TB_20-15_ Broome (2)

Issued by WiRO TB20-15
Topsail Beach Permit Number
CAMA
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"
Issued to Tom and Beth Broome authorizing development in the Estuarine Shoreline (AEC) at 110 Boryk Avenue, in
Topsail Beach, Pender County as requested in the permittee's application, dated March 14, 2020, and received as
complete by DCM on March 19, 2020. This permit, issued on April 6, 2020, is subject to compliance with the application
and drawing dated and received by DCM on March 19, 2020 (where consistent with the permit), all applicable
regulations and special conditions and notes set forth below. Any violation of these terms may subject the permittee to a
fine, imprisonment or civil action, or may cause the permit to be null and void.
This permit authorizes: Construction of a single family residence.
(1) All proposed development and associated construction must be done in accordance with the permitted site drawing dated
received by DCM on March 19, 2020.
(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 Jaso Dail
compliance. Any maintenance work or project modification not covered under
this permit,require further written permit approval.All work must cease when this CAMA OCAL PERMIT 0 IALo
permit expires on: 127 Cardinal Drive Exte 44
Wilmington, NC 28405-
December 31,2023
in issuing this permit it is agreed that this project is consistent with the local Land Q 197 r� �
Use Plan and all applicable ordinances. This permit may not be transferred to `
another party without the written approval of the Division of Coastal pPRMITTFF

Name: Tom and Beth Broome
Minor Permit#TB20-15
Date: April 6, 2020
Page 2 of 3
(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) Shall the plan of development exceed 30% impervious coverage within 75' of the normal highwater line, the
applicant shall effectively demonstrate, through innovative construction and design that the amount of impervious
surfaces exceeding 30% impervious coverage within the 75' Coastal Shoreline AEC shall be managed and the AEC
protected. All proposed development and associated construction must be done in accordance with a credible
innovative design plan,sealed and sealed by a professional engineer.
(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: a • &'`" " DATE: 11IP�0
I (0 1 a._ N
PERMITTEE j !')
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Locality Permit Number 14
• Ocean Hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other
(For official use only)
GENERAL INFORMATION
LAND OWNER-MAILING ADDRESS
Name 4M G f2e4-1, 171rb0 P t-
Address_A 5 IA r bu/ D V e
City L4c.v i K 61lbw State NC' Zip 28362 Phone ctl D 217 & 3 3 i,
Email TQ,b a eve-Ofifcl . CosolA
AUTHORIZED AGENT
Name J/j^n COG k12-Kp
Address Z 15 Sot-fT, ( e ir A lia
City L4I .1t4A.i h7y State /J Zip V_I a3Phone — % 2 31 (9� 1S'
Email \ SNnt'v VsCon b4e f un . co Al
LOCATION OF PROJECT:(Address,street name and/or directions to site;name of the adjacent waterbody.)
fIo Aork Ave 5ufi1 �ofi e-
:t �at /VC
Y
DESCRIPTION OF PROJECT:(List all proposed construction and land disturbance.) bat, . i
1 Gb eXt SIS j
1,, bjd/obM h0✓SE o,t pt I;�t l,S. /e4/0 la Ge (ji 5?41 lf.
SIZE OF LOT/PARCEL: a e3. 3 square feet O. if acres
PROPOSED USE: Residential ($k (Single-familyp Multi-family ) Commercial/Industrial Other
COMPLETE EITHER(I)OR(2)BELOW(Contact your Local Permit Officer if you are not sure'Mich AEC applies
to your property):
(I) OCEAN IIAZARD 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: II52 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 STORM WATER MANAGEMENT PERMIT: Is the project located in all area subject to a State
Stormwater Management Permit issued by the NC Division of Energy,Mineral and Land Resources(DEMLR)?
YES__ NO RECEIVED
If yes,list the total built upon area/impervious surface allowed for your lot or parcel: square feet.
MAR 19 2020

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 I tome 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 put-poses 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 7f?o`xa5 El! .akL u` 13/-00/vL�.
seei,leeir Book l d page a7 a in the ?(eKeoo.f-' County Registry of Deeds.
n�cf 'geed k l q% p . Io2..$�
an owner by virtue of inheritance.Applicant s 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)
•
(1) T,,,,,� ? OIL a l /0 0 000l la, J`7✓, l cJ,/soul, ,,_ "'
(2) Kt anti ( I ua +t; P�U ��n. !1 aZ �b 1k Ave, 72p54, 1 -a rlNx-
(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 14 day of Mettic.k ,20—
Landowner or person authorized to act as his/her agent for purpose of filing a CAMA permit application
This application includes:general it formation(this forma), a site drawing as described on the back of this application, the
ownership statement, the Ocean/lazairl AEC Notice where necessary a check for$100.00 made payable to the locality;and
any information as may be provided orally by the applicant. The details oldie application as described by these sources are
incorporated without reference in any permit which nary be issued.Deviation from these details will constitute a violation of
any permit.Any person developing in an AEC without permit is subject to civil, criminal and administrative RECEIVED
c ion.
EI V ED
h""R 1 9 2020

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: OAA * &'Ii, g(04.1.A.0
Mailing Address: IZlS PKh bu✓ E r7 V
141Arnbvti6 /JG Z0352
0 r
Phone Number: (1v - Co333 (o
Email Address: �a b Q Scot-A.1 • cPAA-
I certify that I have authorized Jatiy• Coc14-rµy
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: New k0skt ( to gory k
Ave,
at my property located at I �O (;o r y k A V L T P9(; ) 8eac 1'.
in PeA ck County,
l 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.
RECEIVED
Property Owner Information:
MAR 1 9 2020
Signature DCM WILMINGTON, NC
l 8t Oryt a.,S 4. &OD 0
Print or Type Name
0 Go
Title
,3 I !02 I aZO,Zo
Date
This certification is valid through I I

ROY COOPER
.:- r 'f
y --i `!r MICHAEL S. REGAN
BRAXTON DAVIS
April 8, 2020
Tom and Beth Broome
1215 Dunbar Drive
Laurinburg, NC 28352
Dear Mr. & Mrs. Broome,
Attached is CAMA Minor Development Permit TB 20-15 for work to be done at 110 Boryk Avenue 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.
Si cerely,
. ap_____.
anya ietila
Permit Support Technician
N.C. Division of Coastal Management
Enclosures
Cc: WiRO files
TB Inspection Dept.
John Cockrum—Agent
State of North Carolina I Environmental Quality I Coastal Management
127 Cardinal Drive Ext.,Wilmington,NC 28405
919 796 7215

z
NOTES: w S
ZONE: TOPSAIL BEACH R3 A� Q CO
MINIMUM BUILDING SETBACKS �',. vi TROUT AVE a
FRONT-7.5' ,o ��
SIDE-5' A m F
REAR-20' 1\2R BORYK AVE a
MAXIMUM HEIGHT-38' J McLEOD AVE 0o
MAXIMUM BUILT UPON AREA-35% (2129.15 SQ FT)
BASE FLOOD ELEVATION-12' GODWIN AVE /01
FREEBOARD-+3'
FINISHED FLOOR AND MACHINERY TO BE AT 15' NGVD 88 (MINIMUM) VICINITY MAP NO SCALE
CANAL # 1
BOAT FLOATING
I IGH WATER LINE
LIFT
I WOOD HEADWALL
WOOD
CP DECK L3 CP
"3r ISIS
— — - - -
N WOOD
$IS WALK
WOOD HEADWALL/ENCROACHES 1.1' Z 30' SETBACK FROM HIGH WATER LINE
ON TO LOT 23 f--CST.- 'r�J IIII — -
cD oPORCH p18.2' 17.9LOT 23 24' LOT 21
MB 10 PG 24 m °'• PROPOSED MB 10 PG 24
2 STORYm HOUSE K
r Co mEPTIC
rTANK
MB 10T G 24 _ _22 ',...------<.0
3�DB 1996 PG 128 (0 18.2 24 J 18' ---
0.14 ACRES �75' SETBACK FROM HIGH WATER LINE
6083.3 SQ. FT. FIP 7.5' MBL 4,R/W— (� / m. — — — — —R/W
60.12' / PERVIOUS WMTP
N 39'09'30" W I .:,GRAVEL SET BENCHMARK
.-DRIVE I IN POWER POLE
EP J 1 : I EP © 15' (NGVD 88)
IMPERVIOUS CALCULATIONS
HOUSE AND PORCH-1152 SO FT
PERVIOUS DRIVE---O SO FT C/L - - - i C/L
LOT AREA 6083.3 FM
N
PROPOSED IMPERVIOUS--18.9%
BORYK AVENUE
60' PUBLIC R/W
R/W— — — — — — — —R/W
LINE BEARING DISTANCE
110 BORYK AVENUE L1 N 51'26'47" E 30.38'
PRELIMINARY PLOT PLAN L2 N 50'49'00" E 5.88'
L3 S 39'43'48" E 60.13'
**FLOOD CERTIFICATION** L4 S 50'49'00" W 1.48'
THIS IS TO CERTIFY THAT THIS PROPERTY IS Q' 30' 60' 90'
LOCATED IN FLOOD HAZARD ZONE "AC' PER
COMMUNITY # 370187 PANEL# 4202.1 MWSp[[}1_ry�1y�p(pfy�p
PL(ISE➢YB/20--1➢DED-IT - GULL(X Y r
'I CERTIFY THAT THIS MAP WAS DRAWN UNDER MY A.L--CAREA UGHT AVEM M -MEAN SEA LEVEL L�***LEyEND***— C
SUPERVISION FROM AN ACTUAL SURVEY MADE UNDER C Ox FPN_FOUND IRON PIPE--FOUND MAG NAIL MPL METER Pq lI INU UNE I AR AS CCO NATES z MY SUPERVISION FROM A DEED RECORDED IN DEED 7L—CENYERUNE FIS--FOUND IRON STAKE E--E--E- OVERHEAD PONE UNE
D
BOOK 1996 PAGE 121,4 OR OTHER REFERENCE SOURCE CONC--CONCRETE FPK--FOUND PK NAIL PA SMN--SET MAG NAIL 0 2
Me 10 PG 24); THAT THE BOU • - S NOT SURVEYED 'c? -COMPU POINT LP--LIGHT I' oy��FR pL� SET
ARE INDICATED AS DRA 9IR. TION IN D UEDEED BOOK MB--MAP BOOK /W-FRIGHT PCF WAY FiLiL EPHONE PEDESTAL CD.
c...1
C
D&UE--DRAINAGE&UTILITY EASEMENT
BOO N A PA N A •l SOURCE SIS--SET IRON STAKE vu--werc9 ucTc9
N/A ), THA I +, •2,1, 3 • OR L
POSITIONAL ACCU 4� •• ' ,I THIS SURVEY FOR: THOMAS A. BROOMS CM
MAP MEETS THE 41E•_ ''.1.-''P"1 N. -DS -_
OF PRACTICE F LA • VEYING j'•'TH W *�
CAROUNA(21 AC . -•••)." THIS .'A . SUBDIVISION: NEW TOPSAIL BEACH
• SEAL U Q —
' L-2904 ,•- LOT #� 22 BLOCK: N//+ SECTION: N/A GAIRY CANADY SURVEYING W —
P.O. BOX: 915 CC 3
if:".
�� RICH KINS, N H GHWAY .1
8574{�f • FENDER COUNTY TOPSAIL TOWTISHIP RICHLANDS, NC 28574A.
REVISED 2/6 20OFFlCE:[phone]^ '^" ^„....
B ' DATE:12/2/14 SCALE: 1'=30' FB 295 FAX:[phone]
,� PG MOBILE:[phone]

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Receipts for
Certified Mail
(Staple Here)
3IIto/2o
Date
Pvcunu.
Adjacent Property Oyvner
1o02. Wocd aid Or
MWngAdiresc 2'7Bci3
City,State,Zip Code
Dear Adjacent Property:
This letter is to inform you that I, T'i\ornas Q.QroDmt: have applied for a CAMA Minor
Property Owner
Permit on my property at 110 Ir. R OALt ,in Topsail Beach,
Property Address
Pender County. As required by CAMA regulations, I have enclosed a copy of my permit application and
project drawing(s)as notification of my proposed project.No action is required from you or you may sign and return
the enclosed no objection form.If you have any questions or comments about my proposed project,please
contact me at (3I3-2.1(,-23 ,or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the CAMA Minor Permit Program,you may submit them to:
Jason Dail,DCM Field Representative
LPO,Town of Topsail Beach
NC DEQ/DCM
127 Cardinal Drive Ext.
Wilmington,NC 28405
Property Owner
12iS O hen Or.
Mailing Address
L0 n;"±mAn9, NC- 255352.
City,State,Zip Code
RECEIVED
MAR 19 2020
DCM WILMINGTON, NC

I. . •os a ervice
CERTIFIED MAIL® RECEIPT
Domestic Mail Only
ZJ For delivery information,visit-00.4r l `,e at www.usps.comc.
T1 WI 7 qr.
4 rk' .
Certified Mail Fee $
cc (i3c7
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El Return Receipt(hardcopy) $ t I i•iI!'
❑Return Receipt(electronic) $ $1 I.I II i Postmark
❑Certified Mall Restricted Delivery $ $j)•00 ll Here
❑Adult Signature Required $ $I •1tlt
❑Adult Signature Restricted Delivery$
O Postage ��
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$
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✓ Sent To
a
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City,State,Z/P+4•

,/GI LII YVIYGO•I MG IVIIYnII Ia YGI IGIIIO.
A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail
A unique identifier for your mailpiece. associate for assistance.To receive a duplicate
Electronic verification of delivery or attempted return receipt for no additional fee,present this
delivery. USPS®-postmarked Certified Mail receipt to the
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mportant Reminders: -Adult signature service,which requires the
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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. LISPS postmark.If you would like a postmark on
For an additional fee,and with a proper this Certified Mail receipt,please present your
endorsement on the mailplece,you may request Certified Mall 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.
.R Fawn nano_Andl 91115 fRiathareal PAN 7aan-n9nnn-«u,

f v .
Receipts for
Certified Mail
(Staple Here)
I'(a'/
20
Date
K,m DU.A,xj
Adjacent Pr@ or&
Mail�in9 Address kC
To�sr�� 13>z�kr IJG 28L i5
City,State,Zip Code
Dear Adjacent Property:
This letter is to inform you that I, Q• Ono-arre have applied for a CAMA Minor
Property Owner
Permit on my property at I o (3,orc,j k at/.Q in Topsail Beach,
Property Address
Pender County. As required by CAMA regulations,I have enclosed a copy of my permit application and
project drawing(s)as notification of my proposed project.No action is required from you or you may sign and return
the enclosed no objection form.If you have any questions or comments about my proposed project,please
contact me at q l D- 276-2390 ,or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the CAMA Minor Permit Program,you may submit them to:
Jason Dail,DCM Field Representative
LPO,Town of Topsail Beach
NC DEQ/DCM
127 Cardinal Drive Ext.
Wilmington,NC 28405
Je1)714- Q.43n.1
Property Owner
1215 aw.bar Dr
Mailing Address
Lcvun .6,13, NC, 2S352.
City,State,Zip Code
RECEIVED
MAR 1 9 2020
DCM WILMINGTON, NC

. . •os a ervice
CERTIFIED MAIL° RECEIPT
7" Domestic Mail Only
U For delivery information,visit our website at www.usps.com
-13 Ha , RU Nc ,ift4FA
., CZ
Certified Mail Fee cc cr
$ $� 7c 1�I
-a Extra Services&Fees(check box,add fee r.i ,prate)
❑Return Receipt(hardcopy) $ 1I •I'!'
❑Return Receipt(electronic) $ I I 1_nil l Postmark
❑Certified Mail Restricted Delivery $ $1(�(II( Here
❑Adult Signature Required $ $0 Ill I
Adult Signature Restricted Delivery$
Postage $ill ..cc
,_�
$ 03%1`rr71_20
Total Postage and Fees
$ $6.95
r Sent To
Street and Apt.No.,or Pb Box No.
City,State,ZIP+4e

VGI UIIC%Z nrau WWI Yr4G fir VVRYGO 111G IVIIV111rrrla VGIIGu10.
A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail
r A unique identifier for your mailpiece. associate for assistance.To receive a duplicate
r Electronic verification of delivery or attempted return receipt for no additional fee,present this
delivery. •,USPS®-postmarked Certified Mail receipt to the
r 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
'mportant Reminders: -Adult signature service,which requires the
r 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
r 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
r 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
r 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.
anon A/O..,a.,.,OCR,Cof ,,,,,,o,,.,

Receipts for
Certified Mail
(Staple Here)
3 -1i-2_0
Date
, i-ex
Adjacent Property Owner ' LL9k, Lane
Mq0.enrit 7 4
City,State,Zip Code
Dear Adjacent Property:
This letter is to inform you that I, /4A lei 1-- Vf 5 have applied for a CAMA Minor
Property Owner
Permit on my property at / /-1/4,)k. f `� ,in #tA P
Property Address City/Town
in Pender County. As required by CAMA regulations, I have enclosed a copy of my permit application and
project drawing(s)as notification of my proposed project.No action is required from you or you may sign and return
the enclosed no objection form.If you have any questions or comments about my proposed project,please
contact me at `'ft--1GS .911q ,or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the CAMA Minor Permit Program,you may submit them to:
Jason Dail,DCM Field Representative
LPO,County of Pender
NC DEQ/DCM
127 Cardinal Drive Ext.
Wilmington,NC 28405
roper y Owner
9c Fra i/ 1 ' t-.
Mailing Address
._ J C- ``/-/S
City,State,Zip Code RECEIVED
DCM WWMLMNC-TON, NC
MAR 1 9 2020

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to M A r r F E L.L 1 '�A V l S
(Name of Property Owner)
property located at q S Sea t4it f Law-*-
(Address, Lot, Block, Road,etc.)
on S ► Crts411L , in Pender County, N.C.
(Waterbody)
He has described to me as shown in the attached application and project drawing(s),the development he is
proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
i attu/u��re
/V/-t2C4n dela AA. / i4-i-
Print or Type Name
qr � 762.. - O/ / I
Telephone Number
3//47Zn2._x..)
Date
RECEIVED
"' ,n,,t nn1\.IrTON, NC
DC
MAR 1 9 2020

NC Division of Coastal Management 10 3 9 4 �-.
Cashier's Official Receipt D
Date: A( 2-0
20
0krIA''' 6dzA /00/----Received From: $
Permit No.:
/ Check No.: s2--3
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Applicant's Name: ` "N Y
Project Address: I /I'l a 3(14 (� 1^� 70f,.7,,j
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Please retain receipt for your records as proof of payment for permit issued.
Signature of Agent or Appli nt: Date:
Signature of Field Repres illative. Date:

Date Date Check From Name of Vendor Check Check Permit Rct.
Received Deposited Permit Holder Number amount Number/Comments
3/23/2020 Thomas and same BB&T 1823 $100.00 minor fee, 110 Boryk Ave, Topsail JD rct.
Elizabeth Broome Beach PnCo 10394