Dewayn Holt 72811D

�
/Y4CAMA / —DREDGE
& FILL No. 728 ' '
ENERAL PERMIT Previous permit# A B C D
)C New _Modification Complete Reissue -Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality j l V , / 1
and the Coastal Resources Commission in an area of environmental concern pursuant to I5A NCAC U v V
E `n ;/( t �'n❑Rules a ejd���
Applicant Name V`�(/� �� ��11 Project Location: County ✓' Y l.• 'y"
Addre c ;,./(s.
\ StreetAddress/StateRoo/a�d/�Lo�t#(s)
City A>C) l / State ZIP 69@- Lot-3tf` ()L` !'" -� )3 Y .
Phone# IP),iO V - E-Mail Subdivision ��
Authorized Agent fl'i[iiit 1 C�� City�� ,cl. t\ _ ZIP (/`
Affected CW ❑EW ❑PTA ES ❑PTS Phone# (__ ) River Basin
OEA ❑HHF ❑IH UBA ❑N/A Adj.Wtr. Body AilV\.i VV (nat" /unkn)
PWS: W Y VJ
ORW: yes / no ) PNA yes no Closest Maj.Wtr. Body
Type o Project/Activity1 �1 Y `p w �tt6 J V�(/�1 V VU i 0\r(
�V/�U� � attmold ��(t eQ Q tyoitA.0 (Scale: ( -ZU
)
1--
Pier(dock)length r
Fixed Platform(s) .■-111■.■ MIMI MIM■
Floating Platform(s) r 1 1
1
1 ,
Finger pier(s) iq'
Groin length
number
Bulkhead/Riprap length ( I
avg distance offshore
max distance offshore
Basin,channel
cubic yards
Boat ramp lil „.
Boathouse/Boatlift t
Beach Bulldozing i {
1 j /
Other �0 ' x ab/j i , t / , 1 I 1 v` i
NblikVAI
� _ ( IHhI1 & IIIiirlpfl-"V ;
Shoreline Length
s n !i!4I; r, __
Moratorium: n/a yes � 1,■■-'/,-�b� ` � & ,,Photos: yes A11111
i Waiver Attached: yes n 1 k♦ I •PIV , {, L_
i
A building permit may be required by: •IV O • t!�l�{J Y I / �Y 1 f • n See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) ,/ rA( In 1-n 4,�/ �J� p
Notes/Special Conditions VA_ aCk \ 11\�Y! � Y Jl OVA, ,a \V V,,(,Y 1J .�1\\ ,„
o \� 11\-v id �VA 0 1
1
..kJ ivirsILI
vk i'l yr
Agent or Applicant rrinted Name PermltOfficer's Pnn ame
Si 'I`Please r d compliant a ment on back of permit Sigta ure /
Application Fee(s) Check# Is ing D to Expiration ate

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: De c,1k/y] /'Id!r
Mailing Address: - -FlT
Phone Number: 33 P 331 - J)O
Email Address:
I certify that I have authorized //I eU
Agent/ Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits //
necessary for the following proposed development: -Z/!f/�� , nJ hjk4 0/
,; e-7 lie e 041416t 744 16) aetil
at my property located at oZ f�d9 ��5r? Y Olr'
in 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:
�v7
Signature
£c "i rr (y ///-
Print or Type Name
OUP
Title
l
I 1 )5 I a 019
Date
This certification is valid through 6 / /5 I cOI1

ADJACENT RIPARIAN PROPERTYER OWNER STATEMENTl �
I hereby certify that I own property adjacent to Z% 0jf L_ A k �� s
v N`ame of Property Owner)
property located at C980 . ! Ids •
�- (Address, Lot, Block, Road, etc.)
on .� r\k-ra-CO�� . in OW I i 0 r , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatior>.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
) 1 y
ago Eat a o(o
Y04
WAVER SECTION
I understand that a 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. (If you wish to waive the setback, you must initial the appropriate blank below.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Infor. ation) �(Adj nt Property_?wneformation)
VIP- op-
Siggnnanir Signuti•e*// /l' n
f12, '+ c��tti . l L rlil �
Print or Tye Name Print or Type Nae
cAvi .\1adk/P,o Box �T34 ��;z oui-cta 2 �
ailin d:Vs �84(a5 Mailing Address,
Cit /State/Zi ip
3�3(,- 3 9 -ggio a �—`� � —� g773
Telephone Number/email address Telephone Number ail address
Date Date*
(Revised Aug 2014)
*Valid for one calendar year after signature'

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to peaik`f c 140L-r 's
(Name of Property Owner)
property located at 2804 6. vAG6(7- I6If ILL
(Address, Lot, Block, Road, etc.)
on j/s4 p2A CAttiS rTV . , in ( AQ ESLI.-16 IBC- , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
Ai I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
Wed I
—� 1 ,tn1,,, � 0
-,.-
/ c6U x_)/ 0
/...._
'----------_______..(
\1G, WAIVER SpCTION
I understand that a 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. (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 Infor ation) (Adjacent Property Owner Information)
�. e 4- �o I. sekA
nature 1� Signature'"
n t or Type Name Print r Type Name
O if E. Yam D C o ,Sox 73t P.6. Ac x
Li-
ryz_p A Mailing Address
ldsp
- � kJ C a8 �S etc rs �c.ZS'
'aj�tel, ��O O City/St?Zip
o -a Co r) ` d�j'ZZ
Telephone Number/email address Telephone Number/email address
Date 0- 56 -19 i2;30—`8
Date*
(Revised Aug. 2014)
`Valid for one calendar year after signature*