72789D - Hodges

�V No. 72786 /,LAMA / D DREDGE & FILL
A B C
GENERAL PERMIT Previous permit#
Clew ❑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 I SA NCAC r) Oy
pp 1 ❑ Rules attached.
Applicant Name 6Rf c�oay b( M c'o4-C. NOD4cs Project Location: County �R t.n/sw i cK
Address 15 8 Awi s o M IZ D Street Address/ State Road/ Lot #(s) 130
City Ru�FF% StateflC ZIP 2-732CNARwTTE •$';REr-T
Phone # ( �34 601 - 86 84 E-Mail ♦J1o&e5 Ohmkern.com Subdivision /VIA
Authorized Agent r1i 5 (//,�On/STP.LACT1oN A -LC City NOLDEM t`,F-Ac1a ZIP 284iv2
Affected ❑ CW �W C)tTA ❑ ES ❑ PTS A Cvr SIT Phone # ( q ► 0) QR - 4 3 SI River Basin LuMaF ti
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s): ❑ PWS: Adj. Wtr. Body C AA/AI. (natat /t unkn)
ORW: yes / PC) PNA yes / iD Closest Maj. Wtr. Body A W W
Type of Project/ Activity C
(Scale: 1 = 2 A
Pier (dock) length
i
aed Platform(s)
X 1(7
pi
oatinv atform(sl O X I
Groin
Bulkhead/ Rip Ile,
length
avg distance ffs'
max distance o h
Basin, channel
cubic yards
Boat ramp
Boathouse oatlift ± W X ± 14
Beach Bulldozing
h r R IMP 3 1 x It, /
OW = 256 -'3'z
i
Shoreline Length SO
SAV: not sure yes
Moratorium: /a yes no
Photos: yes o 7-7 r�
Waiver Attached: '! no C1VML
BoTN note on back regarding River Basin rules.
A building permit may be required by: ��t �/J $ t„e I (K. ti'ou/1hY� use g g
( Note Local Planning jurisdiction)
Notes/ Special Conditions % 200 / ,4'V A LJ- DTI+EtR "CA S TA -Tr. t
A^1 D FrD i=QAL- RE GULATIt> /US A22t-V_
Agent or Applicant t Printed Name
Signature ** Please read compliance statement on back of permit **
S2oa -4 2.Z.4S
Application Fee(s) Check #
IYL15iz M cCIL&IRS,
Permit Officer's Printed Npme '
Signature
2. Az 0 2.019 !o L.ZO 7-019
Issuing bate Expiration Date

North Cambria Depwhent of Environment and Nahmw
DVWM at Comm went
SPA* Eiim Pardue SMAGn C. 08*
AGENT
Date.. 114
for Pamft Nam of
7�6'vl=vc r(OA,
Owmes MmillimeAftum
ftonewnwri'Mki .601--I-a6S4
Age s 110 Aftew.
z%6A W44% �ck
J-�14t^
Phwa N=W(I 10 1 - S66 -I TU
'certffy that I have authorized the agent listed above to act on my behalf, for the purpose of applft
for and obMkft all LAMA Pem*s rmemary to MOO or cormVW the following (activity):
Oock ILFIP+
For My property kx*ed at i SO C64414t 4.1 1;eUck
This cordfka8on fsveld thru (date)*/
IJA 1
Ww"w S%Fwtm ode
127 Cai*W Om E31L, VW=Vklk NC 2M
ftw9IO--IW7216%FAX-91OW)-WI-
An ftd QPF m -1 % Aftwaft POw F pI I P

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: (�Pqc*4 'to c(A �d he ,S
Address of Property: 1q,0 C� qr'a 1 ' 5 I�l_ ` 1�eaCk I �1)C �"Swlc� Cc
(Lot or Street #, Street or Road, City & County)
Agent's Name #: 0 S t C� �� Sy� Mailing Address: 861 k I04y\ &oc� god
Agent's phone #: (910) �?o - �Ac e" :�e ack , NC-
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.
Ilk* 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.nccoastalmanapement.nebweb/cm/staff-listin_g or by calling 1-888.4RCOAST.
No response is considered the same as no objection if you have been notifred 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.)
V ih - I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Prope wrier I f rmation) (Riparian Property Owner Information)
G.'
Signatur A n Signatur
lcy-pl ool I'm S4%4ar+ - OO rnsah
Print or Type Name Print or a Name
� 5� f�llssav\ qJJ
Mailing Address
NL
City/State/Zip
,�s w-%m �I�odgPs@ �nnn��rn. �uvl
Telephone Number / Email Address
l/A III
Date
540(.c Skti O,�or D�,- FN-
Mailing Address
iR ale 'sH, k� ZQ4ia
City/State/Zip
�(o-6(2--4dZ4 164 �u
Telephone Number/ E ail Address
Date
(Revised Aug. 2014)

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property:
r--f�4ato
5
(Lot or Street #, Street or Road, City & County)
Agent's Name #: -fav-'�'�?
i ,t
Agent's phone #: (tb) fta" 43SI
Mailing Address: . JA c�ooi
yak ac�f AL. z t -Voz
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 drawin_q 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 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 wis to waive the setback, you must initial the appropriate blank below.)
CA=11 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(ProOwner Information)
Sigma re
Print or Type Name
tl; .
{mod
Mailing Address
City/3tMG00
Telephone Number / Email Address
Dom 1
�tR1 rian Pr D er Information)
Si¢nutat�
Print or Type N me
Mailin Address ,� V
C
Cityls tate2ip
Telephone Number/Email Addt ss
Date
(Revised Aug. 2014)

?190?6 S C" 0
1,30 C�arloi�-e_
I
LT
�L-V

Date Received
Date De sited
Check From Name
Name of Permit Holder
Vendor
Check Number
C
amohecunk t
Permit Numb- Comments
Recel t or Refund/Reallocated
Co4-1
Columnl
Co1umn3
Colum"
Columns
Columrr8
Column7
Column8
Co1umn9
Ge d N ole Ho0 es
22461P