85773D-BEASLEY

qt
tjdcaarr. /CAMA 4EDD1RCc IE & FDL L,
Y'N FERAL PERMUT
No 85773 A B C®
Previous permit �0 ® g
Date previous permit issued
New ❑ ModiPcagion ❑ Complete Reissue ❑ PartW Reissue
As authorized by the State of North Carolina. Department of Environmental Quality and the Co eaI Resources Commission in an area of environmental concern pursuant to:
I SA NCAC �He Ito Q i ) t2 go Rules attached. 7,!.1 Permit Rules available at the following link: YPMfff, MX—
Applicant Name Authorized Agent
Addres,XW6 1. 1, _ Project Location (County): W C
City Sate / ZIP �Q Street Address/State Road/Lot N(s) �Ol44
Phone # ( ��
Email Subdivision
city ZIP --
Affected ES PTS 4 Adj. Wtr. Body 1 ww/ unk)
AEC(s): ❑ OEA ❑ INA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body Al, M
ORW: yes4o PHA: yes4q
7ype,(off Project/Activi/ty 0 *% l N (Scalle: fir,
Shoreline Length 01,97b "
Access Length tg/ K-birt4 tp
Pler (dock) length i
Fixed Platforms) t�
Floating Platform(s) iL
Finger pier(s) T+'F*bo
Total Platform area
Groin length/N _,,./,,,�
Bulkhead/ Riprap length a3 'rows
Avg distance offshore
Breakwater/Sill �
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
89athos9e�oatli
Beach Bulldozing
Other Rek�b�lt
SAVobserved: yes all Kht
moratorium:
es ® 7WY�°
p --
—
Montorium: n/a yes w�
Site Photos: y
Riparian Waiver Attached: Q no *tAw
A building permit/zoningAermit rVv be required by:odds 4
I%g06 4"St"
I AM AWARE OF STATUTES CRE RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED C.
LC`✓/S � c3t�-s �y
Agenp Applicant PRINTED Na?e? Permi fftc is
tYG r
Slgnature *'PI se�ad Wnpliance statement on back oPpermiq�°9� / Signal
/ ��
L//i O_— c7`
Application Fee(s) CheckN/Money Order Issuing Date
J a/ A
97104 W. UC**
&trD,/t 4L wAtv-r 2-Q t Ch C tt'')
TAR/PAPVNEUSE/BL3FFER (circle one)
See note on back regarding River Basin rules
See additional notes/conditions on back
Initial)

`°AS'4`N /CAMA V DREDGE & FILL N9 85773 A B C 0
Previous permit so 10 g D
9ENERAL PERMIT
� Date previous permit issued
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the7C,tal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC 07MI 0 tol �v ❑ Rules attached. eneral Permit Rules available at the following link: www.degnc.gov/CAMArules
Authorized Agent IV/T
Project Location (County): W
it
Street Address/State Road/Lot #(s) SCL**J.
Affected ❑ cW dW XPTA A VPTS Adj. Wtr. Body Al Ww`,�,�/ (q %man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ElPWS Closest Maj. Wtr. Body Al ""_ ((//
ORW: yese PNA: yesA9
Type of Project/ Activity hposd70 ma J
fins Aid. &;V1 m�
—r
Shoreline Length(.
Access Length CAI16-M
Pier (dock) length 4rl V1 4 T�1 W_ L
Fixed Platform(s) -6161
Floating Platform(s) 1VXr0 k4qAt
t:
Finger pier(s)
v bt
Total Platform area t
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel �-
Cubic yards4111
Boat ramp '•�
BCMS,,rse oatli Jr 8
Beach Bulldozing l�?T� `6"'. I
Other iq,�ib� C
.�
-i.. �r. T • •- • ww `P
.0
SAVobserved:
yes
® o�? � WaIlls�
Moratorium: n/a
yes
/a4�'�
+t ,'ldl.+O+tk
Site Photos:
yes
4] 08 W'
Riparian Waiver Attached:
Q
no y*kAW
0 (36 lk"
A building permit/zonin
ermit m
be re ire d by: ?Ida
- if/Q.; w
Permit Con itions
7
/r%
t
T
=
I AM AWARE OF STATUTES. CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND RE%
Agent or Applicant PRINTED Name
•
..2 ai
Met
s
(Scale: Nl'- )
ri'&r&J'4L
a7 N.�larf�#-
wcuvcr awn}c�'`u�`
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
.� �� ❑ See additional notes/conditions on back
Initial)
Signature **PI se repliance statement on back of permit** Signa" t r
1A ,6/9 ! �
Application e(s) Chec c #/Money Order Issuing Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit conditions. Any violation of these terms may
subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for
compliance. The applicant certifies by signing this permit that: 1) prior to undertaking any activities authorized by this
permit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the
local land use plan and all local ordinances, and 2) a written statement from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
F-1 Tar - Pamlico River Basin Buffer Rules 1-1 Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules
for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the
NC Division of Water Resources. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST Fax: [phone]
(Serves: Carteret, Craven — south of the Neuse River, Onslow
Counties)
Elizabeth City District
401 S. Griffin St. Ste. 300
Elizabeth City, NC 27909
252-264-3901
(Serves: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford,
Pasquotank and Perquimans Counties)
Washington District
943 Washington Square Mall Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Craven — north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: Z,5b - 4+g �� f
Address of Property: ��
Mailing Address of Owner: C) IS Lfi�N� d-� C- 2-S
Owner's email: baLig ;1) LOoL e is MA1L O ner's Phone#:
Agent's Name: Agent Phone#:
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing. A
description or drawing, with dimensions, must be provided with this letter.
b< I DO NOT have objections to this proposal. 1 DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 127 Cardinal Drive Ext., Wilmington, NC 28405-3845. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed 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
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some II the 15' setback
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
L-,4
✓4Pq
- 07-zegW1*^)
Mailing Address of ARPO: ';LT)
y
LJ
LI/4Cf/ T 1-),Z. Oq I,- 5� • /�/L ZB y��
ARPO's email:
ARPO's Phone#: Oi IV - G 1 Z 4 L3
Date: & -1 G - 201.2 *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
_. ..(Top portion to be completed by owner or their agent)
Name of Property Owner: /! (^ W lS
Address of Property: ���� LA)- `NC-)-�-r 1Jr%Ll VE
Mailing Address of Owner: aq
Owner's email: 0$y6A 2L0JL(D(5 IAt4•CC"'bwner's Phone#:
Agent's Name:
Agent's Email:
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing.
A description or drawina. with dimensions. must be'provided with this letter.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 127 Cardinal Drive EX% Wilmington, NC 28405. DCM representatives can also be contacted at
[phone]. No response is considered the same as no objection if you have been notified by
Certified Mail.
WAIVER SECTION J VI
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse01H,or groin fop
must be set back a minimum distance of 15' from my area of riparian access unless waived by me (this
does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign the
appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property Owner (ARPO)
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO::},� 1�d9LC [�j%j Ldl� v Q
Mailing Address of ARPO: Y- " • gD 75 L %��%�1�%�t i 2/ .?3�
ARPO's email: ARPO's Phone#: / t 0 O`�]
Date' -?waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

In
r r.:
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: _� �fLIc 6 - Jq 14 r'v ✓14 /*"'
Mailing Address: ?� LA e, /q- K c D g ► L'�
Phone Number-
Email Address: 04 ( Z 0—
I certify that I have authorized Zat s Z I
Agent f Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: EL014 T IA, L- -)Dr,)C4C
_,*1,2�_11 i (LT Z2_
at my property located at C'�A SLi+J JAL
in />J"04�"jCL! County.
/ furthermore certify that 1 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:
4d
Signature
n (I
Print or Type Name
Title
2 L- 1 20 ZZ,
Date
This certification is valid through I I

CAMA / DREDGE & FILL N9 80108 A B C [
GENERAL PERMIT Previous permit #
New Modification Complete Reissue Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
L Rules attached.
Applicant Name 1(),4 .ij! t GI Project Location: County QYX, 'v!t
Address Q► Q% C Street Address/ State Road/ Lot #(s)
city state ' " zip a� =7.:2 3 `� (—_..e f✓�
Phone # f }
( ) . �'` �1ail Subdivision
Authorized Agent -101 d If`10"ri' City if I �,✓ —� zip _ SQ C
Affected `JCw LgEW IX PTA ES PTS Phone # ( ) River Basin
AEC(s): 1 OEA n HHF O 1H UBA N/A Adj. Wtr. Body ( vV U'
PWS.
/
Closest Maj. Wtr. Body
ORW: yes / no rNA yes
Type of Project/ Activity
(stele: � 5
Pier (dock) length .t ig _ _ -_ _
Fixed Platform(s) t 'e 1 l -1 �_ / _J.
`
Floating Platform(s) t } , 1
Finger pier{s)
+ j
Groinlength
Bulkhead/ Riprap length I
avg distance offshore
max distance offshore � � i I
Basin, channel j r y 1iia f
cubic yards
Boat ramp t
Boathouse/ Boatfift
Beach Bulldozing
Other
Shoreline Length _
SAV: not sure yes no . .
Moratorium: n/a yes no i
Photos: yes no
Waiver Attached: yes no -- —• -- —
A building permit may be required by-
( Note Local Planning Jurisdiction) 1 �/
Notes/ Special Conditions
,
177,-
Y)OR 7(, �
See note on back regarding River Basin rules.
4 -.
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit "*
Permit Officer's Printed Name
rr �
Signature

1h
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAiVER FORM
Name of Property Own
Address of Property:
(Lot or Street #, Street o Road, City & County)
Agent's Name #: JI)eJi ""' t� ailing Address:
Agent's phone #:
ere y certify that I own property a lacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions must be orovided with this letter.
I have no objections to this proposal �— ___ I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at http •/lwww nccoastaimanagement net/web/cm/staff lisilnp or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.
(Property Ow ne. for ' tion
Signature
tc
. tu- .Q
Print or Type Name
Mailing Address
City/State ip
�� OEiJ v0(3B
Telephone Number / Email Addre
�l
Date
(Riparian Property Owner Information)
Signature
_ U vn= acne i+�+G-.•.
Print or Type Name
Mailing Addres 1e
city/State/Zip
Telephone Number / Email Address
W424--
bate
(Revised Aug. 2014)

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Own
Address of Property,
(Lot or Street #, Street o Road, City 8 County)
Ai 1XZJVVJ4 ailing Address: 170
�--
Agent's Name #:
Agent's phone #
hereby certify that I own property adjacent to thg above referenc-ed-property. The in ivi ua
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
I have no objections to this proposal. --V/— I have objections to this proposal.
if you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at http://www.nccoastalmanagement.net/web/cm/staff-listing orby calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.
zI do not wish to waive the 15' setback requirement.
(Property Owne,,Anfor91htion
Signature
Ali Gf�10
Print or Type Name
Mailing Address
CitylState ip
3.3 - o�
Telephone Number/Email Addre
T_
Date
(Riparian Property Owner Information)
Signature v
AJ e T vla
Print or Type Name
� y 7 7 guzij7
Mailing Address
h�fGi-�u�n, )VC &'?37
CitylStatelZip
q/0 - t 7 y " OW --4+,p (,/7ffr f"I
Telephone Number/Email Address
5-�
Date

CAMA / DREDGE & FILL N9 80108
GENERAL PERMIT Previous permit # A B C `
. New Modification Complete Reissue Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality Il -} 1
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC i '
Rules attached.
Applicant Name j (J>ii t �( iProject Location: County 0i<i,09'1,-
Address ++ t 4 Street Address/ State Road/ Lot #(s) —
City State ZIP A' 93 ` . _ .�4 `
Phone # (M ) Z E-Mail . Subdivision
Authorized Agent' ?r� / i i cA t _� City AA �11rVul ZIP
Affected CW EW RiPTA DES ©PTS Phone # ( ) ,� � River Basin r+`fl' _—
OEA HHF D IH D UBA DNA
�'
AEC(s): Adj. Wtr. Body �� VY ..(nat /man> Jun
PWS:
ORW: yes / no PNA yes / no? Closest Maj. Wtr. Body :`�
Type of Project/ Activity _ S f
( • 10
Pier (dock) length j �O k
Fixed Platiorm(s) , f
Floating Platform(s)
i
Finger pier(s) +--
1 ,
Groin length
-- r
number
I
Bulkhead/ Riprap length I _ _ } + y _ l
_—
avg distance offshore j a
2 _
max distance offshore 1►
Basin, channel — # p t
cubic yards
Boat ramp
Boathouse/ Boatlift f x i T }__{ _- #,�_ f___ _+-.4
E
Beach Bulldozing _
_ I
Other
i
Shoreline Length
SAV: not sure es no +
Y
Moratorium: n/a yes noi11 i
Photos: yes no ;. , y'a(titt"t 1,
Waiver Attached. , yes no -_
A building permit may be required by: f L_J See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature "' Please read compliance statement on back of permit 00
Per4mkOfia�, 1' (Cli.-{, ! _ —
%s�jP,rinad Name

1b
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Owner:
Address of Property: � I L/W V UL ' o
(Lot or , Street #, Street o Road, City & County)
Agent's Name #: PJn�' ailing Address:
Agent's phone #: �11C� a3
ere y certify that own property adjacent to the a ove referenced --property. a indi ua
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description ar drawina with dimensions must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
if you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at http•I/www nccoastaimanagement net/web/cm/staff-listing orby calling 1-888-4RCOAST.
No response Is considered the same as no objection it you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.
(Property 7 forplAtion
Signature "
G� a
PrinMore Name
Mailing Address
CitylState ip
Telephone Number / Email Addre
Date
(Riparian Property Owner Information)
Signature
rti+Q+31
Print or Type Name
Mailing Addres
City/state/Zip
Telephone Number/Email Address
Hate
(Revised Aug. 2014)

CAMA / - DREDGE & FILL N9 80108 A B C [
GENERAL PERMIT Previous permit #
New Modification 'Complete Reissue EPartial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Rules attached.
Applicant Name Project Location: County �} ► `'' `.a' ' L lit
Address ai Q% ( _ _ _ — Street Address/ State Road/ Lot #(s)
City / tt 4-d� State _ZIP �� 3 `f - �- Y!0
Phone # ('r:') 3 �_ E-Mail Subdivision
li" Authorized Agent �j /1'1 G� ' . ; �,
Affected J CW (4 EW ® PTA ES PTS
AEC(s): 71 OEA 0 HHF 0 NI L. UBA N/A
PWS:
ORW: yes / no PNA yes / no
Type of Project/ Activity
City c t 5_(r,i _ ZIP
r
Phone # ( ) River Basin
Adj. Wtr. Body R(Yv th nat' man -Ln
Closest Maj. Wtr. Body
-- -- - — (Sine:
Pier (dock] length • -i k (1
Fixed Platt
Floating Pla
Finger pier
Groin lengt
numb
Bulkhead/
avg di
max
Basin, than
cubic
Boat ramp
Boathouse
Beach Bull
Other
Shoreline I
SAV:
Moratonu
Photos
Waiver At
tform(s) _
h
distance
t r
t`�
F
p►
t
er
i
�r
Riprap length
stance offshore
{J1,
offshore
nel
,..
yards
f,
tJ -
Boadift
J
iozin
y
-
-- I
,
ength
not sure yes no
•
n: n/a yes no
414,
yes no
4
..
i (..
Y 54 YO 01,
(VA ird
%f it
ached' vPc nn _.
._.. �.._
__
A building permit may be required by: 7,-444J d'pi See note on back regarding River Basin rules.
( Note Local Planning jurisdiction) //
Notes/ Special Conditions / ( + '�, lJ 711 � lac,
Agent or Applicant Printed Name
Signature " Please read compliance statement on back of permit **
Permit Officer's Printed Name

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:
(Lot or Street #, Street o Road, City & County)
Agent's Name #: In' l,,�/ ailing Address:
Agent's phone #:
ere y ce i that own property adjacent to the above reference property, The in ivi ua
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A escri tion raw with di a sions ust e o d d t is letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at htt ://www.nccoastaimana ement.net(web/cm/staff-listln or by calling 1-888-4RCOA S T.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.
(Property Ow nefj�n=orti
Signature
� Q
Print or Type Name
/�
Mailing Address
City/state/Zip I
Telephone Number7EMail Addre
�l
Date
(Riparian Property Owner Information)
Signature
Print or Type Name
Ma71inftddt��
City/State/Zip
Telephone Number/Email Address
Pate
(Revised Aug. 2014)

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: d.�fJ-
A _
Address of Property: c�./ IvW ww t to, tin
(Lot or Street #, Street o Road, city & County)
Agent's Name #:/%G°� / r 1Failing Address:
Agent's phone
hereby certify that I own property adjacent to Me above -reference grope e m ivi ua
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be provided with thi letter.
T have no objections to this proposal. 1 have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices Is
available at http://www.nccoastalmanagement.tiet/web/cm/staff-listing orby calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.
(Property Owner,4pfor¢tiation
Signature V
- & 0 6sak.
Print or Type Name
Mailing Address
City/State ip
:31p- :i233-�
Telephone Number/Email Addre
(Riparian Property Owner Information)
A,/,
t ature
T
Print or Type Name
y 7 7 4u)T k,7 E
Mailing Address
I-,cfGi-�bu�n, )/(- ARU7
City/StatelLip
q10 - t 7 y " OGaq d14fP(,17tfmA1
Telephone Number / Email Address
Date
Date
A- INA4AI

t� t OFFEit'fi0 . U :CHL _5E A- _D C'+Ol�'r �,.�CI'= �_C1 LOTAA .� �c
1 -t
'r€ ICA -rise "Ga1 » (1 7 12G) I ' gNiI i ew Aed g 4 • fiw
is moo ed for tt�d property that Buyer will pumbaie only for' per�onid -01act does . ,hare
oc�ia *p It Sbi)UW not
be USe d to sell property that
is being unless dae •, �s`;b� :p
�=d n cmW w & tip m&W of &e& as of tfie daft of tire, . If •Wer is
iL
of a new single f aaity dwelling prior to cWn& use ilk sad Offer tea
+� .-.t A a� �;.-.i,t•�,.. - , i a ,� .,<•-.,� � tyj� a ;,�" _ , r.-
Foa� or, if the consviuc6m,is campleteA use the C1tI`ei to, PwvhUt and Contract (btu �� '�%� ►'
valuabsic ode[st! tie 1EOG1 and w OerS to L and SrllEer .
an, Pt kgal sufficiency of which arc y aclrno lodged, Sayer-
Q." . yg q to seU and convey the Prouty on the t aqd conduit= of this Offer TO Purchase and f~ 4mrt t and any
tcmoficatina madc is with its terms (toot
TER
ND DEFIlNI'i ON& Ile temis lusted below- a6f the mean ng ghnn therm as set foRl�
Lms: G.
' TTodd J Su rratt
w
�+ Prvpafiy':Jhe Prey shalt include all that real estate bed below together with aQ appartenances thetrta.mch�cGuag
fihie• —M tatted thereon.
i D"fE: Iif'ttac; I't etty, :will linclude a manufactured (mobile) home(sl Buyer a6d'�Seller should ooc7sider udirtg the
(mob
oixle Home ' ' the Additional um l SWxhW form 2M I -T} w itl� the
} p vts�on m ional Provisions "Addend ''. ; e,�,
rn
� �.
.. ; . .. 1846
1� ortl! CalPOt111a
. why _j�.'+ � ULt: ' i•-Mr•'
authcrcity.over taxes, :i64 ig, Khoo districts, utilities and mail delivery may dii�'er frxxti ad�°i�wwn.
'Tstf`gtto�i,tGptetiAt aipphcatit
���C .�'iOCty[kfl ' , �11 1+1P1SfplL`��11 �11Ufn
P}atc1�ex+ec$.,3llh t.
?lat of n CPM),
Pi cxthes' id�ntiii� on tsumhe lnCtfie lips �3 i �x;7q� N�r�r�� , ��► n.� : t '' Y�•
R
M.
ne r�r :fit cult t'rtxity n} 6r �i�.-ra`tn 1'+ Bixrlc'127 .. ;at'lape '1249
ti•r ..

Defa R—W-d
Dale Deeoaltod
Cheek From Neme
Name ofPermlf Nokler
Vendor
Check number
Cheek
mount
Permk NumbedComments
Recel t w RefundlReallwated
Columnf
Column2
Cdumn3
Column4
COlamn5
Columns
Columnl
Columns
Cafe-9
8/9/2022
Lewis R. Beasley
Beasley
Truist
3619
$ 600.00
GP #85773D
TP for PA rct. 17546
8/9/2022
H5 Construction
Edwards
Truist
10184
$ 600.00
GP #85938D
PA Mt. 17960
8/9/2022
McPherson Marine Services
Eichorn
First Citizens Bank
5255
$ 200.00
GP #85771 D
PA rct. 17964
8/9/2022
_
AMW Docks & Marine Construction
Shepard
Truist
7204
$ 200.00
GP #85929D
BB rct. 18095
8/9/2022
Geoffrey Ricks
JMSM Holdings LLC
First National Bank
2039
$ 200.00
GP #87680D
PA rct. 17967
8/9/2022
H5 Construction
Stars & Stripes 2B LLC 1 of 2
Truist
10143
$ 200.00
GP #87795D
BB crt. 18084
8/9/2022
H5 Construction
Stars & Stripes 2B LLC (2 of 2
Truist
10165
$ 200.00
GP #87795D
BB rct. 18084
8/9/2022
Wallace Cox
same
First Bank
1385
$ 400.00
GP #87617D
BB rct. 18091
8/9/2022
Grice Construction
Stroud
Truist
11299
$ 200.00
GP #87402D
BB rct. 18092