69390D - Carolina

l �
-. � CAMA / � ' DREDGE & FILL
GENERAL PERMIT
XNew ❑Modification ❑Complete Reissue
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[:]Partial Reissue
M03 A
Previous permit #
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 0 -44{. j Z VU
Applicant Name k_aV-p,r 0&1(' C
Address I Z8 22�st ;�� ILA.
City-d-MAl�a, 'Lr atl' Statelt _ ZIP 2
Phone # (a&) Z(a5 - 6511 E-Mail
Authorized Agent C_)', L� <<,(�.a� �Sp l•
�J ❑ RUM attached.
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City
ZIP
B C G)
Affected ❑ CW %"'SEW ❑ PTA ❑ ES ❑ PTS Phone # ( ) River Basin iryf.Q 4:
El oEA ❑ HHF ❑ IH _. El UBA ❑ N/A yAEC s : Adj. Wtr. Bod A �4 �nat[ k
El PWS: n �1n)
Agent or Applicant Printed Name
Signature * Please read compliance statement on back of permit
$20o 651-7-
Application Fee(s) Check #
i
Per fficer's Prin ed Nam
Signature
9k/ is/8
Issuinj Date 6piration Date

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson Dee Freeman
Governor Director Secretary
AGENT AUTHORIZATION FORM
Date: Aug 28, 2017
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
Sharon Clarke
Owner's Mailing Address:
128 Raleigh Rd
Holden Beach, NC 28462
Will Richardson
Agent's Mailing Address:
3235 Seacrest Ave. SW
Supply NC 28462
Phone Number( 919) 265-8522 Phone Number( 910) 367-0335
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
Installation of a boatlift.
(my property located) at 128 Raleigh Rd Holden Beach, NC 28462
This certification is valid thru (date) FEb 28, 2018
DocuSigned by:: ,,
StA rbv, (Lo+(, 8/31/2017
AD33272635164BD_.
Property Owner Signature
Date
127 Cardinai Cdve Ext., W hington, NO 23405 One,
oti a1n_7gR_7�t fi l FAX 91n395-39F4 Intamet• www nrrnastnlmananemant net Norff Carolma

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FORA PIEAMOOBMG PILINGSBOATLIFTBOATSOUSE)
I hereby certify that I own property adjacent to Sharon Clarke ,s
(Name of Property Owner)
property located at 128 Raleigh Street
.(Lot, Block, Road, etc.)
on Canal
(Waterbody)
Applicant's phone #: [phone]
in Holden Beach N.C.
(Town and/or County)
_ Mailing Address: 128 Raleigh Street
Holden Beach NC 28462
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (15) from my area of riparian access unless
waived by mt. (If you wish to waive the setback, you must initial the appropriate blank
below.)
I do not wish to waive
Initial here I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Installation of boat lift on north side of property
(Information for Property Owner Applying
for Permit)
3235 Seacrest Ave SW
Mailin- Address
Supply NC 28462
City/State/Zip
910-367-0335
Telephone Dumber Authorized Agent
U,%& 8-15-17
Signature Date
(Riparian Property Omer information)
JSign here
Signature
Wade Coleman
Print or Type Name
910-443-2019
Telephone Number
Date

,rn 61 Kh"
CERTIFIED MAIL — RETURN RECEIPT REOL-ESTER
DIVISION OF COASTAL NI LAN AGEiY1ENT
ADJACENT RIPARIA.Ni PROPERTY OWNER STATE'IENT
I hereby certify that I own property adjacent to Sharon Clarke s
{Name of Property Owner)
property located at 128 Raleigh Rd
(Lot, Block, Road, etc.)
on Canal , in Holden Beach N.C.
(Waterbody) (Town andlor County)
.Applicant's phone #: [phone] _ Mailing Address: 128 Raleigh Rd
Holden Beach, NC 28462
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(.Individual proposing development must fill in description below or attach a site drawing)
Installation of a boatlift.
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DC114) in writing
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Est Wilmington, NC
DCM representatives can also be contacted at (910) 796-72I5.
No response is considered the same as no objection if you Have been notified by Certified Mail
(Property Owner Information) (Ripa • u Property r Information)
l&c& rL Authorized Agent
Signature Sip
re
Will Richardson Mr John S'001 ie
Print or Type Name Print or e N
3235 Seacrest Ave SW <%
Mailing Address M • g Address
Supply NC 28462 ail a�!-� CIA/ICc's b �/ Se oc �y�7d
City / State / Zip City 4 State / Zip
Telephone Number 910-367-0335 % Telephone Numbe� % b
Date Aug 28, 2017 Date 911
127 Cardinal Drive E)4,VVilmington, North Carolina 28405-3845
Phone: [phone] t FAX: [phone] Internet www.nccoastalmanagernent•net
An Equal Opportunity IAffinnadve Action Employer— 50% Recyded 110°!o Post Consumer Paper

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Date Received
Date Deposited
Check From (Name)
Name or Permit Holder
Check Number]
Check amount
permit NumberiCommenb
Receipt or Refund/Reallocated
9/6/2017;
McPherson Marine Services LLC
Hal & Gail Wall
First Citizens Bank
1070
$200.00 GP 69332D 1 of 2
BS rct. 4909D
9/6/2017 '
9/6/2017
9/6/2017
McPherson Marine Services LLC
McPherson Marine Services LLC
Will Richardson Construction
Hal & Gail Wall
Vernon Ray Martin
Sharen Clarke
First Citizens Bank
First Citizens Bank
BB&T
1079
! 1061
6817
$400.00 GP 69332D 2 of 2
$200.00 GP 69331D
$200.00 8503D
BS rct. 4909D
BS rct. 4906D
BS rct. 4907D
9/6/2017
Will Richardson Construction
Wade Coleman
BB&T
6816
$200.00; D
BS rct. 4908D