -___
Lan owner or person authorized to act as his/her agent for purpose of 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;Mere necessmy, 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 sornres are
incorporated without refemnce 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 administr boe,uidtvE[�
K^Cr TT fl ?n19

ROY COOPER
Governor
9"
-i' frMICHAEL S. REGAN
Secretary
NORTH CAROLINA BRAXTON DAVIS
Environmental Qnealit)
Director
October 24, 2019
Seabees, LLC
29 Crosswinds Estates Drive
Pittsboro, NC 27312
To Whom It May Concern,
Attached is CAMA Minor Development Permit SC 19-36 for work to be done at 1406 S Shore Drive, in
Surf City, Pender County. An electronic copy has been sent to the Surf City Inspections Department and
to your Agent.
To validate this permit, please sign both copies as indicated for our records. Retain the orange copy for
your files, and f.i j*,fi 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.
41 erely,
Tan a K. i ila
ermit Support Technician
N.C. Division of Coastal Management
Enclosures
Cc:WiRO files
SC Inspection Dept.
Moose Construction, LLC—Agent
State of North Carolina I Environmental Quality I Coastal Management
127 Cardinal Drive Ext.,Wilmington,NC 28405

OCEAN HAZARD AEC NOTICE
Project is in an: / Ocean Erodible Area High Hazard Flood Area Inlet Hazard Area
Property Owner: 5-64 3C6S - r!LC
I* 2
Property Address: ( ��°'Z( � ,, , of 6-1--7 y, rJ C
Date Lot Was Platted: 7 ( 'V-/G
This notice is intended to make you, the applicant, aware of the SPECIAL NOTE: This hazard notice is required for
special risks and conditions associated with development in this development in areas subject to sudden and massive storms and
area, which is subject to natural hazards such as storms, erosion erosion. Permits issued for development in this area expire on
and currents. The rules of the Coastal Resources Commission December 31 of the third year following the year in which the
require that you receive an AEC Hazard Notice and permit was issued. Shortly before work begins on the project
acknowledge that notice in writing before a permit for site,the Local Permit Officer must be contacted to determine the
development can be issued. vegetation line and setback distance at your site. If the property
has seen little change since the time of permit issuance, and the
The Commission's rules on building standards, oceanfront proposed development can still meet the setback requirement,
setbacks and dune alterations are designed to minimize, but not the LPO will inform you that you may begin work. Substantial
eliminate, property loss from hazards. By granting permits, the progress on the project must be made within 60 days of this
Coastal Resources Commission does not guarantee the safety of setback determination,or the setback must be re-measured.Also,
the development and assumes no liability for future damage to the occurrence of a major shoreline change as the result of a
the development. Permits issued in the Ocean Hazard Area of storm within the 60-day period will necessitate re-measurement
Environmental Concern include the condition that structures be of the setback. It is important that you check with the LPO
relocated or dismantled if they become imminently threatened before the permit expires for official approval to continue the
by changes in shoreline configuration. The structure(s) must be work after the permit has expired. Generally, if foundation
relocated or dismantled within two (2) years of becoming pilings have been placed and substantial progress is continuing,
imminently threatened, and in any case upon its collapse or permit renewal can be authorized. It is unlawful to continue
subsidence. work after permit expiration.
The best available information,as accepted by the Coastal For more information,contact:
Resources Commission, indicates that the annual long-term •
average ocean erosion rate for the area where your property is \jnco
located is feet per year.
Local Permit Officer
The rate was established by careful analysis of aerial
photographs of the coastline taken over the past 50 years.
N.C. Dept. of Environmental Quality
Studies also indicate that the shoreline could move as much as Division of Coastal Management
feet landward in a major storm. 127 Cardinal Drive Extension
Wilmington, NC 28405-3845
The flood waters in a major storm are predicted to be about
feet deep in this area.
Preferred oceanfront protection measures are beach nourishment 9/ '6' _ l 2'
and relocation of threatened structures. Hard erosion control d 7
structures such as bulkheads,seawalls,revetments,groins,jetties Phone Number
and breakwaters are prohibited. Temporary sand bags may be
authorized under certain conditions.
The applicant must acknowledge this information and
requirements by signing this notice in the space below. Without
the proper signature,the application will not be complete. E1VED
r~�EC
AKI4 40142/A? 0,‘3 Vn9
Property Owner Signature Date to
ACM WII.MiNGTON,NC
Revised May 2010

ra°PO C
� �,
0
w o
w o
U
w v
(r o
1-1vJ SCE
( 406
7 ( L/,41 ' I[ ,4,4
2` G( 44,
Pos
�L•M e�yr1�. 3 -+X
r0Trc /2> ReetAcd
(Jimaz ..a 3 60,G Paws
A 12. si. C+ o P
HECK ID I LP J/ S,Ja 265) 4- 66405

5 '5
1j I I I
T_rh i� III
v 5 100
S
r)S Cc

L ,r zs;L,--) c
U
Z
0 O
W I
ce,
W c
L ((3-)
I1-) D6 S. sX2E--
k Iific
5_. ç'fr4fz6 'z .

Receipts for
Certified Mail
(Staple Here)
(0 /
e
c L A S e4--rtr
scent roperty Owner
ilm Address
vt�� tc. , vA Zc'?
City,State,Zip Code
Dear Adjacent Property:
This letter is to inform you that I, t L C have applied for a CAMA Minor
Property Owner
Permit on my property at I'4b( $ 5'Qe 34 f Sae" ,in Pe IlOnslow
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 '(S ' 6 7,7r ,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,
-C7.44GCf, LC C
Property Owner �t-
ZQ OOe CSe ' S C i 7-4 c1 13✓t
P271— noAo
ailing Address
27 3I Z
City,State,Zip Code
RECEIVED
OCT 0 3 HIP

I. . •os a ervice
CERTIFIED MAID RECEIPT
m Domestic Mail Only
U
*' For delivery information,visit our website at www.usps.com'"
SUFFOLK i VA'2$4 '
Certified Mail Fee
$ $3.50 0482
n Extra Services&Fees(check box,add fee- '�7yy',�,.•"'ate) 02
❑Return Receipt(hardcopy) $ I, �1 I
p ❑Return Receipt(electronic) $ $10_V 0 Postmark
['Certified Mail Restricted Delivery $ SO.00 Here
j ❑Adult Signature Required $ `r yy-
❑Adult Signature Restricted Delivery$ iIVRECEIVED
Postage 5
$ $0.55
.D Total Postage and Fees
$ $6.85 O C T 0 31/� i2019
43 Sent To
StreetandApt.No.,orPaBoxN>5CM WILMINGTON, NC
City,State,ZIP+4e

, .au.ct.Min..on.111.1,U r.%/1111,11 .0 . ..b v
A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail
A unique identifier for your mailpiece. f ase late for assistance.To receive a duplicate
Electronic verification of delivery or attempted return receipt for no additional fee,present this
delivery. LISPS®-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 Mail0,First-Class Package Service*, available at retail).
or Priority Mail®service. -Adult signature restricted delivery service,which
Certified Mail service is not available for requires the signee to be at least 21 years of age
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 a
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.Fora hardcopy return receipt,
complete PS Form 3811,Domestic Return
Receipt.attach PS Form 3811 to your mailpiece; IMPORTARI:Save this receipt for your records.
Form 38OO.Aoril 2015 Mammal PAN 75afM2-000-0047

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: /34<<S, Z LC
Mailing Address: (:aosst--i -"11)s L' s-r4Z..s
Py rlo/I-', 27 ?f2._
Phone Number: 9/ - 6.?0 -
Email Address: (`t,4 flA/e-4910.7 '�'^r�G �'Z•
I certify that I have authorized ( oo$ C S►.A-)e 1 11c (C.d*u�' ��� ,
Agent/c"ontractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: (LP(.cICCrt--1 Or
,-4f7FF io Dec-11
at my property located at /4D6 S . i2df 52 • r $ 2� cz%,i,/`�C ,
in Pr)n612- 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:
Signature
264E-12T—E- Gee
Print or Type Name
MAAJAC.
Title
Date
RECEIVED
This certification is valid through / Z / 3 i / /C
OCT 0 3 2019

. .
•
•
l - �
i . .

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
FOR CAMA MINOR PERMITS
hereby certify that I own property adjacent to -0A4A5-4.44—P144-CA;4141,
/Lr'JG (Name of Property Owner)
property located at vl 'J, S'✓LC b/L, S.�/t r (_7 ,P- C
Address, Lot, Block, Road, etc.)
on ATLAN-rr4 CdAlj in ,SJ 2P CST)/ , N.C.
(Waterbody) (Town and/or County)
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
OCT 03 2019
f1C'M IA/II MMInir_Tnki kir%

M ,
Receipts for
Certified Mail
(Staple Here)
10 f it s
Da e
Adjacent Properly Ovpiter
fyJailing Address
City, State,Zip Code
Dear Adjacent Property:
This letter is to inform you that I, .�G.4/;0*S, L LC have applied for a CAMA Minor
Property Owner
Permit on my property at /2/06 -S $ tw bQ, a Cz i , , in Pen er/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 9s'M •"61.)— (Ur— ,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,
16'65 GL C
Property Owner
25' �a.,ssw=,Jnr t;ems JZ
Mailing Address
Ps-11$4a /20, h)( On/z
City, State,Zip Code
RECEIVED
OCT 0 3 2019

1. . •os a clime
CERTIFIED MAIL® RECEIPT
T1 Domestic Mail Only ' • t
✓ For delivery information.visit our website at www.usps.com
GAW 93:212C A L
Certified Mall Fee
$3.50 0482
-4 $7 Extra Services&Fees(check box,add fee tilate) 02
Return Receipt(hardcopy) $ I
M El Return Receipt(electronic) $ Postmark
• Certified Mall Restricted Delivery $ 40 00 Here
• Adult Signature Required
• Adult Signature Restricted Delivery -14ZIECE IVED
Postage
$0.55
$
Li :11 Total Postage and Fees OCT 0 3 :M3/2019
• $ $6.85
43 Sent To
GAA-W11.4.4iNGT-O-NT-NG
-• ,S•treet andApt No.,or Po 13ox
City, fate,ZIP+44

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 fa no additional fee,present this
delivery. IJSPSQ+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.
1portant 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,which
Certified Mail service is notavailable for requires the signee to be at least 21 years of age
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. 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.
i Form 3800,April 2015(Reverse)PSN 7530-02-000-9047

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to .�C7:44`7-S, 's
(Name of Property Owner)
property located at (440` S. 5-40116- U(1
Address, Lot, Block, Road, etc.)
on //7[4, C DG C4,4 , in Sc>/T �L// 7/ , N.C.
(Waterbody) (Town and/or County)
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
OCT 0 3 201S
DCM WILMINGTON, NC

NC Division of Coastal Management Cashier's Official Receipt $5 71A B II>
Date: 1 r
3 20 7
Received From: , ‘61 6j $
V
Permit No.: Check No.:
Applicant's Name: /42
T of1 t v County:
6 (
Project Address: ( ô (ty 5-. 9614-IL--
6°' 7yr.
Please retain receipt for your records as proof of payment for permit issued.
Signature of Agent or Applicant: Date:
Signature of Field Representative: Date:

Date Date Check From Name of Vendor Check Check Permit Rct,
Received Deposited Permit Holder Number amount Number/Comments
10/7/2019 Moose SeaBees, LLC BB&T 1402 $100.00 minor fee, 1406 S Shore Dr, Surf JD rct.
Construction City PnCo 8571