74379D - Cole

$,CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
KNbw ❑Modification ❑Complete Reissue ❑Partial Reissue
No. 74379 A
Previous permit #
Date previous permit issued
C O
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 in '7 N j 2 O C)
❑ Rules attached.
Applicant Name ,12 V C O t,{c Project Location: County B;Z,&, / 5 W I C K
Address 521 N MAi.✓ 5-r Street Address/ State Road/ Lot #(s) /Pq
City --I�L0V State ZIP 2737/ ►�/—S� -
Phone # 0102 ZO - D471 E-Mail cow, Subdivision QQ /V/A
Authorized Agent MA^fT 114ow City. e c ZIP 2 X *& 2
❑CW
XEW
)(PTA El ES ❑PTS
AnE:,v'T Phone # (9L0) S$0 - 5231 River Basin LLkmemrt.
Affected
AEC(s): ❑ OEA
❑ HHF
❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body C' 4,4 A iL (nat a� /unkn)
❑ PWS:
W
ORW: yes /
PNA
yes /�
Closest Maj. Wtr. Body A I W W
Type of Project/ Activity ::r Al V r A t t_ IC w n o A; 4-1 EL Tee
Fing
Groi
Bulk
Basin
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Boat
Beac
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A building permit maayl be required by:
( Note Local Planning jurisdiction)
T� WN o>: No t4> Ewi �E A G►1 ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions -_!j H. 2 O O A Ltr n-n-1 e i--- F-y- o f T,- D L
S%TF & LD CAL- RE CGu I-A-riQW S 4PP01
Agent or ApplicAt Printed Name
Signature ** Please read compliance statement on back of permit **
$—�70o AW 2 375
Application Fee(s) Check #
yI,ER- 9C-67 R�
Permit Officer's Printed Name
Signature
/d /24 / Zia 19 t24020
Issuing Efate Expiration Date

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CONSTRUCTION
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7
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Holden
PROJECT: 107 Durham St., Holden Beach
----------------------------------------------- Durham St. ------------------------------------------------
Not to scale

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit
P
Mailing Address:
Phone Number:
Email Address:
_J
I certify that I have authorized H5 Construction LLC
Agent /Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
�owu � (�i— IA504
at my property located at
in �(a)P.9WIda, County.
J 6 4 11�k vK&1,1t S+
l 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:
signature
Print or Type Name
Title
/ /
Date
This certification is valid through / I

I hereby certify that I own property adjacent to _ OIL s
O� � u � � � � Na a of Property Owner)
property located at
(Address, Lot, lock, Road etc.)
on �. % CL,( in A A,— , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
lacatio .
I have no objection to this proposal.
1 have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
I
'VA,V V e, "� l�lSl� 1 V`�t� D t,� 1 l Ll�� t^ W41 VC 5
,. Cs3�� I�o�e W�t
.ems
ro eyj
tin Aru-� ,
WAIVER 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.)
N)�— I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Prope Owner Information)
Sijnaltn c� Signature*
Print or Type Name Print or Type Name
A a r a l ovy s
Mailing Address Mailing Address
T Pq V z "I14,
ylst elzip City/State/Zip
Telephone Number / email address -- Telephone Number / email address
Date Date
(Revised Aug. 2014)
`Valid for one calendar year after signature*

I
I hereby certify that I own property adjacent to J Lim �4 �- 0 1 C- _ 's
I O,:� ID u V Y `(k M Sf1w6, of Property Owner)
property located at
(Address, Lot, lock, Road etc.)
on Gl, h D—] , in &A,,.. EZS7� , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
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)
WAIVER 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.)
I do wish to waive the 15' setback requirement -
I do not wish to waive the 15' setback requirement.
(Property Owner information) (Ad -scent Property O ner Infor ation)
wrt,—J—J-1�6, —,I--
Sigmrni e Sig Pure*
Print or Type Name Print or Type Name
Mailing Address Mailing Address
City/Stal(Zip City/State/Zip
Telephone N mber / email addre s Telephone Number/ email address
Date Dnten ~
(Revised Aug. 2014)
°Valid for one calendar year after signature'

Date Received
Data Dmosited
Check From Name
Name o/ Perm(( Holder
Von"
Check Number
Check
amount
Permit NumberlComments
Receiot or Ref urM/Reallocated
Column!
Col~2
Column3
ColumM
Columns
Column
Column7
Column8
Column8
7
o #74379D