SC_21-26_ Davis (2)

411
RECEIVED
Issued by WiRO SC21-26
Surf City Permit Number
CAMA DCM WILMINGTON, NC
MINOR DEVELOPMENT " `~
PERMIT
NORTH CAROLINA
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"
/orne..
Issued to Jane Hemel Davis authorizing development in the Estuarine Shoreline (AEC) at 636 Little Kinston Road in
Surf City, Pender County as requested in the permittee's application, dated July 1, 2021, and received as complete by
DCM on July 2, 2021. This permit, issued on July 23, 2021, is subject to compliance with the application and drawing
dated and received by DCM on July 1, 2021 (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: Elevation of a single family residence(i.e. raising existing residence).
(1) All proposed development and associated construction must be done in accordance with the permitted site drawing dated
received by DCM on July 1, 2021.
(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)
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 C.
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
Wilmington, NC 28405-3845
December 31,2024
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 PFRMITTEE<

h'or 11 /
Name: Jane Herney Davis
Minor Permit#SC21-26
Date: July 23,2021
Page 2 of 2
(4) 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.
(5) Any proposed for grading within the 30' Coastal Shoreline buffer(as measured 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 vegetated and stabilized and must remain in a vegetated state.
(6) All development shall be located at least 30' landward of the normal/mean high water line. No impervious
coverage/built upon area, including but not limited to the house(including eaves), foundation pad, covered
decking, etc.shall extend into the 30-foot coastal shoreline buffer.
(7) This permit does not authorize the excavation or filling of any wetlands,even temporarily.
(8) Should the amount of impervious coverage located within 75' of the normal high water line exceed 30%, the
applicant shall effectively demonstrate (through innovative construction and design) that the amount of impervious
surfaces coverage in excess of the 30%limitation would be collected and managed, and the AEC protected.
(9) Upon completion of construction and prior to the issuance of a Certificate of Occupancy(CO), a letter of certification
must be received from the designer of the innovative system installed, certifying that the permitted system has been
installed in accordance with this permit, the approved plans and his design specifications. Any deviations from the
approved plans and specifications must be noted on the Certification and a permit modification may be required
prior to receiving a CO.
(10)All structures 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.
(11)Pursuant to 15A NCAC, Subchapter 7J.0406(b), this permit may not be assigned, transferred, sold or otherwise
disposed of to a third-party.
SIGNATURE94--/r(-a-
106-tn>° DATER
PERMITTEE

Issued by WiRO SC21-26
Surf City Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT J' r
NORTH CAROLINA
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 Jane Herney Davis authorizing development in the Estuarine Shoreline (AEC) at 636 Little Kinston Road in
Surf City, Pender County as requested in the permittee's application, dated July 1, 2021, and received as complete by
DCM on July 2, 2021. This permit, issued on July 23, 2021, is subject to compliance with the application and drawing
dated and received by DCM on July 1, 2021 (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: Elevation of a single family residence (i.e. raising existing residence).
(1) All proposed development and associated construction must be done in accordance with the permitted site drawing dated
received by DCM on July 1, 2021.
(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)
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 CAMA LOCAL PERMIT OFFICIAL
this permit, require further written permit approval.All work must cease when this
permit expires on: 127 Cardinal Drive Extension
December 31,2024 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

Name: Jane Herney Davis
Minor Permit#SC21-26
Date: July 23, 2021
Page 2 of 2
(4) 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.
(5) Any proposed for grading within the 30' Coastal Shoreline buffer (as measured 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 vegetated and stabilized and must remain in a vegetated state.
(6) All development shall be located at least 30' landward of the normal/mean high water line. No impervious
coverage/built upon area, including but not limited to the house (including eaves), foundation pad, covered
decking, etc. shall extend into the 30-foot coastal shoreline buffer.
(7) This permit does not authorize the excavation or filling of any wetlands, even temporarily.
(8) Should the amount of impervious coverage located within 75' of the normal high water line exceed 30%, the
applicant shall effectively demonstrate (through innovative construction and design) that the amount of impervious
surfaces coverage in excess of the 30%limitation would be collected and managed, and the AEC protected.
(9) Upon completion of construction and prior to the issuance of a Certificate of Occupancy(CO), a letter of certification
must be received from the designer of the innovative system installed, certifying that the permitted system has been
installed in accordance with this permit, the approved plans and his design specifications. Any deviations from the
approved plans and specifications must be noted on the Certification and a permit modification may be required
prior to receiving a CO.
(10)All structures 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.
(11)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

Locality 13LLT CI Permit Nuntl><r,
Ocean hazard _��. Estuarine Shoreline k ORW Shoreline Public Trust Shoreline._.___-__ Other....-
(
For(Octal use onity
RECF 'E D
(.ENE AL INFORMATION
LAND OWNER-MAILING ADDRESS
Name _._._• C../2 _ �? rl"►'? t :�G i t - DCM WILM$NG`ION. N(;
Address l G : ..j .bhI rc. K- . )
City ikfC!,},v t' � � State %ip,T`� -�' �I'hune °' 43 1 ' 144
Email iE n a - ! �t%), !f ' A.-'
A 11TI 1012'ZEI)AGENT
Name
RECEIVE -
Address
City 311E
y - - - - State ..._ - .. f. Phone __
Entail • M WILM►NGTON,N
D
LOCATION OF PROJECT:(Address,street name and/or directions to site;name of the adjacent waterbody.)
1-1 j
5 L � J r `�
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.)
SIZE OF LOT/PARCEL: square feet _._ acres
PROPOSED USE: Residential Ri (Single-family MMulti-tastily [] ) Commercial/Industrial i Other �]
COMPLETE EI'I'I IER(I)OR(2)RELOW(CcuNacl your Local l'erusi&Officer if pau are,in sure which ANC applies
toPius'properly):
(I) OCEAN IIA%ARI)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-hearing attic space)
(2) COASTAL.SIIOREI.INE AECs: SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
UPON SURFACES:/3`73square feet(includes the area of the foundation ofall buildings,driveways,covered decks,
concrete or masonry patios,etc. that are within the applicable AEC.Attach your calculations with the project drawing.)
STATE STORMWATTER MANAGEMENT PERMIT: Is the project located in an area subject to a State
Stormwatcr Management Permit issued by the NC Division of Energy, Mineral and Land Resources(l)EMLR)?
YES NO
1 f yes, list the total built upon area/impervious surface allowed fir your lot or parcel: _square feet.

(YI'IIER PERMITS MAY III 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),13uilcling,Electrical,Plumbing, !tenting and Air Conditioning,Insulation and Energy Conservation, I'IA
Certification,Sand Dune,Sediment Control,Subdivision Approval,Mobile!tome Park Approval. I lighway Connection,and
others.Check with your I.ocal Permit Officer for more information.
STATEMENT OF OWNERSHIP:
I, the undersigned,an applicant for a CAMA minor development permit, ►eing either the owner of property in an AEC or a
person authorized to act as an agent for purposes of applying Ior a('AMA 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)
.Lan owner or record title,Title is vested in name of _..-:. c n e kin 1Ji1e Dct,
see Deer l3ook _.. . .- - page -_ in the- P aL,A4 r` r ..._..� 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) (�1 r -� Nt r 5 U •
;•d_tAt- �t� t�n U f r> C_r` ' l ;Halo RC r f C y
(2). /.�'l a r'-1.. 4.n � i:f SC /Z . .3_.v _ -_- -4_ e. .%.- ,-1 -K.►'4.50 _4 =
(-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 0oo(lproofing techniques.
I furthermore certify that I am authorized to grant,and do in fact grant,permission to Division ofCoastal 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 (!__._. .. day of - i.,.I t ,20{.Z
4 • 4 A
Landowner person authorized to act I '.'her agent for purpose of filing a CAMA permit application
This application includes:general information(lass fm,n), a site drawing as described on the hack of this application, the
ownership statement, the Ocean Ilazaid AEG Notice where(lawsuit);a check/n $100.00 Iua(lc'payable to the locality,mul
ant'i)I/W'nl(lliou as may be pltwided orally lit'the ap i/kant. The details oldie application as des('rlb(r(I1W these sources are
ihl('o)porale(l tr'itlhout iefei'ence in any i ee 'be issued. Deviation Jinn(these c%lails 1t'l/i CnnSI)nite a violation of
am p(wmil. Any pm son developing in an AEC n'ithout permit is.cuhjecl to civil.ffin►inal and a(/I))Inli #' `4c1{o!t•
JUL 0 2 2021
_... .•mir T0N.NC

7 STATE.4„
ROY COOPER I
Governor
ELIZABETH S.BISER
Secretary
BRAXTON DAVIS NORTH CAROLINA
Director Environmental Quality
July 23, 2021
Jane Horney Davis
102 Pebblebrook Drive
New Bern, NC 28562
Dear Ms. Davis,
Attached is CAMA Minor Development Permit SC 21-26 for work to be done at 636 Little Kinston Road in
Surf City, Pender County. An electronic copy has been sent to the Surf City Inspections Department.
To validate this permit, please sign both copies as indicated for our records. Retain the gold 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.
Sincerely,
A4- '-'67,4 /L' 1
Anita M.Webb
Permit Support Technician
N.C. Division of Coastal Management
Enclosures
Cc: WiRO files
SC Inspection Dept.
Cnvirnnn,ontal fluality I nivicinn of Cnactal Mananomrnt

Bali*"Sketch (Page - 1)
gairomfamt NOT APPLICABLE
PRAM/MUM 636 LITTLE IONSTON RD
crier SURF CITY Ca* FENDER BIN NC 38 Cm3 284464522 I
.1251.511111141101.111111.11.
. mac
11011224
3 ,1
1010110014
oasis 10000311
11.14 p00M
51431181
11011013011.111410
G91...c
ARRA CALM/MOOS SUMMARY LIVRIGANALDING AREA BREAK
Code demeellie Orr ;wrw. w.ra.. 4aiNr...
Mal risme noose irre.seers Mt JAM Plait nese
4 6 0aa0ii sonese3 06.00a0 ea.me 26.00 a 00.00 9a.0000
Pn MOM MCI WAWA 11.00 a 37.50 412.3000
WIZ 0000MUM 1101111.13111
3•� 0_0000 426.0000 0.00 a 12.00 96.0000
TOTAL LIVA&L.E (rounded) 1373
TOTAL BUILDING (Aapndild) _ 83 L�3 Oira9411ona Teti Ornunill61.+ tob
runkSATAISO for Wiener app ammo i,6M .s. ' ' 9L 0 2 2021
Hell WILMINGTON,Ne

Receipts for
Certified Mail
(Staple Here)
6 -
Date in a_r 14 / A n 50✓2
Ad'ace t Property.Owner �r�3 ya a La_i ;c�r� 1
Mail ipg Address C , Z g D V
YL
, S �n
City,State,Zip Code
Dear Adjacent Property: II '' �
This letter is to inform you that I, -Same-Fibl 7e ►.�L S have applied for a CAMA Minor
Property Owner "
Permit on my property at �o 2ta i TI!c� n I YIDS71b ri ,in Pen r/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 g5--0-/, 71 -` ,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, % j-)' ,110
SA.n-t !6 r ney Da i 5
Property Owner 1
16 r
Mailing Address
N gee n > �J C o2?1/45-6R
City, State,Zip Code
RECEIVED
JUL 01 2021
DCM WILMINGTON, NC

U. . - S . - -
CERTIFIED MAIL°4hECEIPT
Domestic Mail Only
3
1 For delivery information,visit our website at www.usps.com
Vinent4F.21.1*
A L. LI ki
Certified Mail Fee
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$ 17
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0 Return Receipt(hardcopy) $ ULM(
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$Total Postage and Fees 06/16/2021
$
3 Sent To
ina-rX 4son. 21:Citarl$6ra
3 Street andApt
3 La_Xciae...1.1)
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Electronic verification of delivery or attempted return receipt for no additional fee,present this
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3 Form 3800,April 2015(Reverse)PSN 7530-02-000-9047

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: � A>? tab rn t 1)QOI S
MailingP
Address: / � �- e_.)<)Lb. hr-oak pN
jtip 6P r n Iv C R
Phone Number: 5�- (p 71 - /b-2
Email Address: S Q ytoli 6 4 S Lol e►z I
I certify that I have authorized NIn i c`/ tt), I'[. j a r-cI S �f✓n�} �?+S
Agent/Contractor
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) 3 to L. t- f<; 11-5 .1-0 ko) 5 u ( ;
in f�e 1— County.
AJ� y
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:
(-liriLv\--e--
Signature
rneNi
Print or Type Ndme
Ow n e
Title
l /5-1 eZbZ1 RECEIVED
Date
JUL 01 2021
This certification is valid through / / DCM WILMINGTON, NC

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to TotyQ Po r-ne t lS ,s
(Name of Property Owner
property located at () 3 (,o L` e k I rt S71-n j G�
Address, Lot,Block,Road,etc.)
on , in 5 lkT'"-c C i , 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
JUL 01 2021
DCM WILMINGTON, NC

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Receipts for
Certified Mail
(Staple Here)
ate
V iC� —pr 3— /(24.)6Ct rt. L4
Adjacent Property Owner
b Li t -tle K i ne->h AO/
Mailing Address , y45-
City, State,Zip Code
Dear Adjacent Property: �" ' 1
This letter is to inform you that I, .1 CL n a° lib n/e i J 75 have applied for a CAMA Minor
Property Owner
Permit on my property at 6 3 tp L( Pie Kj k-? 4CV Rc ,' Pend r nslow
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 ZCZ (_ '7/ /l 2 ? ,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, �
��� 0-0�h r'`� C17&)) /$
Property Owner /
)!%., P)1 1 � i-o D k< 7
Mailing Address
1 Berri 4 0ZR' 570cZ
City, State,Zip Code
RECEIVED
JUL 01 2021
DCM WILMINr Tr)KI nir

I. . os a entice
CERTIFIED MAIL® RECEIPT
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Ho1k Rt 119 el 148/45,
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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(VS 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.
nportant 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 Mails,First-Class Package Services, available at retail).
or Priority Mails service. -Adult signature restricted delivery service,which
Certified Mail service is not available for requires the signee to be at least 21 years of agr
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 beara
certain Priority Mail items. USPS postmark.If you would like a postmark on
For an additional fee,and with a proper this Certified Mall 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.
Fnrm 3Rf10_n..di Onu iwe„er.<i P M 7tan.no.nnn.ou,

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: -TCt Y1 +L Alb tilt Da-di5
/� 1
Mailing Address: / D - P-i 2)P. b r b c k P N-
A Bern t e ,7R5-143Z
Phone Number: QZ. 2- (v 71 - / 2 Z 7
Email Address: S Q n al 6 S tapd 4 e v/ i rt k . Ilea)—
! certify that I have authorized n i c.. 1 /AL R i C Q -0/3 (ji ine., 'S
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: / i-P4-- ( tic\ h a kce-
/17 t.
at my property located at 6. 3 to L; 1+ e K c yi 5 4- R ) 5 u ;f eLiy
1 NC
in �e)no�l e r-- 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:
(:)64 1-/-- C'et
Signature
--Tone. Hb me _Dad;6
Print or Type Name
o w ri e
6 Title
I /JC I eZb,Zi
Date
RECEIVED
JUL 01 29?1
This certification is valid through I I
DCM WILMINGTON, NC

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to J( Yti_ 06 r'Lt ) t)/,S 's
(Name of Property Owner)
property located at g /p L 171-JP h S -4)VI 'lGY
Address, Lot, Block, Road,etc.)
on , in 5 rf C% - , N.C.
(Waterbody) (Town and/or Count
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
JUL 01 2021
DCM WILMINGTON, NC

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REVISIONS
DAVIS RESIDENCE .a QArc utao►nw Ammo DAVID TERKE�70W AND ASSOCIATES,P.C.
636 LITTLE KINSTON ROAD CON8u 0 ENGINEERS er NAME T a0.47E
�I1az1 WET N0
901 roc aeo1E ores ..w e., °. w n/zo11 P�SURF CITY,NC ELEVATIONS ,,,r,,,,°,v,,NC MO) I
'i ,NONE.ON or PROEM NOr. a of - 0 :er Y oT :n/Sa11
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T

OCEAN HAZARD AEC NOTICE
Project is in an: Ocean Erodible Area High Hazard Flood Area Inlet Hazard Area
Property Owner: �rL - rr t? i 5
Property Address: n RA .Sze r e e v25
Date Lot Was Platted:
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 alter 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 \s_j/eso f. �(4_i
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
The flood waters in a major storm are predicted to be about Wilmington, NC 28405-3845
feet deep in this area.
Preferred oceanfront protection measures are beach nourishment (,�/Q
and relocation of threatened structures. Hard erosion control //
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 RECEIVED
the proper signature,the application will not be complete.
JUL 01 2021
Pro etfyOwnerSignature Date DCM WILMINGTON, NC
Revised May 9010

B-.• S-a' A E-6'
STRUCTURAL NOTES
. EAST ETNRS
= lOAD3'. LIVE LOAD•.O PSF
if- WIND LOAD NEC PSF
LIMBER: STIP WS2NMI.ALL IAODO FM
SHALL BE TREATED FOR ABO V E GAG
EXPOSURE.PE GSNAI BE TREAT
GROUND CONTACT.
NAPDWARE:NAILS/I D NMGERS SNAIL BE STA
STEEL ALL BELTS SMALL BE NOT a
GALVANIZED.
RAANO: MATCNEASTBNG
SNORE EX61EGSTRUCTURE.DETAIN ORDERS
°B 2a PILNG.DETACH PLUAISNG AND ELECTRA AS
__A—_—_—__A_—.__—_.d--.—_—_J_—_—.—_ _—_—_ _L____It Ia:oLwEo AND RASE STRUCTURE TO SPECIFIED
III' I I T ELEVATION.REATTACH GIRDERS TOPEBG REA
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REVISIONS
DAVIS RESIDENCE No. DATE DESCRIR1ON APPROVED DAVID TECONSU O)NAN�EEOgATES,P.C.RS NAME DATE 4e. A.`
636 LITTLE KINSTON ROAD SOS PINE GROVE WINE
OEsiaeD Bw. or 00/22/2G21
SURF CITY,NC PILING PLAN BUANGTM.NC 28.UV GRAIN BT. or 0tC.EANED BY- Or /2T//2021 X
— P.C..(SIG)'..-.. PAI:(..)MA-SOBO SUAVERNISEL Sr 0I IN/2J/2021 4, reA'
DT PROJECT NO. M016 Coos No 81016 40510
CaNORATC LICENSE N0.C-ZEN OLT-A21
PROJECT IaBE2 10016

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636 LITTLE KINSTON ROAD 90T MK WOVE maw DEATH BY: 6T 00/2f 2,
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DAVIS RESIDENCE No. 0�E orsa+P.a.. APP.olm DAVID TERKELTOUB MID ASSOCIATES,P.C.
636 LITTLE IINSTON ROADCONSULTING amn Fn a r o.��on,/zozl r" He
STAIR PLAN AND SECTIONS 002 PRO CROW ORMoaew a,: or o. ,nozl
SURF CITY,NC P.o]E:(na)++a .m r,.19(910)».-.3000 °`E°°r` or o.)vnozl i.3
0i PROJECT No..20010
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REVISIONS DAVID TERKELTOUB AND ASSOCIATES,P.C.
CONSULTING ENGINEERS OESaEO Rv: N DT ON/27/2021 ' '
DAVIS RESIDENCE tro. DATE DEscAsna APPROVED ALE OATS m
636 LITTLE KINSTON ROAD
SURF CITY,NC STAIR PLAN AND SECTIONS 903-la`.NC""NE aE 0, o oa/27/202i ,"7i•
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OT PROJECT NO.:200,6
CORPCFASE LICENSE NO.C-2674 Cp0 ME 20016 62115..0 04-62.2031
PROJECT Now.: 20016

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DT PROJECT•O`20N6
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U.S. DEPARTMENT OF HOMELAND SECURITY TOMB Mo. 1FSn_n008
Federal Emergency management Agency I Expiration Date: November 30, 2022
Nation& Flood insuranc.e Program
i
ELEVATION CERTIFICATE
important: Follow the instructions on pace.:,
Copy ail pages of this Elevation Certificate and all attachments for(i)community official, (2)insurance agent/company, and(3)building owner.
SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name Policy Number:
JANE HORNEY DAVIS
A2. Budding
Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and
Box Company NAIC Number
636 LITTLE KINSTON ROAD
City State ZIP Code
SURF CITY North Carolina 28445
A3. Property Description(Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
PORTION OF LOT 42 AND ALL OF LOTS 43 AND 44, SEARS LANDING
A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat.34d25'52"N Long.77d33'40"W Horizontal Datum: D NAD 1927 ❑x NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 5
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) 0.00 sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s)within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b 0.00 sq in
d) Engineered flood openings? ❑Yes No
A9. For a building with an attached garage:
a) Square footage of attached garage 0.00 sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A9.b 0.00 sq in
d) Engineered flood openings? ❑Yes ❑x No
SECTION B—FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
81. NFIP Community Name&Community Number B2. County Name B3. State
TOWN OF SURF CITY 370186 PENDER COUNTY North Carolina
B4. Map/Panel 85. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood 89. Base Flood Elevation(s)
Number Date Effective/ Zone(s) (Zone AO, use Base Hood Depth)
Revised Date
3720423500 J 02-16-2007 02-16-2007 VE 10.0'
810. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9:
❑ FIS Profile 0 FIRM ❑Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ❑x NAVD 1988 ❑ Other/Source:
812. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes 0 No
Designation Date: ❑ CBRS ❑ OPA
RECEIVES:.
JUL 01 T 5/5/Z01.0
CE/IA Cr,rr.,naF_n_az F1 OP1C' Rg.nlaroc oil nrovinue arlifinne Fnrm Pang.1 of

ELEVATION CERTIFICATE OMB No. 1 ate: Nob
Expiration Date: November 30, 2022
IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number:
636 LITTLE KINSTON ROAD
City State ZIP Code Company NAIC Number
SURF CITY North Carolina 28445
I
SECTION C—BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. Building elevations are based on: x❑ Construction Drawings* ❑Building Under Construction* ❑ Finished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations—Zones A1—A30,AE,AH,A(with BFE),VE,V1—V30,V(with BFE),AR,AR/A,AR/AE,AR/A1—A30,AR/AH,AR/AO.
Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only,enter meters.
Benchmark Utilized: NC CORS Vertical Datum:NAVD 1988
Indicate elevation datum used for the elevations in items a)through h)below.
❑ NGVD 1929 ❑x NAVD 1988 ❑Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
Check the measurement used.
a) Top of bottom floor(including basement, crawispace, or enclosure floor) 16.0 ❑x feet 0 meters
b) Top of the next higher floor N/A ❑ feet ❑ meters
c) Bottom of the lowest horizontal structural member(V Zones only) 14.0 x❑ feet ❑meters
d) Attached garage(top of slab) N/A ❑ feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building feet 1
(Describe type of equipment and location in Comments) 13. ❑ ❑ meters
f) Lowest adjacent(finished)grade next to building(LAG) 4.8 ❑x feet ❑ meters
g) Highest adjacent(finished)grade next to building(HAG) 5.6 ❑x feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
structural support N/A ❑ feet ❑ meters
SECTION D—SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.
I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false
statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? 0 Yes ❑No ❑Check here if attachments.
Certifier's Name License Number ``,t i t i i i i i i1i
JAMES A. LEWIS L-4562 ```���N CAR lio/i
Title '���', ESS/ '''`/iy
PROJECT MANAGER •0A;r ;.!L •.-ys
Company Name — i 4 -
CHARLES F. RIGGS&ASSOCIATES, INC. — 2 —
Address •-9 •L' Q.
:
• ~f,
502 NEW BRIDGE STREET 1 '.+ S J V
CityState ZIP Code �i/ FS • \"
J CKSONVILLE North Carolina 28540 ���i i i i IAi i i t�)?` zorit,,
Signature Date Telephone Ext.
44024.— /J. 'S,5/a°Zv [phone] 41
Copy all p es of this Elevation Ce ificate and all attachments for( ommunity official,(2)insurance agent/company,and(3)building owner.
Comments(including type of equipment and location, per C2(e), if applicable)
EXISTING DWELLING IS ONE STORY ON PILINGS, OPEN BELOW, BEING RAISED AND PLACED ON TALLER PILINGS.
EXISTING BOTTOM OF BAND=6.8'; PROPOSED BOTTOM OF BAND=14.0'
PRELIMINARY FLOOD MAPS SHOW A CHANGE IN FLOOD ZONE TO VE(13), SURVEYOR RECOMMMDakir4CING THE
BOTTOM OF THE LOWEST HORIZONTAL STRUCTURAL MEMBER AND ELECTRICAL EQUIPMEN A'T`i3.0'OR HIGHER.
J U L U i (CFRA#20-04-11)
Form Page 2 of 6

I.�YPROFESSIONAL LAIN SURVEYOR.
DO THAT I HAM SUR1EIID 1
PROPERTYTIE �$ PRACTICEPEN ACCORDANCE iD CARQ%',,
N NORM CAROENA TINT 118 RATIO a F4567p /,y
PRECISION AS CALORASFD RY unruocY,.p(���O 7 R/W 4 R/W
N il:
DEP IN rlamo. ;2'?Q ?
-� 'C
LEUBS 8 � ff
-c0 ME _'7 CI COMM OELING WHOM EAVES -1360 SCR.
'� Fs Ai 1�' �� ZI t EIOSM6 QAM./ANT ORIYE -0 SCR• '
0, FIWIRMG CMPRED SINN A RRl -fV 4R 97E
716 0 TO CERTIFY 7MT M SIRA[CT PROPERTY R LOCATED 0I< EW NC TOTAL RifltMOUS SUFACE -1572 3631.
IN FLOOD 016 AE' TOTAL LOT AW4 -45% Not MONRY SKETCH
NA2ARD AREA AND RDOD Vim 11P�R- `�*104 SPECIAL
A ?I EOSINS NPERNOUS AREA -SW AN NR KW
SPECIAL R000 HAZARD AI[A AS DERMANED BY RE MIRK Y
MANADDENT AGENCY,AND THE NATIEML ROSE/INSURANCE PITONS/AL w�
°0'R°"'3 01ae"572w"'2°304/ PENUARY 1a 2007 2
3L I Ens1NG DELRI0*NWT EAVES N1NN 75'AEC -1412 SCFL C,
/ i$ 1 Ews1NG 4FAIEL/OIRT DINE MIN 7Y AEC -0 5GR.
mow COVERED Stan WW1 73'AEC -147 NET al 1—
.../
/ Ep37NG TOTAL NPERwa,S SUIIFACE WNW 75'AEC -1556 3,R.
ROW LOT ARE 1B71M 7Y APE _17M9 11 -, Z
RAT / /I EWING IMPERNO S AREA■11i1 75'AEC -a7H
/ / . W c
SPOT LANE sRl / I NOW OR FORMERLY zatea�� 0 --, J
60'R/W(ASPHALT-PUBUC) i / / IBROCKS i
_C-- NOW OR FORMERLY D.B.2277,P.423 weer-JrCC
¢ �� I D.B.526.� P. 153 SEARS T 4lANDB4G 1
ME SEW .TS -
\ M.B.3,P.57 2
N.\ PORTION OF LOT 42 Oft V
/'1 - li
SEARS LANDING
N.B. 3.P.57 ATE KNEE DAIS 0
'
RAT ' ' I \ f \ AL SPaN 0193*N1OWl 11 0N1RDR1EOD1 1ED-•i b' a 1- 4 --- -� +AD
�0f nil= I \ DA 4235.P.153
C4 EON N-7 •'00'W 177.30' 1 .
51N 26. 67. - 02.31'- ER .zr 42 43P
* \-- 7.5'SETBACK
-.1,-1 4236-3/-NNe-0000 TOTAL21 SR.Ft.
I� K §• IV 1 W" M-ea \ ERR N a \. ' \\ 0.556 ACRES
V 1...„..
U Es \- , ON 4235.P.153
a n in
�1�"a h ®� • \ o NIL 3.P.57
NOW DR FORMERLY rn $ • AM�,aR1 - .y lDT D �n
YAMi aDc \ 2,
D.B. 4097,P.11 Z a ' �'1.� ( \ \ 1p cc CONIRK CORNER
J.FL BATTSOT1 Hags ro M KT 2 I- `'"'X / \ - -.1---- OOP (857NOEON DENO OBR 'PPIE(01RN 1104111317�RDxwNNa Dual
M.B.36.P. 132 INTO 5,y_Ert • -r a, '' •f Lle (8519q 6001 Rao(POUN)
z i d Je.BR1LCRRa!SJ�`- ao Ep umBs i Z V/ ON MEMO NANKIN NM.( [011RIOL 4 0 g _ °°" oR RISING PARm1-RAa NEL(F01Ao) COVE
z �- t —\— ERRS-EWAN RARROAD SPIKE
w a g cN OP T" -C _ la MINIM NA2946 uc
< 5 _2' -1 0; 1 ( me NON N7MREMlED FONT
< _ 1I R/W RANT OF MY
LINE TABLE 9S I o aIUM+n A NP SET sr R COMMIT MONUMENT(caN7Ra CORNER)
I LOT 44 / MR SET IRON ROD
UE 1E710111 DIRECTION T. ¢ I 1 / + SIN SET PARKER-MIEN (CONTROL COWER)
9 LI 29.66' N11Z1.00W (COMM CORNER)
gL2 /s.63' M23'3rw'11 I �7.s'sEteAo�' 1aaRa.,Nj�T'' t—_4n �� 1 fa-OVER WEER
VALVE
p u 1E53' N12RY261 SIR S8T20'00`E 201.36' ��AIO/'p�I ¢,1 I-F TRrwAT
A LA 6.60' 1051774YE A W/2e/A= ®-SANTARY 9EYER MANIQE
Si =CLEAN OUT
' .m ®_TELERIOIE PEDESTAL
I NOW OR FORMERLY 1EtEws10x PEDESTAL
PAPANU -EWER CONIC MILE MAKER
D.B.4617,P.999
PCLE
LOT 105 PO- NDS POIF
t
J.H. TTS HEIRS -M -PONDS IRE
M.B.9,P.53 MD-ELECTRIC TRANSPORtlR
XA -11011W.INN TIMER RAG(JAD/DCW 07/2/202
GRAPHIC SCALE
N,FOR
o
CHARLES F. RIGGS & ASSOCIATES, INC.(c-7so) JANE HORNEY DAMS B1�
LAND SURVEYING - CONVENTIONAL BOUNDARY$PHYSICAL SURVEY
GLOBAL POSITIONING SYSTEMS, (a InE)
1 LAND PLANNING & COMPUTER MAPPING PORTION OF LOT 42 AND LOTS 43 & 44, SEARS LANDING. U.S. 3, P. 57 EWeb- M1
502 NEW BRIDGE STREET LANDFALL EXECUIIYE SUITES TOPSAIL TOWNSHIP, PENDER COUNTY, NORTH CARC4JNA ACTUAL FIELD SURVEY DATE: 04/29/2020
P.D.BOX 1570 1213 CIRBREIH DFDVE JANE HORNEY DAVIS, OWNER; D.B. 4235, P. 153 MAPPING DATE: 04/30/2020
JACKSONVx1E,NC 26540-1570 Wl1BNGTON, NC 28405 FEU)BOOK: 1113 PAGE: �,Q,__
TELEPHONE: [phone] TELEPHONE: [phone] 636 U1TLE KINSTON ROAD
s E-MAIL r ggeland*IggsIandn4cam PROJECT NUMBER: 2o-04 11 1

t
i
Locality_ ..._ Permit Number.
Ocean flaw(' ____ Estuarine Shoreline ORW Shoreline ______Public'Trust Shoreline-_-_____ Other. _
(Ivor official use only)
RECEIVED
GENERAL INFORMATION .
AIL. 0j
LAND OWNER-MAILING ADDRESS
Name.._._ 1 /t . _ 1.-1 G..L'%?a.! ....Pa U.s S - DCM WILMINGTON, NG
Address...l.G , ...!' kohl .h rG s K `� r
City lJ __.. t�._r_ ___state N C.— zipVei ,ZPhone X. . - 6 7/ - 14 9
Ismail p` E
t.i
AUTHORIZED AGENT
Name RECEIVE°
Address q 2.2021
City--_ ...._ _ . _______ State .... _..... .. Zip -— Phone ,NC
Ismail M' LW
LOCATION OF PROJECT:(Address,street name and/or directions to site;name of the adjacent waterbody.)
1.0 31,, Li +)e k f it�/6 rt h'(
r-F :_y__ /U C „1 g q9 S--
DESCRII''I'ION OF PROJECT: (List all proposed construction and land disturbance.) _....... _.
T. __...itfl.tt_- f-/ ._._j
SIZE OF LOT/PARCEL: square feet .__ _ . acres
PROPOSED USE: Residential I.I (Single-Ibmily tl Multi-family ❑) Commercial/Industrial fl Other Q
COMPLETE EITHER(I)OR(2)BELOW(Contact your Local Permit Officer if race are noI sure which AEC applies
to,Puar properly):
(I) OCEAN IIAZARD ARCS: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 AR,Cs: SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR IlUII:T
UPON SURFACES;/3'yJsquare feet(includes the area of the foundation of all buildings,driveways,covered leeks,
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 Management Permit issued by the NC Division of Energy, Mineral and Land Resources(DI:MI.R)?
YES NO
If yes. list the total built upon area/impervious surface allowed for your lot or lxtrcel:. .square feet.

I
i
Locality
Permit Numbe.r..
1
Ocean thwart! Estuarine Shoreline _ ORW Shoreline Public Trust Shoreline__ Other
, (!'ar official use only)
RECEIVED
GENEgm,INFORMATION .
AIL 0 I
LAND OWNER-MAILING ADDRESS
Name. ---3'.....CLDe.-.-.. ... 14 v.r_r) /e_A _Pa...v.( ,.6 _., .DCM.WILIVIINGTON, NG
Address....i 0 .._Pekble,b r_C.k> K. V I-
_ .. . .
City Akw_.„.6e,rr-1 . ......_ State NC-- Zipk?filyhune .X.3c - 6 11 - 11,2
,
neAti'4 (0 .L.710 6 yk--1 i A k 4...n .
...1
A UTE IOR IZED AGENT
Name . VED
. ....-------- -----BECEI--- - --
... -
Address - - •
•
City Stale - Zip Phone
--6-MN'14
Vs11-MIN
Email - 0CM --1_______
_. .
-- —
LOCNI'ION OP PROJECT:(Address,street name and/or directions to site;name or the adjacent‘vaterbody.)
..
6r; 3 ta L; -W e. - k 1 tt. :-.,--/-6 ti ed _. ._
—
c
,..„2(....kr+ C 7 -i- y
twsouPTION OF PROJECT: (List all proposed construction and land disturbance.) _
ill:11:1 t NC Division of Coastal Management
Cashier's Official Receipt 14S A B C D
Date: '4--: f 1 202 i
Received From: 2 '
$Permit No.:
Check No.:
Applicant's Name: -
County:
Project Address: . •
t
Please retain receipt for your records as proof of payment for permit issued.
Signature of Agent or Applicant: '
Date: • --