74381D - Burns

i AMA / 7 DREDGE & FILL No. 74381 A B C Q°
q!ENERAL PERMIT Previous permit #
New Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality Q^ i' ��
and the Coastal Resources Commission in An area of environmental concern pursuant to 15A NCAC j�
` ❑ Rules attached.
Applicant Name L1 e v n Project Location: County/•+.. L w
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Address oC�JaV Street Address/ State Road/ Lot #(s)
City �cf n State PC, ZIP
Phone # O a�i `}(021 E-Mail .r+u�� co..., Subdivision
Authorized Agent U k J(_ j a S C
Affected ❑ Cw *IEW MTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ElHHF ❑ IH ElUSA ❑ N/A
❑ PWS:
ORW: yes / fib, PNA yes /
Type of Project/ Activity
City ZIP ,2k4
4r Phone # (IL0 )5W Gy 10 River Basin ( ,,A,��
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A building permit may "b� required by: Tk, r, Hole:
( Note Local Planning Jurisdiction
Notes/ Special Conditions / "tt((,`
ITN L,.. kA lu.\1 n..� mil._ �► ..u._� �r.na.,
iok
Agent or plicant Printed ame I '
Signatu *`* Please read compliance statement on back of permit **
/ oar—, I "J--
Applicatio ee(s) Check #
❑ See note on back regarding River Basin rules.
Ilk
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PermitOffi�jName
-ram
Sjgnature ,
Issuing to E piration Date

Name of Property Owner Requesting Permit: Terry & Cheryl Bums
Mailing Address: 2020 Henniker St
Apex, NC/L27523
C'� /
Phone Number: / � q--
Email Address: [e-mail]
I certify that I have authorized Joel Klass
Agent /Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: install boat lift
at my property located at 150 Martin Dr. Holden Beach ,
in Brunswick County.
I 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:
Signature
Print or Type Name
J/--
Trtie
-71 '
Date
This certification is valid through �'L 13/ LZ�—

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT 14
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM t
Name of Property Owner: Terry & Cheryl Burns
Address of Property: 150 Marlin Dr Holden Beach Brunswick
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Joel Klass Mailing Address: PO Box 279
Agent's phone #: [phone] Supply, NC 28462
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 tetter.
_ 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 httpJ/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 Certitled 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 I
Signdfiire
Print or Type Name
2020 Henniker St
Mailing Address
Apex, NC 27523
City/StatelZip
Telephone Number/Email Address
Date
(Riparian Property Owner Information)
a-x4,--
kgp;atu�re
Joseph & Sallie Callahan
Print or Type Name
31 East Tecumseh Ave
Mailing Address
Strathmere, NJ 08248
City/State/Zip
Telephone Number/Email Address
19
Date
(Revised Aug. 2014)

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: Terry & Cheryl Burns
Address of Property: 150 Marlin Dr. Holden Beach Brunswick
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Joel Klass
Mailing Address: PO Box 279
Agent's phone #: [phone] Supply, NC 28462
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 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://www.nccoastaimana-gement.netlweb/cm/staff-listing 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 Owner Information)
Signature
Terry & Cheryl Burns
Print or Type Name
2020 Henniker St
Mailing Address
Apex, NC 27523
City/State/Zip
Telephone Number/Email Address
(Riparia o e er Information)
s' t re
Cohen Realty Inc
Print or Type Name
PO Box 545
Mailing Address
Norwood, NC 28128-0545
City/State/Zip
Telephone Number/Email Address
Date Date
(Revised Aug. 2014)

I
--21V

Date Received
Date Deposited Check From Name
Nama of Pormh Holder
Vendor
Check Number
Check
amount
Penult NumbenLomrnents
Racal t or RetunWReallocarod
Columnl
Column2 Column3
Columnd
Columns
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10/18/2019 B & J Construction of NC/Joel Klass Terry and Cheryl Burns BUT 2092 $ 200.00 GP 74381 D BB Mt. 91020D