74700D - Kelly

f'CAMA / ❑DREDGE & FILL No. 74700
GENERAL PERMIT Previous permit# A B C
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality, T 1 ' �,��0
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
61q❑ Rules attached.
Applicant Name Ic"WEL, - U►i
Address (2-1-' L%�JE
City�Sy + StateNJ G ZIP 28 (PI
Phone # (31A 'SW Vr 33E-Mail Q as c'.
Authorized Agent VkS (2bjs T(&.)LTt ot-J
Affected ❑ Cw
AEC(s): ❑ CEA
❑ PWS:
ORW: yes /®
,?EW � PTA ❑ ES ❑ PTS
❑ HHF ❑ IH ❑ UBA ❑ N/A
PNA yes / ©°
Project Location: County `�(=� ►�+5�+ C,�
Street Address/ State Road/ Lot #(s) ( QS
2 aU#JIJZ oAJ S r
Subdivision
City 16k6u. eo Qe^C4 ZIP Z$'1(o2
Flll- Phone # River Basin La,.., o-
Adj. Wtr. Body A N k— (nat d /unkn)
Closest Maj. Wtr. Body AA,-,3%-O
Signature Please read compliance statement on back of permit ** Signature
215Z33-7- 6 -/ 5 d-06 Gi q
Application Fee(s) Check # Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: �� '��/ �-, /
Mailing Address: f �_1� �_" ILL, �.,n_
-----------------
Phone Number: --------�---------------------------------
Email Address:_ �s(,��.L�_�.t_J v yr------------
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: PWC lift_ ramp_ floater and dock --
at my property located at
in_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:
Print or Type
-----------------
Title
Date
This certification is valid through __� _J__-_--- _4Z.0

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNExe
RNOTIIFICATIONIWAIVER FORM
Name of Property Owner: �, . �>/ /4
Address of Property: 1 D ��y ,� /4r
-(Lot
�or, Street #, Street or Road, City & County) Agent's Name #: U/ f Ty� Mailing Address: .� Iz` t 1� U.+�+.,
Agent's phone #: g 1 V l S �S D— `�t 3 �1 T N c-
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 httpJ/www.nccoastalmana-gementnet/web/crWstaff-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)
nature /
Print or Type Name
1-7 �d
Mailing Addr ss
Z?
Oty/State,Zip
Telephone Number / Email Address
—/7- 1.a/q
arian Pro ertZ:� Information)
r -
Signatur
o,A%
Print or Type Name
Z/3 )7 0,P, r� ,
Mailing A dress
city/statelzip
7P �/ y3:3 z �
Telephone Number / Email Address
(�-17 Z-2,9/9
Dale Data
(Revised Aug. 2014)

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM"
Name of Property Owner:
Address of Property:
I K ;ti. Fr i
(Lot or 1 t
1.
Agent's Name #: - �/�Vlr� (, tit Mailing Address: 4) q PAWI,-
Agent's phone #: f Ud `7 3 t C a ��
�L1nSLU fvC � -'
Street or Ro d, City & County)
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. 1 have objections to this proposal.
If you have objections to what /s being proposed, you must notify the Division of Coastal Management
(DCM) in wilting within 10 days of receipt of this notice. Contact information for DCM offices is
available athttp://www.nccoastalmanactement.netAveblcrWstaff-listin 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.
ape Own Information ( i arian Property Owner Information)
Print or Type Name/
Mail
ing A dress
`//
City/staatt eop
aZYZ
Telephone Number/Email Address
Date
1541,
Print or Type Name
Telephone Number/Email Address
--6 - / V,-/ --
Date
(Revised Aug. 2014)

=H5=
11111111"Umm
Holden BearlS Canal
105 BURLINGTON ST.
Michael and Sylvia Kelly
/PROJECT: 105 Burlington St., Holden
P/L
107 BURLINGTON
Tony Jordan
Not to scale

I CERTIFY THAT THIS MAP WAS DRAWN UNDER MY SUPERVISION FROM AN ACTUAL SURVEY
MADE UNDER MY SUPERVISION (DEED DESCRIPTION RECORDED IN BOOK 4011, PAGE 633; THAT
THE BOUNDARIES NOT SURVEYED ARE INDICATED AS DRAWN FROM INFORMATION IN BOOK 6,
PAGE 132; THAT THE RATIO OF PRECISION IS 1:10,000; AND THAT THIS SURVEY IS OF AN
EXISTING PARCEL OF LAND; AND THAT THIS MAP MEETS THE REQUIREMENTS OF THE
STANDARDS OF PRACTICE FOR LAND SURVEYING IN NORTH CAROLINA (21 NCAC 56. 1600),
THIS 22ND DAY OF JULY, 201 ``1��111111i�ir
PROFESSIONAL LAND SURVEYOR
NOTES: - SEAL
BASED ON FEMA FLOOD MAP 3720201500K, THIS PARCEL - 0 L-3W7
APPEARS TO BE LOCATED IN FLOOD ZONE 'AE', BASE,yOQ' v�
FLOOD ELEVAnoN=12.0'. W.•��?:
THIS PARCEL IS SUBJECT TO ALL RECORDED AND /01HER
UNRECORDED EASEMENTS WHICH MAY OR MAY 140T BE _
SHOWN ON THIS SURVEY.
FOR ADDITIONAL TIE UNE, SEE MAP CABINET 6, PAGE 132.
(AREA BY COORDINATE METHOD
DEED REF: BOOK 4011, PAGE 633.
TONY & WANDA JORDAN
DEED BOOK 4112, PAGE 947
STREET ADDRESS: I
LOT 175
105 BURLINGTON STREET
HOLDEN BEACH, NC 2W2
T5" RIPARIAN OFFSET
N90. 00' DO-E 100.00'(TOTAL)
RAMP
jTQ IRS}
2.0' OVERHANG c
7.8' A/C 28.0'
(TYP.)
�\
SINGLE STORY
C^
DECK
LOT 176
PWC
oWOOD FRAME o
CP HOUSE o Y
5,000 SQ.Fi.
'
o
DOCK $
ON PILINGS
0.11 ACRES
FISH
STATION
$
wooD �4' WOOD
zao'
VV>
BULKHEAD FENCE
g 7.+
N90' DO' 00'W 100.00'(TOTAL)
1.30'
So
A
IV
xR•
mow-
mar- owe
1
a n
ron�J�
m D
o
x
v
IMPERVIOUS AREA CALCULATIONS:
BUILDING WITHOUT OVERHANGS = 1,374 %FT.
BUILDING WITH OVERHANGS = 1 703 SQ.FT.
R/W
OCEAN
BOULEVARD WEST
60'
RIGHT-OF-WAY
SURVEI'FOR
SITE HOIDEN BEACH
VICINITY MAP '
NO SCALE
HS CONS TR UCTION
LEGEND —�
L-M m I
RAr ■ ImmAmmm
s 0 yr ■m w
■ ■ ■as ■■
■■ , ■o Now
IN ■ ■�■ ■■
v mm lass
Y. ■■rvw
LOT '.76, CANAL G, HOLDEN BEACH SUBDIVISION
REPUTED OWNER: MICHAEL & SYLVIA KELLY
0 15 30 60
SCALE IN FEET
A
East Coast Engin & Surveying, RC
9 i 9 Y 9-
ENGINEERS* ERS•SURVEYORS
4912 Main Sheet Phone: [phone]
Poe Cffce 3ox2469 Fax:[phone]
ShaHotte, Nortn Carolina 28459 Firm License Number C- 014
PROJECT g: 2254
DATE LOCKWO D F
TOWNSHIP: LOCKWOOD FLY
COUNTY: BRUNSWICK
sTATe
SCALE 1'=30'
CREW: CT, DM
FB/PG FILE
TAX ID: 231MFO23
DRAWN BY. ITS
REVISIONS:
9 ADDED
PROPOSED
PROPOSED DOCK, RAMP
At FLOATING DOCK

Date Received
Date De .sited
i Check From Name
Name o/ Permit Holder
Vendor
Chock Number
Chock
amount
Permit Number/Commenta
Receipt or Refund/Reallocated
Columnl
Co/umn2 Column3
Column)
Column3
Column!
Column?
Column!
Column!
8/15/2019
H5 Construction
Richard Penn Construction, LLC
Michael Kelly
Chet Willis
Trace & Eric Schmidt
BB&T
Navy Federal CU
First Citizens Bank
2337
1140
$ 200.00_
$$ 200.00
GP #74700D
GP #74568D
GP #74889D
GP #74329D
GP #74569D
BB rct. 9106
JD rot. 8551
PA rct. 7971
PA rct. 9154
I JD rct. 8552
8/15/2019
8/15/2019
Eric and TraceSchmidt
4070
$ 200.00
8/15/2019
Clements Marine Construction
Elizabeth Landis
First Citizens Bank
5195
$ 400.00
8/15/20191
Richard Penny Construction, LLC
Patricia & Thomas Kaznowski
_
Navy Federal CU
1 1141
1 200.00