66590D - Arnold

,LAMA / ❑ DREDGE & FILL
GENERAL PERMIT
New ❑Modification ❑Complete Reissue ❑Partial Reissue
db h S fN hC 1' D fE dN IR
A B
Previous permit #
Date previous permit issued
ize y t e tate o ort aro ina, epartment o nvironment an atura esources
oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rules attached.
Namei� �' �, Project Location: CountyK-
<(A Street Address/ State Road/ Lot #(s)
{ �7 SC�w7t Stateer'$IF1 �l k J
C, all Subdivision
W Agent � i`i` � � �,Z Art�SGh CC 415 ( DY► City ZIP
❑ cW XEw XPTA El ES ❑ PTS P`hione �) J Vj" ©� J S River Basin 1/1iv� b
❑ OEA ❑ HHF ❑ IH ❑ URA ❑ WA
Adj. Wtr. Body (nat it
❑ PWS:
(es / ,no PNA yes / no Closest Maj. Wtr. Body
Project/ Activity
v�
k) length
tform(s)
'latform(s)
=r(s)—
igth
nber 1
I/ Riprap length
distance offshore
illdozing
LAMP- "it 1
(-I X �0
attached:
Ino
n
n
no
(Scale:, " = d
ig permit may be required by:
_ocal Planning jurisdiction) + ,
❑ See note on back regarding River Basin rr

A � NC Division of Coastal Mgt. Habitat Impact Coml
VlQ
Applicant: kyr,.OL
Date: shg�((
Describe b low the HABI AT 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
Fit
(Applied for.
(Anticipated final
(Applied for.
(Ar
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
dis
Habitat Name
Choose One
includes any
Excludes any
total includes
Exi
anticipated
restoration
any anticipated
res
restoration or
and/or temp
restoration or
ten
ternimpacts)
impact arno nt)
ternimpacts)
am
Dredge ❑ Fill ❑ Both ❑ Other
d—
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

e�A
HCDENR
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:. 1 -/
Name of Property Owner Applying for Permit: Name of authonzed A ent for this project
w K� c�
Owner's Mailing Address:
r s
A.
( C112�C � e
Phone NumberF/ 0) 1Lysa
Agent's Mailing Address:
Phone Number Ell 0
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 Ppnnits necessary to install or construct the following (activity):
(my property located) at ZALI d4a
This certification is valid thru (date)
Property Owner Signature Date
C�PLO YY, -Z,

ADJACENT RIPARTAIN' PROPERTY OWNER STAT'ENUM
(FORA PIE OO IIVGPL INGS/BOATLUVBOATSOUSE)
I hereby certify that I own property adjacent to = f Is
(Name of Property Owner)
property located at
.(Lot, BloEk, Road, etc.)
(Waterbody) (Torn and/or County)
Applicant's phone#: n1/6tn ? --/Z1)� Ma ivg Addrwi
He has desczR;ed to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand chat a pieVraooring pilings I boater / boathouse
must be set back a mifimurn distance of fifteen feet (151 from my area of riparian access unless
waived by me. (If you wish; to waive the setback, you must initial the appropriate 1 l nk
below.)
I do not wish to waive,
M I do wish to waive that setback requirement_
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing devdopme4
(Information for Property Owner Applying {Riparian Pr
for Permit) operty Owner Information)
Mailing Address
City/ tate/
MicG�aeG �ciGGi ,t
Signature
Michael Phillips
Print fir Tams+ ATnrna

F:.
CIV
ADJACENT RIPARLkN PR.OPERW OWNER STAUMNT
(FORA PlE.l MOORING PLUNGSBOATLRMBOATHOUSIZ)
I hereby certify that I own property adjacent to Go n -� h-D `s
(Name of Prop" Owner)
property located at
.(Lot, Rlo6; Road, etc.)
on Ci' n s in tL . N.C.
(Waterbody) (Town and/or County)
Applicant's phone#:�ir��7—%Zip M1Address:
e
He has described to me, as shown below, the development he is proposing atthat location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift I boathouse
must be set back a minimum distance of fifteen feet (15D from my area of ripauan access unless
waived by me. (If you wish to wive the setback, you must initial the appropriate blank
below.)
I do u wishto waive
do wish to waive that setback requirement -
DESCRIPTION Arty/OR DRAWING OF PROPOSED DEVELOPMENT. -
(To be filled in by hzdividu& proposing development)
(Information for Property Owner Applying {Riparian
for Permit)
Mailing Address
. q
Cityl E;t-e
Information)
Signature
or Type Nam �

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Replace
% Recondition exlating float
CANAL
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Anne Arnold
124 5ailsbury 5t
Holden Beach NC, 2b462
reloc,
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