74356D - Fridy

�_,CAMA / ADREDGE & FILL No. 74356 A B C
GENERAL PERMIT Previous permit #
XNek ❑Modification ❑Complete Reissue El 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 _+ k . O Z.00 s-
❑ Rules attached.
Applicant Name T)AV 17 70-1.0)1
Address (rA N C
City ,,Nh•J State tN(- ZIP 2 bli3
Phone # (A�4) OAt , E-Mail
Authorized Agent b(LEt-, Hof,e^J
Affected ❑ CW )CEW )d PTA X ES [APTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / 6;) PNA yes /&
Project Location: County ZiLuNSwtcY__
Street Address/ State Road/ Lot #(s) 128
Lt0AJS ?A-J n(t%ve
Subdivision
CitjEAcl-1 ZIP 28" (07- _
)YA+ Phone # ( 0) 540 (o S 10 River Basin L 0 e (z-
Adj. Wtr. Body C A xjA t-- (natnat M5_�)
Closest Maj. Wtr. Body "'J VJ
Type of Project/ Activity xUet,AcE '0ocit•i4b �� Ac-,ct t1 ^+D Z%jL1Lk EAC/ ;N SAME tT�zPgInr
(Scale: Iu _ Z C) I
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A building permit may be required by: TOWM Of H0 LpEN 13E AWN ❑ See note on back regarding River Basin rYttes.
( Note Local Planning Jurisdiction)
Notes/ Special Conditions ALc. Grw%NtTt• S or o-4H oo (:)-f do i r-OrAi- S r4 Tf4/fir$
f t�rnA� ttEt,tt�T�,,..s Aray
Ag or Appli PrIl d` Name
lam' �
Si at e 4 PleAse read compliance statement on back of permit
low CV__ -356(0
Application Fee(s) Check #
_00'160J4, 1911,Wk-
Permit Officer's Printed Name
— ­_ T��
Signature
9-�-
Issuing Date Expiration Date

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CERT1FtED MAIL •RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACF,NT RIPARIAN PROPERTY OWNER NOTIFICATIONtWANER FORM
Name of Property Owner. ') -'4 0 A Vc-\-
Address of Property: 1 a'5T - L,
(Lot or Street #, Street or Road, City & Caurty)
Agerrt`s Name #: � Mailing Address: 150 �^ n � , V14 P-
Agent' s phone #: q1 D S a D t- ) p
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 descriofion or drawing with dimensions must be provided with this letter.
s T have no objections to this proposal. I have objections to this proposal.
If you have objections to whatis being proposed, you must notify the Division of Coastal Management (DCM) in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext,
Wilmington, NC, 284053845. DCM representatives can also be contacted at [phone]. No considered the some as no ob'ection if ou have been noted by Certified Mafl: response is
WAIVER SECTION
understand that a pier; dock, mooring pilings, 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 mus_ t_ initial the appropriate blank below.)
1 do wish to waive the 15' setback requirement.
_ l do not wish to waive the 15' setback requirement �� - Same �GC� aS �
erty Own do rmatio (Adjacent Property Owner Information)
f'
Signature �Si iur
S�
' ur l/
Print or Type Name ri�ore Name
Z���?�_�GQ� 'C
Marling AddresseC `
-L!?'<L W Z2
City/State/Zip
704-� '?q f 79-??�
Telephone JVumber
2- /=
date
Mailing Address
City/StatelZ'
Telephone Number
2
ate
Revised 611 &2012

r41T
/ Comr*te items 1, 2, and S.
Print your name and address on the reverse
so that we can return the card to you.
t Attach this card to the back of the mailpiec e,
_or on the front if space permits.
I. Article Addressed to: 9
Oe-ji4wd
�jcu�2Cv��3n�S �1•C-
9590 9402 2597 6336 4682 27
Mcile Nw*w Ma►rafer from service tabq
7016 0600 0000 5521 6559
5 PSN 7530-02-004.9053
A. Sijoaftira z
[8 Agent
XredNsme4)
0Addressee
B. Received by (PriC. Date of Delivery
o^ V'kr _ >;
D. Is daGvery address d ff from item 1? ❑ Yes
tf YES, ether delivery address below: p No
3. Service Type
Q priority Mtl Expres, . ti
❑ Adult Signature
❑ Registered Mail-
0 Adult Adrtfi�i nSe Ree6ietied Delivery
MaO
Q Registered Mail Restricted
❑ Certified Mail RwWcted Dellvtxy
CI Retu nyReceipt for
❑ Collect on Delivery
Marchand se
❑ Collect on Delivery Restricted Delivery ❑ Signature Confirmation-
"' " sured Mail
❑ SSnat ure Confirmation
cured Mail Restricted Delivery
Restricted Delivery
var $110,
(Iilli�ltlllliflisUi'"1S)ii'1'1i;

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$1

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Chock From (N*moJ
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Chock Number
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amount
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Columnl
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Columns
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Column7
ColumnB
Columno
8/6/2019
Holden Docks and Bulkheads
David Fridy CresCom Bank
3586
$ 600.00 'GP #74356D BB rct 9135