86061D - Windham

,301*0WAS rkT�CAMA ❑ DREDGE & FILL N° 86061 A B C M)
I GENERAL PERMIT Previous permit
Date previous permit issued
rrNew ❑ Modification ❑ Complete Re ssue ❑ Partial Reissue 6X6— (% )o? ��
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of enviro en/ I concern pursuant to:
I SA NCACy-M � % GJC--' `' ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name n^n11,`MCKVLfky"1
Address 9���_ 77FJ -1 ✓�
City l,L^�Z%ww} State ZIP
Phone # (_ )
Authorized Agent - X7 l v-v 1 . t \IN
Project Location (County): bs— tLJ
Street Address/State Road/Lot #(s)
Email Subdivision j gyp`
City �J t N" ZIP Z�qC q
Affected y CW �eEW rTfTA ❑ ES ❑ PTS Adj. Wtr. Body �^-, �Q �-` a an/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body mvrs&�
ORW: yes PNA: (bno
Type of Project/ Activity
Shoreline Length zoci
Access Length .—
Pier (dock) length Xe'
Fixed Platform(s) AY-( Z r
Floating Platform(s) 2-q '1c6 '
Finger pier(s) `—
Total Platform area
Bulkhe d/ Riprap length
Avg dista a offshore _
Breakwater ill
Max distance/ ng1
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing _
Other
SAV observed: yes
Moratorium: n/a yes
Site Photos: ye
Riparian Waiver Attached: es
�t - �
A building permit/zoning permit
�m('
Permit Conditions �L-1C/n1
Applicant PRINTED
r .act &0, j
L03'5w
IJ
+ u4L
required by:
CRC RULES AN CON
�,1✓lWC-
FjZ oz— `TZ51 L-r\
THAT APPLY TO THIS PROJECT AND REVIEWED
4-rl)'I
Permit Office
(Scale: IJK'S )
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
%4��
(Please Initial)
Signature **tease read compliance stateme irt�ck of permit**
�- 1SZ.�
Application Fee(s) Check #/Money Order
Issuing
11 z-z 1 z Z

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 ower(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
F-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 Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/ 1-888-4RCOAST Fax: [phone]
(Serves: Carteret, Craven — south of the Neuse River, Onslow Fax: [phone]
Counties) (Serves: Beaufort, Craven — north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District
Wilmington District
401 S. Griffin St. Ste. 300 127 Cardinal Drive Ext. Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax:[phone]
(Serves: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

,o��� c❑DAMA ❑ DREDGE & FILL (:.. �/J N° 86061 A B C -o
GENERAL PERMIT Previous permit
,2� Date previous permit issued
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
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:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Address
City State ZIP
Phone # (_ )
Email
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ IDEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length.
Access Length
Pier (dock) length
Fixed Platform(s).
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
Permit Conditions
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City ZIP
Adj. Wtr. Body (nat/man/unk)
Closest Maj. Wtr. Body
(Scale:
�� ❑ TAR/PAM/NEUSE/BUFFER (circle one)
3 :;its ', w• i
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit" Signature
Application Fee(s) Check #/Money Order Issuing Date
Expiration 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:
1-1 Tar - Pamlico River Basin Buffer Rules
F-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 Manasement 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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: WINDHAM, JASON R CHRISTEN M
Mailing Address:
Phone Number:
Email Address:
5202 TALLEY LN
Wilmington NC 28409
910 367 1877
Jasonw4141 @gmail.com
I certify that I have authorized Southern NC Marine
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
Pier and Dock Construction
at my property located at 5202 Talley Lane Wilmington NC 28409
in New Hanover 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:
Signa ure
Jason Windham
Print or Type Name
Title
Vim/ 3l / 2022
Date
This certification is valid through / /

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completedby owner or their agent)
Name of Property Owner: WINDHAM, JASON R CHRISTEN M
Address of Property,
Mailing Address of Owner:
5202 Talley Lane Wilmington NC 28409
5202 Talley Lane Wilmington NC 28409
Owner's email: Jasonw4141 @gmail.com Owner's Phone#: [phone]
Agent's Name
Southern NC Marine
Agent Phone#: (910) 512 - 7647
Agent's Email: [e-mail]
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 Drovided 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 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/all of the 15' setbacic�_ a / / — i
Signature 2fXdjacent Riparian Property Owner
-O R-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: Coastal Port LLC
Mailing Address of ARPO: 6401 //Pin/e /[ Grove Drive Wilmington NC 28409
004*1
ARPO's em//ail.411M/t?6tlAl A rco�371dYG' ARPO's Phone#: (910) 262 - 7323
Date: (l— 2Z *waiver is valid for up to one year from ARPO's Signature*
Revised May 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 completedby owner or their agent)
Name of Property Owner: WINDHAM, JASON R CHRISTEN M
Address of Property:
Mailing Address of Owner:
5202 Talley Lane Wilmington NC 28409
5202 Talley Lane Wilmington NC 28409
Owner's email: Jasonw4141 Cgmail.com Owner's Phone#: [phone]
Agent's Name: Southern NC Marine
Agent's Email: SouthernNCmarine@
Agent Phone#: (910) 512 - 7647
il.com
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
►' 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 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/all of the 15' setback
Signature of Adjacent Riparian Property Owner
-O R-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name ofARPO: EVANS, SHAWN R KATHERINE M
Mailing Address of
ARPO: 105 Quail Ridge Road Wilmington NC 28409
ARPO's email: SG t!'�hl[ arl�sii�co�h ARPO's Phone#: WO : � 16t l
Date: 6 - 22 *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: WINDHAM, JASON R CHRISTEN M
Address of Properly: 5202 Talley Lane Wilmington NC 28409
Mailing Address of Owner: 5202 Talley Lane Wilmington NC 28409
Owner's email: Jasonw4141 @gmail.com Owner's Phone#:
910 367 1877
Agent's Name: Southern NC Marine Agent Phone#:_ _ (910) 512 - 7647
Agent's Email: [e-mail]
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.
,)_ 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 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, sift, 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/all of the 15' setback
Signature of Adjacent Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: A844 �Lh-�r�� yt t/�..:�tri/fiU�1
Typed/Printed name of ARPO: District 3: Counties - Brunswick New Hanover
Mailing Address of ARPO: 5501 Barbados Blvd Castle Hayne NC 28429
ARPO's email: AL�&tgMtrsztn[�oVARPO's Phone#: (910) - 398 - 9800
Date: 1i j�//1F) - "waiver is valid for up to one ear from ARPO's Signature"
REC I V E D Revised May 2021
JUN 0 9 2022
NC DOT

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June 9,.2022 in CASTLE HAYNE, .NC 28429. .
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1 of 2 6/11/22, 7:44 AM

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New Haicuer Cc,Lnty, NC

Date Received
Date Delwslted
Check From(Name)
Name o/Permk Holder
Vendor
Check number
Check
amount
Permlf Number/Comments
Receipt or Re/und/Reallacated
COlumni
Cdumn2
Cdumn3
Colu-4
Co1umn5
Column6
Co1umn7
Column6
Column9
7/27/2022
7/28/2022
Gregory Holden
Polatsek
United Bank
5639
$ 200.00
GP #85956D
PA rot. 17956
7/27/2022
7/28/2022
John McClure
Dills
United Bank
1104
$ 600.00
GP #85760D
PA rot. 17962
7/27/2022
7/28/2022
American Marine Construction Inc.
Horseman
First Citizens Bank
89783
.$ 200.00
GP #85768D
PA rct. 17957
7/27/2022
7/28/2022
Vann Dean Construction LLC
Bryant
First Citizens Bank
1573
$ 200.00
GP #85767D
PA rot. 17955
7/27/2022
7/28/2022
H5 Construction Services, LLC
Hall
Truist
10144
$ 200.00
GP #85769D
PA rot. 17958 '
7/27/2022
7/28/2022
Tommy Earnhardt
same
Uwharrie Bank
6098
$ 200.00
GP #85774D
PA rot. 17963
7/27/2022
7/28/2022
Devane Family LLC
same
First Bank
1529
$ 200.00
GP #87623D
BB rot. 18080
7/27/2022
7/28/2022
AMW Docks & Marine Construction
Bistarkey
Truist
7301
$ 400.00
GP #87787D
BB rot. 18082
7/27/2022
7128/2022
James Godwin II
Godwin
First Citizens Bank
8975
$ 200.00
GP #87652D
JD rct. 18110
7/27I2022
712112022
Southern NC Marine LLC
Oldham & Jade Holdings, LLC
First Bank
1535
$ 200.00
GP #87653D
JD rct. 18111
7/27/2022
7/28/2022
Southern NC Marine LLC
Windham
First Bank
1528
$ 200.00
GP'#86061 D
JD rct. 18073