74886D - Bouska

A)CAMA / _1 DREDGE & FILL No. 74886 A B C Q
G E 14 E RAL PERMIT Previous permit #
New -]Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality c
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC _ oa i-t ! I U C) U% H S Z-00
❑ Rules attached.
Applicant Name �� ik j cI U� S �k Project Location: County S1,..0^1, ,,,k
i
Address 2(o I q so,, t Dr, Street Address/ State Road/(L'ot #(s) � y/
City StatehJ�ZlP
p a�y�3 Sw �• c� 1'1 C� ,i
Phone # GUA y 30 3*7 0 E-Mail Subdivision
Authorized Agent (,l/� ( i City H111L, [.cac.k ZIP Z!FV-k.;;t
Affected El Cw NEW ® PTA KES ❑ PTS Phone # ( ) River Basin L h�
1-1OEA ❑ HHF ElIH ElUBA ❑ N/A
AEC(s): Adj. Wtr. Body � ( (nat /unkn)
1-1PWS: /
ORW: yes /PWS PNA yes /r o Closest Maj. Wtr. Body Iu/w
Type of Project/ ActivityAl JJ�kI•�.�� (��� A��G.cB.�� n��ra�DwS ly�+U �c� T�eDJ ^A ✓1 t�0 N+�✓c `���
L
Pier (dock) length (D )e8
Fixed Platform(s)
Floating Platform(s) 1 AD,
Finger pier(s)
Groin length
number
,8Uu head iprap length_
avg distance offshore 10
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
NN EEFA
������111111ri/
Shoreline Length 5-C), ■p-muN SEEM
SAV: not sure yes FUMM-AL10-
ymmmmAAwE ■I
Moratorium: n/a yes (9 1 , �_ V '
Photos: yes
Waiver Attached: yes no I
—
A building permit may Be required by: L 0, ^ o � �� ►) � c.
( Note Local Planning jurisdictions)
Notes/ Special Conditions / `` � -t", 4 A t ,,,t \k A -A
Agent or Applicant Printed Name
S g tuurre�Please read compliance statement on back of permit**
W 1
Application Fee(s) 6heck #
(Scale: J) T S
❑`` See note on back regarding River Basin rules.
ovd At Chr,ci,.., ioc.' 1aV � ,. 1'•.\\
r,.\ �s Cbc �_
Permit is Pri ted Name
Signatu e
I Z 2aZ� S 25 2oZ�
Issuin ate Eipirat# Date

ADJACENT RIPARIAN PROPERTY O(NNER STATEMENT
I hereby certify that I own property adjacent to David Bouska
,s
property located at 141 Swordfish Drive Sw (Name of Property Owner)
Canal(Addrms, Lot, Block, R—, etc.
on
in Holden Beach NC 2U62 N.C.
(W y) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
Initial --�I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAINING OF PROPOSED DEVELOPMENT
(Individual propoWng development must fill in description below or attach a site drawing)
Replacement of docking facility
t
�Ltkl, R p'.I
WAIVER SECTION
I 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 must initial the appropriate blank below.)
initial here 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
f p
Si ure ,� Complete
.. !! `` �( Si Lure
Print or Type Name Print or T me
M ding Add ss Marb Address
'' C- �K S
City telZip r cry t `�----
Ct�--���-�33 '�_-
Telephone Number Te phone Number
7— �? S _ ,7
Dote Dare
(Revised 61182012)

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: David Bouska
Mailing Address: 2614 Springwood Drive
Greensboro NC 27403
Phone Number: 336-430-8728
Email Address:
I certify that I have authorized Will Richardson
Agent i Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Installation of bulkhead wall
and replacement of docking facility
at my property located at 141 Swordfish Drive Holden Beach NC 28462
in Brunswick
County-
/
furthermore certify that l 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:
NO
`-Signature
_ DA✓ • ,.* &,# s K'k
Print or Type Name
Owner
Title
12 / ti / I
Date
This certification is valid through 02 / 28 / 20

Sue Prise
139 5wordflsh Or
919-894-0366
CANAL _
Aligned with
neighbors wall
DAVID & ALICIA BOUSKA
141 5WORDFl5H OR
HOLDEN BEACH NC 28462
alhoun
dfish Or
336-312-3538

ADJACENT MPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to David Bouska
property located at 141 Swordfish Drive Sw
(Name of Property Owner)
/g
(Address, Lot, Block, Road etc.)
on Canal , in Holden Beach NV, 28462 J N-C.
(woody) (City/Town andlor County)
The applicant has described to me, as shown below, the development proposed at the above location.
Initial G_ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
Ormkvidual proposing development must fill in description below or attach a site drawing)
Replacement of docking facility
Ii
Lti.J k- h c f. D
WAIVER SECTION
I 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 must initial the appropriate blank below.)
initial here � 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner information) (Adjacent Property Owner Information)
Print or Type Name
Mailing Address r
nr 1, , is i c`t
S
Telephone Number
f cj.
Cpmplete
Signature t
mil! � � U �-%. ►>M2d ^ C1 1 �.G � :.)
Printom
r Type Nae
a
MOMM Address
i'1Sk)rlrz'` !\f C 1 ? —CG
cnylstaterr h
Te ne Number `��-� S C c?
y P, t\)
Dxo
(Revised 611a2o12)