87164A - Atlantic Telephone Membership Corp

N9 87164 B c D G'
Previous permit
Date previous permit issued
New E]Modification ❑ Complete Reissue ❑ Partial Reissue
As autiorired by the Stalse of North Carolina, Department of Erwironmental Quallty and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC ._..._._.. 17H - t (boo El Rules attached, ® General Permit Ryles avaliable at ttre followkrg Enk: Mm dm eav! at lA les
.City '31"Wtttorte. Stato_(V.L__-_ZIP 4'6101
Pnp # (Q(Q) 70 -'4$i j
Email W.kotdLA- Q A•i-YnC. ChM
Affected MCW OEW MPTA �r�tES ��PTS
AEC(s): �OEA IRA � LOW Ll$PIMA ❑PAIS
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length _�tX,,
Access Length "*
Pier (dock) length
Flied Platform(,)
Floating Platform(s) _
Finger pier(si_ _
Project, Loudon (Courtly): U
Street Address/State Road/Lot #(s)
I.1 — —"
Subdivhion
City --Re4-i.___----
M. Wu.. Body
Closest Mal. Wtc Body
Total Platform area
Groin length/N
Bulkhead/ Rimap length
Avg distance offshore
Breakwater/Sill
Max distance/length - -- - -
Basin, channel
Cubicyards____
Boat ramp
Boathouse/ Boatlift
Beach ��B([u,lldo8n
other5,8( -
1
SAVobserved: yes '
Moratorium: `afar yes no-
--
SRePhotos:-
--
RiparianWaiverAttached: yes
i t
A building permit/toning permit may be required by:
i
(Scale -
Permit Condidons
TAR/PAWNEUSE(BUFFER (dreV®one)
See note on back regarding Rlver Basin rules
See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND RENEWED COMPLIANCE STATEMENT. (Pleaselnitial)
Agent or App'wnt PRINTEDName
Signature "Please read compliance statement on back of permit"
Syoo. O° 3a38i►'i
Application Feels) Check N/Money Order
_ . if !zi'
Expiration Date

©CAMA ❑ DREDGE & FILL
a GENERAL PERMIT
0 New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
N9 87164 0 B C D
Previous permit
Date previous permit issued
As authorized by the S^tate of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC / H , i (boG ❑ Rules attached. ® General Permit Rules available at the following link: www.d .nc. ov CAMArules
Applicant Name A16 n C. Tejcp6oa 1 t lPM1 AuthorizedAgent V ti U Ji A--saGiq;i PA
Address "�. 0. &S-1 3 19 O Al �/1� Project Location (County): l_kO WQM tt
.City skt[ �ig— State NC ZIP OLt`I59 Street Address/State Road/Lot#(s) V 5TQ �1 p' 'A
Phone #(l ram+)'7ST-'M1 WT-s' 4(�"I%'kftn. e LI t zlye'
Email Khb1cE2>` p a+mc co rV% Subdivision'
ubdivision '1 - �^t t...t
City_ 1�4 ex -A Tcr-J ZIP of I9,l4
Affected ❑ CW ❑ EW PTA ❑ ES ® PTS Adj. Wtr. Body Tr `151U it. r!,jt OC LH1. Z(V'er to man/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body L(11if- . 2-Lver
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale:
A building permit/zoning permit may be required by: s1-t'.(VLIc CtNt'^
Permit Conditions.
TAR/PAM/NEUSE/BUFFER (circle one)
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)
�c LtTAt0.
R.Oe.,�iti 1M'BQ
Agent or Applicant PRINTED Name
Permit 0 'eejr's
l�
- AM
RI TED Name_
,(I.
- /�. l
Signature **Please read compliance statement on back of
permit**
Signature
3o3�b�f
�/ /za
V/
Application Feels)
Check#/Money Order
Issuing Date
Expiration Date

,Acwr" KCAMA El DREDGE & FILL N° 87164 A B C D
1) GENERAL PERMIT Previous permit
� Date previous permit issued
0 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
Phone # ( )
Email k c` '
ZIP
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
P
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ pTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale: )
ShnrelinP I Pneth
Floating Platform(s)
Finger pier(s)
6
■ME
No
E
mom
rnC
A building permit/zoning permit may be required by:
Permit Conditions
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ 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
Signature *"Please read compliance statement on back of permit*
Application Feels) Check q/Money Order
Permit Officer's PRINTED Name
Signature
Issuing Date
Expiration Date

RECEIVED
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION JAN 0 5 2024
Atlantic Telephone Membership CorpQa156d°1_EC
Name of Property Owner Requesting Permit: dba FOCUS Broadband
Mailing Address; PO Box 3198
Shallotte NC 28459
Phone Number: 910-754-4311
Email Address: o d e e\- a} r1 C ,Corte
I certify that I have authorized McGill Associates PA
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Installation of telecommunications
(fiber optic) conduit to extend telecommunications services to underserved areas
at my property located at multiple locations
in n County.
4,-, "">
1 furthermorb certify that l 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:
� Signature
t� H01A,,,
Print or Type Name
C� 0 %��ai�) 1"1a ape✓
Title
>n l z l 23
Date
This certification is valid through

■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mallpiece,
or on the front if space permits.
1. Article Addressed to:
Kgr1 D•4-KimbeelyB•Y►1i51iaro
Il 17u1,19 air
HQ+VieW PR i99go-yoW
A. Signature
S. Receivbd by (Pr/nted Name)
D. Is deliverbaN 11114Wr+rtiy(e
If YES, enter delivery ad ress belo
DEC 18 2023
III IIIIiI IIII 1111111111
II I IIII IIII!094
1111111111111111111
IIII IIitilllll II e
Adult
leMRestricted DeliveryEd�®
9590 9402 8314 97937I
O Certified Mail Restricted Delivery
Mm
❑ Agent
C. Date of Delivery
L111111`IM•
us. Postal Service- I
CERTIFIED MAIL° RECEIPT
Domestic Mail Only
❑ Collect on Delivery
2. Article Number (rransidr from service label) ❑ Collect on Delivery Restricted Deliver rU •'
_ 9589 0710 5270 0310 7729 77 estdctedDelivery r` at'iu dr F 9 y!I
r PS Form 3811, July 2020 PSN 7530-02.000.9053 C3 Certified Mall Fee M
r-1 $ 84 • �� 0459
-- n'1 rr9gS,Servicesa ees RheckEo.•, ayyrmec �� (16
O 19faewm gecelot eieNcaoN < 8-
■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mallpiece,
or on the frnnt if snare nprmitc
James G-1-5tephanie Lille
,aa)q -I TRkWrrctn Gri4ln
W I I I is rns4tk, N C a -I V12.
If YES, enteb tIv iyMY below:
DCM-EC
III IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII tedIt Snature ifedMrl1®ReatrietedDelive
9590 9402 8314 3094 9793 31 D Codified Mail Restricted Delivery 07
❑ Collect on Delivery Rl
2, Article Number (Transfer from service label). ❑ Collect on Delivery Restricted Deli 171
_ 9589 0710 5270 0310 7729 60 estrioledDelivery Iti
C3
PS Form 3811, July 2020 PSN 7530.02-000-9053 rq
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RECEIVED
DEC 1 8 2023
DCM-EC

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FOR REVIEW
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FINAL DRAWING
FOR REVIEW
PURPOSES ONLY
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FOR
CONSTRUCTION

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odrWnYl io ownx [lna. Ellmm uYia n[eT ox oorY vaN nE canners YMern wu{ewYNlnwErw {GBYYY NYrEa1GYla YYP waR
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JOKER IMNI M eISE YY T I1E M M M3iM
d Ndl/Y YIwNNfr WIRNI1011WCIQN{iYIATa
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6 WnWFnM WYIdLYN{lYlmllYYmdedanilWlONOmArCµlE4alYd NY 61lRRFONIMY
! pMOYI nNdPYWlN01YPAWOOYFNIOM
1 µ(F#EYYC4 YnhRla rMJN lllNalp aYBiIUCIId OWI Y�Yln0.ID N1d MYT[YRONRY µnaWJiwMRIl64 WlNP Y4lR BT[MAi,NHn
E MTM WOli1 NnSMEN1<d{nKIgNM4FLRlYYYYI@eYNRP®MW01 M10lYillNOYIOrY11 Wml
! YAEIUIdKI YIDMO WlO1 Nl OMPORIRIwMCY wIYOEYIJe:NfAYYIMTYYMPWMIt4wYV
10 rN4aElYICEMd[CTYIfE mEwMMCTM WILY WECr/YWVIF WIRl4dr Y1ENI. M'MilMhY6l
NOTE:
ALL WORK WITHIN NCDOT RIGHT OF WAY MUST BE COMPLETED IN
ACCORDANCE WITH NCDOT SPECIFICATIONS -SPECIAL PROVISIONS
R/W 16A1 FOCUS BROADBAND.
TYPIC,
7I2 vap4a RoYi SW
S4A° 103
m cg i l l 910 bae NC zea°
N, Flan Nwft N C.
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fMQIppOCV01Be.CM11
FINAL DRAWING
FOR REVIEW
PURPOSES ONLY
NOT RELEASED
FOR
CONSTRUCTION
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