TB_19-29_ Wareham

Issued by WiRO TB19-29
Topsail Beach Permit Number
CAMA
MINOR DEVELOPMENT
ft
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 John Wareham authorizing development in the Ocean Hazard (AECs) at Lot 10 N. Anderson Blvd. (PIN #4223-
46-0773-0000), in Topsail Beach, Pender County as requested in the permittee's application, dated November 25, 2019, and
received by DCM on December 6, 2019. This permit, issued on December 31, 2019, is subject to compliance with the
application and drawing dated received by DCM on December 6, 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: Construction of a beach access walkway, deck and gazebo.
(1) All proposed development and associated construction must be done in accordance with the permitted drawings dated
received by DCM on December 6, 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)
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This permit action may be appealed by the permittee or other qualified persons
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within twenty(20)days of the issuing date. This permit must be on the project / W Z
site and accessible to the permit officer when the project is inspected for / Jason Dail
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compliance. Any maintenance work or project modification not covered under CAMA LOCAL PERMIT OFFIBI
this permit,require further written permit approval.All work must cease when this Q
permit expires on: 127 Cardinal Drive Extensiln -;
Wilmi NC 28 5-384
December 31,2022
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 ' uired if conditions above apply to permit)

Name: John Wareham
Minor Permit#TB19-29
Date: December 31, 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) With exception of the beach access walkway, 140 sq. ft. or less of elevated uncovered decking and 182 sq. ft.
gazebo, all other 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.
(8) The authorized deck and gazebo shall be structurally independent of one another(i.e. have own support pilings and
structurally detached).
(9) 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.
(10) 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.
(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.
NOTE: All construction must conform to the N.C. Building Code requirements and all other local, State and Feder6
regulations, applicable local ordinances and FEMA Flood Regulations. Z
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SIGNATURE: DATE:
l/17 420
PERMITTEE

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I 01:1ZA,t' '6'0 G11 19 I r. —°"
Locality Permit Number 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
Ocean Hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline other treatment system),Building,Electrical,Plumbing,Heating and Air Conditioning,Insulation and Energy Conservation,FIA
(For official use only) Certification,Sand Dune,Sediment Control,Subdivision Approval,Mobile Home Park Approval,Highway Connection,and
others.Check with your Local Permit Officer for more information.
GENERAL INFORMATION
STATEMENT OF OWNERSHIP:
LAND OWNER-MAILING ADDRESS I,the undersigned,an applicant for a CAMA minor development permit,being either the owner of property in an AEC or a
^,f t t L1i/��,,^n person authorized to act as an agent for purposes of applying for a CAMA minor development permit,certify that the person
Name V ll t vVot7 lr OW t ` c�, listed as landowner on this application has a significant interest in the real property described therein.This interest can be
Address
��I�,2�,��10 Pam t�`i , /�2� 2 described as:(check one)
City Lo gy I t wl State I-K) Zip 400�i Phone J(1—44 1(1 an owner or record title,Title is vested in name of (O ,
Email J au c4 r Z @p I l r co see Deed Book -illy-1 page 2021 in the rvtt - County Registry of Deeds.
AUTHORIZED AGENT an owner by virtue of inheritance.Applicant is an heir to the estate of
S ai�'( (�LS etkn probate was in County.
Name O V
/J 1/� i-h-gor t yy rim.
i t t WA Iy 4L if other interest,such as written contract or lease,explain below or use a separate sheet&attach to this application.
Address !/l'T l J�(� 1q,Jl,IJ� IV l�.p�� q q�/_
City `It -_State � Zip( 4 Phone to-329 1�o 1 NOTIFICATION OF ADJACENT RIPARIAN PROPERTY OWNERS:
w �1 n ^ /� ',1 C�` awl I furthermore certify that the following persons are owners of properties adjoining this property.I affirm that i have given
Email �t l a, IN wa S t U� Q I,,.WI Y 1 ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
LOCATION OF PROJECT:(Address,street name and/or directions to site;name of the adjacent waterbody.) I^(^,(/N�apm`e�)�`' L/+�,� ^n
(i)II ,I0 LXN.Q of 1tr 1 �,f,p0 Address 1 uldi Vl 1 kl c Z?bl 9
(,61- 10 N.P� 6 riun 61vd Cht3.4 d-22 --410-61-13-60c0) (2)i urica,n ti)mpinrat CO{ eciini tcycla nimn ern i q( 4-t �anfbrd. i
(3) tur�►Ytgter►(Nc. Z
Mod. �yy���/y�/y� (4)
DESCRIPTION OF PROJECT:(List all proposed construction and land disturbance.) I l j V 1 IIXJVCJ d ACKNOWLEDGEMENTS:
`ry'V r r VI,m �r It IAA r„V f/��/� (�ry r)n),.0 Ca-
n i( f I r ti1 n mull�. 1.1� i,the undersigned,acknowledge that the land owner is aware that the proposed development is planned for an area which
WC {.udat JI C Ca tCJ a 5a -09 dtx I l.--"1 ld V V may be susceptible to erosion and/or flooding.I acknowledge that the Local Permit Officer has explained to me the particu-
- hazard problems associated with this lot.This explanation was accompanied by recommendations concerning stabiliza-
SiZE OF LOT/PARCEL:21O4N- square feet 0 50S acres
tion and floodproofing techniques.
PROPOSED USE:Residential Er(Single-family RrMulti-family❑) Commercial/industrial❑ Other ❑ 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
COMPLETE EITHER(I)OR(2)BELOW(Contact your Local Permit Officer if you are not sure which AEC applies related to this permit applicatio .
to your property): e
(I) OCEAN HAZARD AECs:TOTAL FLOOR AREA OF PROPOSED STRUCTURE:I rU2 square feet(includes This the Z 7 day of ,20
air conditioned living space,parking elevated above ground level,non-conditioned space elevated above ground level but
/,,e
excluding non-load-bearing attic space) trn �((s on`t, w
A -1 Landowner or person aut orized tti act as his/her agent for purpose of filing a CAMA permit application
(2) COASTAL SHORELINE AECs:SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
UPON SURFACES: square feet(includes the area of the foundation of all buildings,driveways,covered decks, This application includes:general information(this form),a site drawing as described.on the hack of this application,the
concrete or masonry patios,etc.that are within the applicable AEC.Attach your calculations with the project drawing.) ownership statement,the Ocean Hazard AEC Notice where necessary a check for Sf00.00 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
STATE STORMWATER MANAGEMENT PERMIT:Is the project located in an area subject to a State incorporated without reference in any permit which may be issued.Deviation from these details will constitute a violation of
Stormwater Manager Permit issued by the NC Division of Energy,Mineral and Land Resources(DEMLR)? any permit.Any person developing in an AEC without permit is subject to civil,criminal and administrative action.
YES NO
If yes,list the total built upon area/impervious surface allowed for your lot or parcel: square feet.
RECEIVED
DEC 0 6 2019

AGENT AUTHORIZATION FOR CAIVIA PERMIT APPLICATION •
Name of Property Owner Requesting Permit: SA t 41Y
Mailing Address' 12-S1D /V)ilU;ICX
Ca/OULI 4k4) 3'2-
Phone Number 3W1 F143
Email Address: jU-1-di-Z- eY)
I certify that I have authorized LQS114)
(Kgeny Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 1Xj1Ut-00-0
'7CRtk, u- LivdTZQLL, of\ oUs
°A.2z3
at my property located at t)::A y") JC1 f o-rf5-0X
in , ) .4\C-V..Y County,
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
Propert 0 "ter Infpçmatiojç
Signature
Print or Type Name
OV\fat/
Title
2S. 7C.W1
Date
RECEIVED
This certification is valid through I t / 2C..)-aiL)
DEC fl 6 2019
DCM WILMINGTON, NC

SITE DRAWING/APPLICATION CHECKLIST
e make sure your site drawing includes the following information required for a CAMA minor development permit. ay
_oval Permit Officer will help you,if requested. r
r
SICAL DIMENSIONS APPLICATION FOR
a
Label roads IC
CAMA MINOR z Label highways right-of-ways
Label local setback lines
Label any and all structures and driveways currently existing on property Coastal Management DEVELOPMENT
Label adjacent waterbody 9
ENVIRONMENTAL QUALITY
SICAL CHARACTERISTICS PERMIT
Draw and label normal high water line(contact LPO for assistance) In 1974,the North Carolina General Assembly passed the Coastal Area Management Act
Draw location of on-site wastewater system
(CAMA)and set the stage for guiding development in fragile and productive areas that
If you will be working in the ocean hazard area: border the state's sounds and oceanfront.Along with requiring special care by those who
Draw and label dune ridges(include spot elevations) build and develop,the General Assembly directed the Coastal Resources Commission
Draw and label toe of dunes (CRC)to implement clear regulations that minimize the burden on the applicant.
Identify and locate first line of stable vegetation(contact LPO for assistance)
Draw and label erosion setback line(contact LPO for assistance) This application for a minor development permit under CAMA is part of the
Draw and label topographical features(optional) Commission's effort to meet the spirit and intent of the General Assembly.It has been
designed to be straightforward and require no more time or effort than necessary from
If you will be working in a coastal shoreline area: the applicant.Please go over this folder with the Local Permit Officer(LPO)for the Show the roof overhang as a dotted line around the structure locality in which you plan to build to be certain that you understand what information he ^
Draw and label landward limit of AEC or she needs before you apply. r;
VIIN Draw and label all wetland lines(contact LPO for assistance)
Draw and label the 30-foot buffer line Under CAMA regulations,the minor permit is to be issued within 25 days once a
ELOPMENT PLANS complete application is in hand.Often less time is needed if the project is simple.The
process generally takes about 18 days.You can speed the approval process by making
f Draw and label all proposed structures certain that your application is complete and signed,that your drawing meets the
✓ Draw and label areas that will be disturbed and/or landscaped specifications given inside and that your application fee is attached.
Note size of piling and depth to be placed in ground
Draw and label all areas to be paved or graveled Other permits are sometimes required for development in the coastal area.While these
Show all areas to be disturbed are not CAMA-related,we urge you to check with the Local Permit Officer to determine
Show landscaping which of these you may need.A list is included on page two of this folder.
E TO APPLICANT
We appreciate your cooperation with the North Carolina Coastal Management Program
you: and your willingness to build in a way that protects the resources of our beautiful and
• completed all blanks and/or indicated if not applicable? productive coast.
• notified and listed adjacent property owners?
• included your site drawing? Coastal Resources Commission
• signed and dated the application? Division of Coastal Management
• enclosed the$100.00 fee?I Ob1L @cotfached trtelt4 I rIc "1I1 •
• completed an AEC Hazard Notice,if necessary?(Must be signed by the property owner) Y fro
KM of lit '� ,e r'4S��.r..' FOR STAFF USE �.' '��a +�.`%- ..ra-)' (•
r :-
doiice Posted Final Inspection Fee Received _
as bons ElX C
zrn
' �_1 Al 04
fiction Issued 0 Exempted __ Denied Appeal Deadline(20 days from permit action) DCM Form EBr952-2015/Revised
2
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.74
WESTON LYALL I �.
Structural&Civil Engineering Land Surveying Serving Eastern North Carolina arrwWrrr.
STRUCTURAL ENGINEERING
CIVIL ENGINEERING
LAND SURVEYING
214 Highway 17 N. Suite 1
Holly Ridge,NC 28445
910-329-9961 Office
Firm License#P-0937 www.WestonLyall.net
November 25, 2019
To: North Carolina Division of Coastal Management
127 Cardinal Drive Extension
Wilmington,NC 28405
Subject: Lot 10 N. Anderson Blvd., Topsail Beach,NC 28445
The purpose of this letter is to notify the North Carolina Division of Coastal Management of
the proposed 6'wide walkway with gazebo and uncovered deck to be built at Lot 10 N.
Anderson Blvd., Topsail Beach, Pender County. The property owners are John& Val
Wareham, who can be contacted at(317)443-1943. Please see the enclosed CAMA Minor
Permit Application as well as the preliminary plot plan for the proposed dimensions and
location of the project.
Thank you,
1,144.1,4/
Weston Lyall, PE, PLS, PLLC
RECEIVED
Pile Plans,Foundation Designs,Structural Designs,Structural Analysis, DE( 0 6 2019
Stormwater Designs,Commercial and Residential Properties
Subdivision Designs,Land Surveys,Plot Plans,Elevation Certificates
All Your Engineering and Surveying Needs DCM WILMINGTON, NC
Licensed Engineer in NC SC VA Al. MS

yy
r f' ROY COOPER
i tZ �r;;,er„oj•
r MICHAEL S. REGAN
s y± ;secretary
4.;v,v.d
BRAXTON DAVIS
January 2, 2020
John Wareham
12810 Ashworth Street
Carmel, IN 46032
Dear Mr. Wareham,
Attached is CAMA Minor Development Permit TB 19-29 for work to be done at Lot 10, North Anderson
Blvd. (PIN #4223-46-0773-0000) in Topsail Beach, Pender County. An electronic copy has been sent to
the Topsail Beach Inspections Department and your Agent.
To validate this permit, please sign both copies as indicated for our records. Retain the orange copy for
your files, and return the white copy to us within 20 days of receipt in the enclosed, self-addressed
envelope
•
This is not a valid permit until it is signed and returned to our office.
Thank you for your prompt attention to this matter.
i
Sincerely,
U./
Tanya K.,Pietila
Permit Support Technician
N.C. Division of Coastal Management
Enclosures
Cc:WiRO files
TB Inspection Dept.
Weston Lyall-Agent
State of North Carolina I Environmental Quality I Coastal Management
127 Cardinal Drive Ext.,Wilmington,NC 28405

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t�° ATLANNC OCEAN
mown MAP(PIM
N. ANDERSON BLVD (HWY 50) NOTES:
(60'PUBLIC R/W)
1.THIS PROPERTY IS SUBJECT TO RESTRICTIVE
COVENANTS, UNDERGROUND UTILITIES,IF ANY.
2.NO TITLE SEARCH BY SURVEYOR.
3.AREA BY COORDINATE METHOD.
EI ____ R/W EIR N4S°08'58"E 25.1 T EIR R/W 4.THIS SUBJECT PROPERTY IS LOCATED IN
V N47°53'31"E 54_,67' ^t — — e —_ FLOOD ZONE AE(EL-12) COMMUNITY PANEL
I
APPROX TOE #3720-423400-J EFFECTIVE DATE:2-16-2007
I .., it 7.5'MBL OF DUNE
pp. 1$.0'MSL
5.REFERENCES:DB 4647,PG 2029;MB 5,PG 69;
/ WARNER !t MB 59,PG 52
!DEVELOPMENT& ' i PROPOSED 6.ZONE:R-1 SURF CITY
I CONTRACTING io 13'X 14' SETBACKS PER TOWN:
DB 3412,PG 32$ ;W GAZEBO FRONT- 7,5',SIDE-5',REAR-20'
r: O
APPROX TOP
If,ix `-gx OF DUNE 21.1'MSL LEGEND-
SIR-1/2"Set Iron Rod
v
EIP-Existing Iron Pipe
1 aa ' ''ROX FIRST LINE ER-Existing Iron Rod
la" , OF VEGETATION EIPD-Existing Iron Disturbed
et). Z ku CP-Calculated Point
r U .7 R/W-Right-of-Way
o% s,„„n + O5 DUNCAN MBL-Minimum Building Line
N t i o DB-Deed Book
t, 1 �N HUMPHREY MB-Map Book
•2'' m+ DB 1A, PG 7118
PG-Page
i` f �� FLNV-First Line of Natural Vegetation
t, PP-Existing Powerpoie
r
�_l.jj -Property Line Surveyed
_Ili 11 APPROX TOE — —'" -- -- — -Property Line Not Surveyed
OF DUNE 9.1'MSL -Minimum Building Line
IMPERVIOUS CALCULATIONS:
———— 548°1729"W 25.27' LOT AREA 2,082 SF(0.05 AC)
PROPOSED GAZEBO-182 SF
TOTAL IMPERVIOUS COVERAGE: 182 SF
(PERCENT IMPERVIOUS-8.7%)
ATLANTIC OCEAN
PROPERTY DESCRIPTION:
RECEIVED OWNER:JOHN WAREHAM,TRUSTEE
MAILING ADDRESS:
12810 ASHWORTH ST
NORTH CAROUNA DEC 0 6 c_O I.; CARMEL, IN 46032
RENDER COUNTY MB 5,PG 69,DB 4647.PG 2n2A

November 25, 2019
To: Duncan R. Humphrey C/O Catherine Brooks Dusenberry
7487 Danford Rd.
Burlington, NC 27215
Dear Warner Development & Contracting,
I, John Wareham, have applied for a CAMA Minor Permit on my property at Lot 10 N. Anderson
Blvd (PIN #4223-46-0773) Topsail Beach, NC 28445, in Pender County. This property is located
approximately 100' away from the Atlantic Ocean. 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
by mail at the address listed below. If you wish to file written comments or objections with the
Local Government CAMA Minor Program, you can submit them to:
Jason Dail
127 Cardinal Drive Ext.
Wilmington, NC 28405
Sincerely,
John Wareham
12810 Ashworth Street
Carmel, IN 46032
RECEIVED
DEC 0 6
DCM WILMINGTON, NC

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ; U ^14'1 V\di We 4Ll,i'i 's
(N me of Property Owner) `,`���r
property located at 'CV- !D l , f fl t 1f ,UA k.�[lv'# <4� --` '-OT13-�-)
(Address,_Lot, Block,, Road, et
on � i 1� Ll k` , in ..,,V t i •0 riC.l , i r ' Gr Cu N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
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.
I do not wish to waive the 15' setback requirement.
(Pro, rt 6wner o tion) (Adjacent Property Owner Information)
</,it _ i
Si 1 ature Signature*
'tint or Type Name Print or Type Name
12- lG ISN>,31131/1 St- . RFCEIVED
Mailing Address Mailing Address
( ay(r114 1 1 t L 4-tLC
City/State/Zip City/State/Zip �)F_I. 0 o
2,0, 44.3. (ciq-�
Telephone Number/email address Telephone Number/email address
i II ici lq DCM WILMINGTON, NC
Dale Dale*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

November 25, 2019
To: Warner Development & Contracting
P.O. Box 20361
Raleigh, NC 27619
Dear Warner Development & Contracting,
I, John Wareham, have applied for a CAMA Minor Permit on my property at Lot 10 N. Anderson
Blvd. (PIN #4223-46-0773-0000) Topsail Beach, NC 28445, in Pender County. This property is
located approximately 100' away from the Atlantic Ocean. 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 by mail at the address listed below. If you wish to file written comments or
objections with the Local Government CAMA Minor Program, you can submit them to:
Jason Dail
127 Cardinal Drive Ext.
Wilmington, NC 28405
Sincerely,
John Wareham
12810 Ashworth Street
Carmel, IN 46032
RECEIVED
DECU6 '
_.. NINGTON, NC

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,eruneu mail service provtues me rvnvwtng LieneuMS;
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. 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
fora specified period. delivery to the addressee specified by name,or
to the addressee's authorized agent
aportant 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 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 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 Mall item at a Post Office'for
the following services: postmarking.H you don't need a postmark on this
-Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion
of delivery(including the recipient's signature). of this label,affix It to the mailpiece,apply
You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.
electronic version.For a hardcopy return receipt,
complete PS Form 3811,Domestic Return
Receipt;attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Join \AiciI d clay-I 's
11 � ) I (N me;o}f Property Owner)
property located at lCT 110 N • ' !t ►-� f 0l� , ti; 4223--40^0T3-QCW)
(Address, Lot, Block, Road, et
on Rt 1(1 C(Qak in i �l ( t � i iC CC • , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
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.
I do notr wish to waive the 15' setback requirement.
(Pro I rt owner 4 or tion) (Adjacent Property Owner Information)
>> ,e //// -/
Si Jattire Signature*
je )u\l'r1 lK,c 4-01.;)61
'tint or Type Name Print or Type Name
IZe,►LaG1i>`t;Yii Sr . RECEIVED
Mailing Address Mailing Address
(AY rvu 1 i j t , 4luC'-:i2- DEC 0 6 y'u
City/State/Zip City/State/Zip
1"I, 443. (`-iq .
Telephone Number/email address Telephone Number/email acOtatt WILMINGTON, NC
iIJzcjpt
Dale Dale*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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RECEIVED
DEC 0 6 2019
DCM WILMINGTON,NC

gl NC Division of Coastal Management
Cashier's Official Receipt 8747 ABC D
Date: %/12'Ql 20
V ,e CSC l c�.0 L . I;v
Received From- { $
Trov
Permit No.: jl J Check No.: '7 1)1YiVl.\-\(-7 \I\iv v/OrveS \\A&.
Applicant's Name: County:
Project Address: V°I/ \z1 Vet\A MZ l �Vc Ct A t1/,y
J
Please retain receipt for your records as proof of payment for permit issued.
Signature of Agent or Applicant: n Date:
cCY
Signature of Field Representative: �� Date: /' lC\
till:1 NC Division of Coastal Management
Cashier's Official Receipt 8 7 9 3 A B CP
Date: 20/ 2
Received From: C G /1 t2( ��/ `,, v
Permit No.: °� - ChecCA k No.: 4 �4I A'l
Applicant's Name: 4--(. . '7 �l r -2! i 7f ' County: /L.
Project Address: �� V ' '� 41L2 511 (I
Please retains receipt for your records as proof of payment for permit issued.
Signature of Agent or Applic Date:
r _7 ./
Signature of Field Represe --�__.---t----. Date:
•
pt- M