78788A_Bucceri, Mary_20201124

✓CAMA / !�rDREDGE & FILL
PERMITA B C D
Previous permit #Wq!�ERAL
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 15A NCAC
M� attached -
Applicant Name IV loZireL-7s
f ,
Address 1110 G } Dr. za
City-iif, h +bp_x Tot i %zk`p StateAl,3 ZJP,Qt-a3Cf
Phone #E-Mail _
Authorized Agent r
Affected CW VEW ✓PTA JES PTS
AEC(s):
OEA HHF lH UBA WA
PWS:
ORW: yes 0 PNA yes G
Project Location: County J
Street Address/ State Road/ Lot #(s) j 9 Alrr f k Q ,ems 1 zp
�-�
Subdivision
City +ko(-,t Skc�eS ZIP a-�q4 9
Phone # ( ) River Basin Aa?&s 4,
Adj. Wtr. Body. G_fr •'TV,Or k _- (9/man /unkn)
Closest Maj. Wtr. Body Cwr - i c c k-
Type of Project/ Activity 12�0 r-� Q. `�" 3L J Esc ke- ti
Pier (dock) length (Scale:
Fixed Platforms) -
Fkaadng Platforms)
Fingerpier(s)
Groin length
CL_A rap length3
avg distance offshore d r
max distance offshore '
Basin. channel
cubic yards
Boat ramp
Boathouse/ Boatlift
j�
Beach Bulldozing
Other
1 _
t
t
�� A } A
cx
@ �JlsE-
i
i
3
Shoreline Length Z 1 o I t�i, '� ( \ C•
SAV: not sure yes'��
Moratorium: 6yes
no'Photos: no � `ti-�� ! Pr
Waiver Attached: yes no Ij
A building permit may be required by: _ 5gy!Jkg, �f e,
( Note Lod Planning Jurisdiction See note on back regarding River Basin rules.
Notes/ S{fecia! Conditions Wei_ jVJ e,..-! 4b =7e a14o?-t a z ,tn Lv - r gl r, lx h s 1
i �bn 591 � fi�+o Since `�c .
5"a^ a— fof-
Grow-- r qc c "CA 20-bef f- Cori,,t�-
Agent or Applicant Printed Name Permit Officer's Printed Name
—, t
Signature �easempliance statement on back of peremit's Signature
L
=4rlr";fir.
Application Fee(s) Check # IssuingDate Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
Mailing Address:
,ecevic
NIty 2 s E21
DCM-EC
. -",
4 vo�
I certify that I have authorized (agent) i to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) Y-A VA12C1 1 M' x 7—$'±2 1 ,
at (my property located at) (q A 10
This certification is valid thru (date)
Owner Signature
,J 10 /3(126
Date

■ 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 mailpiece,
or on the front if space permits.
1. Article Addressed to:
Im mvw
21 w � Du u Lcop
,5baA W Sh�yA1 W Vqqi
A.
X �. ❑ Agent
❑ Addresse
B. Received by (Printed /fie C. Date of Deliver
6 h (\ P I I� 'I //-11
D. Is delivery address different from item 17 ❑ Yes
If YES, enter delivery address below: ❑ No
CeN
Ill'III'IJill I1IIiIIIIIIIIIIIII'II1IIIIIIIIIII O d„kSrvci PeReWictedDelive El ❑Regsteed'MailRetrit
9590 9403 0415 5163 8360 58 ry s
Certified Mail® Delivery
?. Article Number (Transfer from service labeo
7015 1660 0000 6035
❑ Certified Mail Restricted Delivery ❑ Return Receipt for
❑ Collect on Delivery Merchandise
❑ Collect on Delivery Restricted Delivery ❑ Signature ConfirmationT
❑ Insured Mail ❑ Signature Confirmation
1399 Restricted Delivery Restricted Delivery
)C C— -gA11 e.,ai onl R oars 7a,2nso_nnn_oncn - n,,., —c,. o.+�— Qo. i,i

UNITED STATES POSTAL SERVICE
RALEIGH NC 275
7 NOV 2020 PM 3 L
First -Class Mail
Postage & Fees Paid
LISPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4" in this box•
USPS TRACKING#
9S90 94dlt�k'I�iN���illl�,illilliillillillillliilii,

■ 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 mailpiece,
or on the front if space permits.
1. Article Addressed to:
`<6
03n--
II I IIIIII illl 111 l l i l l 11 lilt 11 l it l llll l 111 1 1 lli
9590 9403 0415 5163 8360 41
Agent
B Re eived (Pbnt,Ed Name) I C. Date of Del
V A Nw W
D. I delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
Receivcd
NO 2 4 11.[
3. Service Type � ❑ Priority Mail Express®
❑ Adul $ign'WtB- , ❑ Registered Mail-
0 A il Signature Re8trfeed Delivery ❑ Registered Mail Restrict
Certified Mail® Delivery
❑ Certified Mail Restricted Delivery ❑ Return Receipt for
❑ Collect on Delivery Merchandise
2. Article Number (Transfer from service label) ❑ Collect on Delivery Restricted Delivery ElSignature ConfrmationT
ElInsured Mail ❑ Signature Confirmation
7 015 1660 0000 6035 1412 Restricted Delivery Restricted Delivery
x r,..,,, '1Q11 e..st en1 a o Kl n.,, —f„- aofi— Rcrai nl

UNITED STATES POSTAL SERVICE
P'HIL.A©ELPHiA PA 14
1.2 NOV 2020PM 5 1L
First-Cla.
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+415 in this box•
bY� z7g3�
USPS TRACKING#
'9 90 9403 fUf 1-sl16 1,13�6�i i111���i�f+�llttLl�Fll,f�l,�l�lill

CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERED
'pon Itumlei 11- 00. 20
-7 S �Y1,�VIeW Date Receind
Name of Adjacent Pr
operty roperty Owner NOV 2 3 ! r�"-
(
Address
City, State Zip
To Whom It May Concern:
DCM-EC
This correspondence is to notify you as a riparian property owner that I am applying for a CAMA Minor permit
to tf a, 1nNlkvwAA IrA,if Is J-A 61
on my property at j I N .
in AL
County, which is adjacent to your property. A copy of the application and project
drawing is attached/enclosed for your review.
If you have no objections to the proposed activity, please mark the appropriate statement below and return to
me as soon as possible. If no comments are received within 10 days of receipt of this notice, it will be
considered that you have no comments or objections regarding this project. If you have any questions about the
project, please do not hesitate to contact me at my address/number listed below.
If you have objections or comments, please mark the appropriate statement below and send your
correspondence to: Dabni Shelton / Wes Haskett, Town of Southern Shores, 5375 N. Virginia Dare Trail,
Southern Shores, NC 27949. Telephone: [phone]; Fax: [phone].
Sincerely,
Property Owner' Name am" ' Ca
p m' Telephone Number / Email ddres-
X I have no objection to the project described in this correspondence.
I have objection(s) to the project described in this correspondence.
Adjacent Riparian Signature Date
0k%C.11 Hv�dle✓
21J
(Io 11(a
Print or Type Name
Telephone Number / Email Address

Receind
NOV Q R 2��t
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This map is prepared
from data used for the 19 North Dune LOOP Owners: Bucceri, Mary Jo E Trustee - Tax District: Southern Shores
inventory of the real Southern Shores NC, 27949 Primary Owner Subdivision: So/sh Blk 61-a Lots 26-44 Ph
rJ property for tax Parcel: 022523031 2
• purposes. Primary
information sources such Pin: 986805083516 Land Value: $409,500 Lot BLK-Sec: Lot: 31 Blk: 61-a Sec:
as recorded deeds, plats, Misc Value: $17,700 Property Use: Residential
wills, and other primary Building Value: $339,800 Building Type: Traditional
tiiLr. public records should be Total Value: $767,000 Year Built: 1993
consulted for verification
of the information

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