69141D - Bellini

OCAMA / DREDGE &FILL p1�1'3 .0
E N E RAL PERMIT Previous permit # A B C OD
New Modification OComplete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
/P ❑ Rules `attached.
Applicant Name 7 C Qgrs � 11�( 0 . -\, Project Location: County
Address— QZ S 12 +A s _ Street Address/ State Road/ Lot #(s)
City a t- 7-s (� j State NC ZI P�y65 CY^ M
Phone # ( )_
Authorized Agent
Affected ;N CW
AEC(s): ❑ OEA
❑ PWS:
E-Mail
J<EW ❑ PTA ❑ ES ❑ PTS
❑ HHF ❑ IH ❑ UBA ❑ N/A
ORW: yes / no PNA yes no
Type of Project/ Activity
Pier (dock) length y X Z Q r
Fixed Platform(s) 17 'Zr V iL V
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift 12 p(�Zr
Beach
Other
Subdivision
City
ZIP
Phone # ( ) River Basin
r
Adj. Wtr. Body Dn\&'_,_ �A��t ( Qnatman unkn
Closest Maj. Wtr. Body 1� tfJ_
t
r
Shoreline Length p—► ` `
SAV: not sure yes t r
I
Moratorium: n/a yes -T-Ei
Photos: yes n
k-\0 I
Waiver Attached: yes
A building permit may be required by: QCA
( Note Local Planning Jurisdiction) '
Notes/ Special Conditions l e. ' f" � //�d aK * 44
1 '4 C R ( s rA,- LA.7 %Yll % 'I G.. c j ( 1 (V A.1t 2e
Agent or Applicant Print
Signature lease read compliance statement on back of permit
A 2 00-- 7Z39
Application Fee(s) Check #
rr
(Scale: '= ZD )
❑ See note on back regarding River Basin rules.
C"

WIRO
Date Received Date Deposited Check From (Name) I Name or Permit Holder Vendor I Check Number Check amount I Permh NumbedComments Receipt or Refund/Reallocated
6/7/2017 Edward or Bonnie Gore 1same Sharonview Federal C.L 3251 $200.00 GP 69140D BS rct. 4626D
6/7/2017 Grice Construction Peter Griffith BB&T 11284 $200.00 GP 69238D SF rct. 4269D
6/7/2017 Grice Construction Frank Ward, Jr. BB&T 11282 $200 00 GP 69233D SF rct 4266D
6/7/2017 Holden Docks & Bulkheads Town of Holden Beach CresCom Bank 2996 $400.00 GP 69232D SF rct 4265D
6/7/2017 James or Mary Hartsell same SunTrust 2173 $200.00 GP 69231D JD rct. 4264D
6/7/2017 Grice Construction Mom's Revocable Trust BB&T 11283� $200,00 GP 69234D SF rct 4268D
6/8/2017 Jerry Ennett Richard Stanley Coastal Bank & Trust 641 $200.00 GP 69182D JD rct. 3869D
6/8/2017 Paul or Christine Minervini Rich Balot Marine Federal Credit U 2216 $100.00 minor, 146 Oceanview Ln., NTB On- JD rct. 4209D
6/8/2017, Frank R. Bellini same LG Federal Credit Unior 7239 $200.00 GP 69141D BS rct. 4629D
6/8/2017 Carolina Bluewater Construction Co Robert Purcell BB&T 17781 $200.00 GP 69240D SF rct. 4272D
6/9/2017 Will Richardson Wrenn Patterson BB&T 6735 $200.00 GP 69239_D _ SF rct 4273D
6/12/2017 ___ Permit Pals Michael Ervin CresCom Bank 1580 $400.00—major, 10 Monroe St., OIB BrCo SF rct 4274D
6/12/2017 Permit Pals Julie Elkin Fisher CresCom Bank _ 1578 $400.00 major, 6 Monrose St, OIB BrCo SF rct 4651 D
6/12/2017 Permit Pals Alonzo Pringle CresCom Bank 1579 $400.00 major, 8 Monroe St., OIB BrCo SF rct. 4275D
6/12/2017! Permit Pals Michael Green CresCom Bank 1577 $400.00 major, 4 Monroe St., OIB BrCo SF rct. 4652D
6/13/20171 Allied Marine Contractors/Hal Fogleman Louis Cox First Citizens Bank 5734 $400.00 GP 69183D JD rct. 3871 D
6/13%2017' Allied Marine Contractors /Hal Fogleman Donald Waters First Citizens Bank 5733 $600.00 GP 66324D JD rct 3870D
I

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant:
Date: �
Describe below the HABITAT disturbances for the application.
All values should match the name, and units of measurement found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount
-H
Dredge ElFill [IBoth ❑ Other
q V
90
Dredge ❑ Fill ❑ Both ❑ Other ❑
Z Z 1
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Fla & lc_ &11 i A 1 's
r 1 (Name of Property Owner)
property located at -� � Z-4�1
(Address, Lot, Block, Road, etc.)
on i0 Av ),f A, is in zac.,'J , 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, 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 ,etbback, 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 Ow Information) (Adjacent Property Owner Information)
Signature f/ Signature
Ar
a ilk �Pll ��l I �%^� fYPrNc�I or
Print or Type Name Print or Type Name
EO A / f - 020 f& 11+F
Mailing Address Mailin Address )
0 aC- � 151c� � �il -- 2-my a(,--
�.r /L d X 2- t 6.-
City/State/Zip City/StatelZip
7 ®y- 77;C -Y- '?f/ - IY3P
Telephone Number > Telephone Number
e—' ZS-.s--- 2S -/7-
Date Date
(Revised 611812012)

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Owner: / I n & IC 9f P),\1
Address of Property: Z ` .SF ) 2Jh JI - r9a k TT-1z,-d /q (:, 60-S-0' L
(Lot or Street #, Street or Road, City & County)
Agent's Name #: SP Mailing Address:
Agent's phone #:
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. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. 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, 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. 1 CAC 6 +Ae+-,'�
I do not wish to waive the 15' setback requirement.
(Property O er Information)
Signature
Print or Type Name
Mailing Address
o, (r ���lGw� /UC. 1-1
City/State2ip
775- 6-C
Telephone Number
Date
(Adjacent Property Owner Information) /
Signature
Print or Type Name
,q&v OLDolt T
Mailing Address
,�5 1 �1
City/State/Zip �L Z�
Telephone Number
ZS 2ji'--?
Dad
Revised 611812012

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