66627D - Cohen

1' CAMA / ❑ DREDGE & FILL 1 `� ayg�E�NERAL PERMIT ��� ! Previou s permit # A B
New []Modification [-]Complete Reissue ❑Partial Reissue Date previous permit issued
prized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC -1 1IOU
❑ Rules attached.
it Name Project Location: County M1 S ox—r
b x5 Street Address/ State Road/ Lot #(s)
N �f1c110b �. State zip i
6 (T) H I F- AKQ E-Mail Subdivision
Eed Agent C A n\ kV%A Aow o, V\ City `��/` t PC ZIP
ku� �"-7 �10 5`15-� lob 1
ElCW I EW $(PTA El ES ❑PTS Phone # (" ) River Basin WV
❑ OEA /❑ HHF /❑ IH ❑ URA ❑ N/A Adj. Wtr. Body C1 r`% 1 (nat i
❑ PWS: � "�
yes / no PNA yes / no Closest Maj. Wtr. Body �� VVV /
,f Project/ Activity P\ hem Yl�-dl�t
r' 1 � Lt� "-%✓ W � � I (� � p �' V1 4Ct 1
>ck) length � 1
latform(s)
1
Platform(s)
:ngth
amber
A/ Riprap length
g distance offshc
ax distance off*
hannel
bic yards /
np
ise/ oatli a�
ulldozing
e Length
tiV QI
not sure yes o
•ium: n/a yes n
......... .._._...
yes ni4
Attached: yes no
ng permit may be required by:
Local Planning Jurisdiction) 1
h C�
(Scale: t,
❑ See note on back regarding River Basin r

NC Division of Coastal Mgt. Habitat Impact Com
Applicant: Cp (n Q
Date: b , ��, /� o (�
Describe b ow 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
FI
(Applied for.
(Anticipated final
(Applied for.
(A
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
di:
Habitat Name
Choose One
includes any
Excludes any
total includes
Ex
anticipated
restoration
any anticipated
re:
restoration or
and/or temp
restoration or
ter
ternimpacts)
impact amount
temp impacts)
an
1
O W
Dredge ❑ Fill ❑ Both ❑ Other
S� 0
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill 0 Both ❑ Other ❑

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
'at McCrory Braxton C. Davis
Governor Director
John E. Skvarla, III
Secretary
AGENT AUTHORIZATION FORM
Date: ��_ / ( 7
yne of Property Owner Applying for Permit: N e of Authorized Agent for this p oject:
,oho,
vner's Mailing Address:
r good , No, =as
lone Number 3g GY
Agent's Mailing Address:
w � -q Lom-P-,Ys
Phone Number /J 00
ertify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
and obtaining all CAMA Permits necessary to install or construct the following (activity):
r my property located at
is c ificatio is v lid ru LP
Prop"/Owner Signature Date

C,F TWJEQ MAIL- RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property owrQAhen Realty, Inc.
Addressof0dpAkt!'lin Drive, Bolden BeachtNC 28462 Brunswick County, NC
(Lot or Street *, Street or Road, City b Gay)
Agent's NameFO.rbara S Andreas
MaMngAddre=3247 Holden Beach Road
Agent's phone *910-540-9879 Holden Bea2b, NC 28162 �.
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. Adescrigfion or dglyft. with dimenatong. must be WyJS ed with this letter.
v f '60-;oi i. po I have objections to this proposal.
Ityouhawobjectionstowhatisbeingproposed,youmustnodfytheDhIslonofCoastalManage+ wt
(DW) in wMing within 10 days of receipt of this notice. Contact ►nfomodon for DCM of m Is
BMiiabfaorby calling 1.888-4RCOAST.
No Is considered ft some as no o
Mpctfon #you have Deer batitled b Cariifleti Ma/f.
WAIVER SECTION
l understand that a pier, dock, mooring piings, boat ramp, breakwater, boathouse, or lift must
be setback a minimum distance of f 5' from my area of riparian access urdess waived by me. (if
you wish to waive the setback, you mmt initiaf the appropriate blank below.)
I do not wish to waive the 16 setback requirement.
Cohen Realty Inc. by Robert A Cohen
Print or Type Name
P 0 Box 545
Ma —Address
(Riparian Pro rty ner Information)
YAW -
Sign re
Sherri A Holloway
P►inl or Type Name
615 Pennington Ridge Court
Mafq Address
Norwood,NC 28128
C✓lowataTO
Lewisville, NC 27023
MyisrarerzilD

CERTIFIED MAIL - RETURN RECEIPT REgUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Own6qphen Realty, Inc.
Address of 4&e eroarlin Drive, Holden Beach, NC 28462 -- Brunswick County
(Lot or Street #, Street or Road, City & County)
Agent's Naa*l*ara S. Andrews Mailing Address: 3247 Holden Beach Road
Agent'sphong#0-540-9879 Holden Beach, NC 28462
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 roposing. P description or drawing, with dimensions, must be provided, with this letter.
I fiAYe noobjecitocwto this p {k3 1 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. Contact information for DCM offices is
available athttp://www.nccoastaimanagementnetlweblcrWstaff-listingorby calling 1-888-4RCOASr.
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 wis waive the setback, you must initial the appropriate blank below.)
_ 1:�tio wish#�'airaivs the ��`ti3at�s�1<`e�ulc�rx�t.
I do not wish to waive the 15' setback requirement.
r p rty net Inform tion)
ohen Realty, Inc. by Robert A Cohen
Print or Type Name
P O Box 545
Marling Address
(RtnProperOwn r in ation)ty
f
Signature
Terrence J. Burns
Print or Type Name
2020 Henniker St
Mailing Address
Norwood NC 28128
Apex. NC 27523

CA RO LI NA B LUEWATER CONS MUCInON
Custom Beach, Mainland, and Golf Course Homes
Complete Design / Engineering / Building
6934-9 Beach Dr. 5W, Ocean We Beach, North Carolina 28469 [phone]
.00
30' Cama
12'-10' 28'-0" 9'-2'
Do do
_--- • 16'xIY •
Alum. Floating
Dods w/ 8" Piles
1 12' x 16' B'- FB°""
Boat Lift
& 10" Piles
E
----� of
'v
CANAL #3
12' x 10'
Open Deck
S1'19'00'W 50.00'
i Existing Bulkhead
LOT 188
—� 5,000 SF
7.8
Owner. Terrence J. Bums
anon u.,....:�.,, c•