74392D - ERWI

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`YCAMA / ❑ DREDGE & FILL No. 74392 A B C �g
GENERAL PERMIT Previous permit #
I1New Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality u
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rules attached.
Applicant Name � R W = �.�.�Project Location: County , c C.
Address 12CA I Street Address/ State Road/ Lot #(s) v� o S y
City State ZIP aY- ivy S 4!� T)r.
Phone # (ei to _MW f w Subdivision
Authorized Agent c, n S •- City
ZIP a '�r`I(v 9-
Affected ❑CW E;OW )PTA ❑ES ❑PTS Phone # ( River Basin L" 4—,
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ URA ❑ WA Adj. Wtr. Body A (l, J W )
Oman /unkn
❑PWS: n1WLJ
i I
'
Agent 6r AppTicanf Printed Nhfne
PermitOMM
Signature Please read compliance statement on back of permit*
Signature
64 u'
Applic -on Fee(s) Check #
Issuing Date
1111112
Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: kkC
Mailing Address:
Phone Number: Q( G- 4 L) 3-- Lo v d 3
Email Address: W(-
�biP1Y1 b V4n LQl)-I �ia. �I GW
I certify that I have authorized --a,%1 Cm C1 C) l.(J o nifm ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Q V �\j �f COJYY(
i'
at my property located at c�
in I County.
I furthermore certify that I 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:
Signature
r c WnEll-"
Print or Type Nam
—Pr-6s rd (-eiv-L � n
Title
I I /q/ Q•6a
Date
This certification is valid through )_/q/ a ba0

RECEIVED 11/09/2019 02:01PM 9108427003
. From:
11/08/2019 12:13PM 9108427003
TOWN OF HOLDEN BEACH
11/09/2019 14:20
TOWN OF HOLDEN BEACH
#102 P.002
PAGE 01/02
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NO'FIFICATION/WAIVER FORM
Name of Property Owner. DE; d,Q(7 Y A a b CY U)e)t �Y" 15eh)I LLC
Address of Property:
(Ldt or Street 1#, Strbet or Road, City & County) &
��66 1
Agent's Name #: Ca 4 � * it Q u�� Malling Address: C�q/ oL7YJILQ L.l) l a711�ci 1�0
Agent's phone #. S. J Da V?57L
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 pr rIr-
lion or dra��win w i enslons t be rovi with this [ffetter.
Ioobjections to i pr posm �� ✓ I baave bjectioonns o this proposal, ���r�e)��wI�.1�1 1I51
If you have obf ectlons to what is being proposed, you mustnotifythe Division of Coastal Man2pamenf 1 jr
(DC" in wrlt/ng within 10 days of receipt of this notice. Contact information for DCM offices Is
available athttp://www.nccoastalmanaaemant.netlweb/cm/staff-lisfino orby calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notifled by CertlfTed Mail
WAIVER SECTION
I understand that a pler, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a mfnlmum 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 doinot
Ish to waive the 15' setback requirement.
wish to waive the 15' setback requlrement.�*- -1 T W CL t jm (
61 SP�f�li(k,
(Property Owner Information) (Riparian Property Owner Information)
St ature azure
�--dx r ljm�fr ---D- lc)0��
Prin Type Name
Malting Address �—
u ov1 v 00aR d �N:>-
City
21b- 0514-15 rU_�
Telephone Numberl Emef7Addmas
Date
.TOM
T Ps o , n
Print oorrtype ame g �0 se Q 14a De. ►S lv
a � ,
Matting Address U ' j �(
Clb�/S(at P J
Telephone N� p�prIErgal/Address
KLtfhe� ne.1(.C,cvft(i.1C9rrtCl�l.C(,Yn�t
a, i
Date
(Revleed Aug. 2014)

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: I . 6aL-A—
Address of Property: S'C' 1% I,��
(Ldt or Street #, Strbet or Road, City & County)
Agent's Name #:�(�JG>Il`71/ Mailing Address: r�l'E��
q V
Agent's phone #: �;1jnn = y?S-Ll— �7�
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 jhe development
they are proposing. A description or drawin4 with dimensions must be provided with this letter.
:f,&—I have no objections to this proposal. I have objections to this proposal.
74-5 !?f R ry of
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 athttpJlwww.nccoastalmanagement netlweb/cm/staff listing orby 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) (Ri pe Owner Information)
4S4iat"ure Signature
Pnn r Type Name Pnnt or Type Name
Mailing ess
6usoluCitylstNl-f�
i �-
G1b-05-u-sIc
Telephone Numberl Email Address
Date
9 `7 17a ,
Mailing Address
�3ccne. c,
CitylState ip
On s-� q3
T-cMephone Numberl Email Address
(O
Date
(Revised Aug. 2014)

7016 3560 0000 5737 2509
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■ Complete items 1, 2, and 3,"'
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
A. Signature
X���
❑ Agent
❑ Addressee
B. eceived by ( tinted Name)
C. Date of Delivery
or on the front if space permits.
t'
Estel Norris ET Lois D
D. Is delivery address different from item i? ❑ Yes
If YES, enter delivery address
below: ❑ No
8772 Highway 105 South
Boone, NC 28607
3. Service Type
❑Priority Mail Express
II I'll Il III III I II IIII I II lI III IIIII I I
It Signature
❑ Registered MaiITM
<LIA
lt Signature Restricted Delivery
❑ Registered Mail Restricted
9590 9402 3258 7196 8506 66
ified Mail®
Delivery
ified Mail Restricted Delivery
❑ Return Receipt for
❑ Collect on Delivery
Merchandise
2. Article Number (Transfer from service label)
r7 Collect on Delivery Restricted Delivery
❑ Signature Confirmation-
7016 3 5 6 0 0 0 0 0 5 7 3 7 2 5 0 9
I Insured Mail
7 Insured Mail Restricted Delivery
❑ Signature Confirmation
Restricted Delivery
_ —
YS orm , JUIy 2015 PSN 7530-02-000-9053
(over $500)
Domestic Return Receip'

2765 2769 2755
0 231 NB040 231 NB030
rn
��O ? 2838 �. 2803
2851 c"7 2831 2827 . �.: y� _ 7
{ Parcel PIN: 200620916624
r ;"9► 1 Calc. Acreage: 0.21
to
Zoning: R75 �? ,4SEA iIS 1A Dj< SbV
Legal Description
L-5 J D GAINEY PL 27/222 1` ��„< �•
i 2860 j
285 Owner Information
' Owner Name:
A ERW 1 LLC `e. -
r Mailing Address:
291 STONE CHIMNEY RD SW
f ? SUPPLY, NC 28462-3290
Deed and Plat References n o N
Deed Book:03921
Deed Page: 0527 1�1
Plat Book: 0027 *'
Plat Page: 0185
Parcel Photo
Zoom to
Search Address or Parcel II Q
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