66692D - Hollingsworth

CAMA / L DREDGE & FILL 1 /
.3PENERAL PERMIT Previous permit #
]New XModification El Complete Reissue ElPartial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources �
:oastal Resources Commission in an area of environmental concern 4AW
pursuant to 15A NCAC
k [I Rules attached.
it Name OM � �� (1 � W 6( i T t Project Location: County &AsX ( L.
Q + Street A¢flress/ fate Roa /Lot #(s)
i� Stat.V ZIPiH- 1 1 -
r
1
t -U ) fflE-Mail _ Subdivision
:ed Agent l�J� Cityl�%t �. «� ZIP
❑ CW PTA ❑ ES ❑ PTS Phone # (�) jr " `River Basin 7, vW
ElOEA ❑ HHF ❑ IH ElUBA ❑ N/A Adj. Wtr. Body �1 V ! T — E N nat
❑ PWS:
Closest Maj. Wtr. Body
f Project/ Activity.
)ck) length_
latform(s)
Platform(s)
ength
ember
id/ Riprap length'
,g distance offshore
iax distance offshore
:hannel ?
Bulldozing
(Scale:
Attac yes no
A �.
ing permit may be required by:
Local Planning jurisdiction)
") iA,, i--,Ii I'\ y- - , _ 1 . II
❑ See note on back regarding River Basin

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: �� � t;�V �v6fi Permit #: %
d � l0
Date: 0 D/�j► �/0\101
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp .
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
d V ul
Dredge ❑ Fill ❑ Both ❑ Other IXr�
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both El Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑. Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill [I Both C] Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

US MAIL
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner: 4�4AR tt- 4-4a i.(_ , ^jgs wo/tiA- --
Address of Property: ( �t�1�[t-9 4-
(Lot or S
Applicant's phone #:
#, Street or Road, City &
Mailing Address: 4?r alit —
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this pern
has described to me as shown oil the attached drawing the development they are proposing. A description of drawin
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 E:
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, clock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance
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' set back requirement.
I do not wish to waiye-the IS' set back requirement.
(Property Oywper Information)
Signature r
;?A)� �L C,J t,.lit .i
/t� Wu 11'
�-
not or Type Jjame
T<oU
ling Adiress
'i
(Riparian Property Owner Information)
Signature
Print or Type Name
7g80
Mailing Address
Log v e I/UPUP, 6 �C z

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property
Owner Applying for Permit:
�� A�j
Mailing Address:
7317
I certify that I have authorized (agent) !kla- C WS-�rtjc- -t Oj to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
15 �
install or construct (activity) l �, 040 Chi. l A j= 7
at (my property located at)
-A
This certification is valid thru (date) vv /� �6
Property Owner Signature —� Date

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
-DIVISION OF COASTAL MANAOEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVf R FORM
a �c1 `T�11 � n l�o7 - --
Name of Property Owner: � �.1.r._--..._.__ --�.-_---�.-�-_--..----
Address of Property: �_` __
�(t.ot or Street , Street or Road, City & CounTy
to `) Mailing Address:
Agent's Name #:yC�`
Agent's phone #: - Q�
I hereby certify that I own property adjacent to the above referenced property. The individual applying for
this nermit has described to me as shown on the attached -drawing the development they are proposing.
I have no objections to this proposal. __-_ I have objectiw1s to this proposal.
If you have objections to what, is being proposed, you must notify the Division of Coastal
Management MCM) in writing within 10 days of receipt of this notice. Corresggnplenae.shauld be
mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM represent4oves can also be
contacted at [phone]. No response Is considered the same as no objection /f you Wo been
notified by Certified Mail. ---- -
WAIVER SECTION
1 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.
I do not wish to waive the 15' setback requirement.
(Property Owner I f rmation)
—CC t t n
r rr�r�ru•c
Print or Type ame
�15---
lda ing Address
city/state/zip
-
Telephone Number
(Adjacent Property Owner Information)
-- Sign�dm•e
JM _�_�r+ey r✓
Pint or Type me
- --- 3 -� 8
Melling Address
0 - R i�
city/strate/zip
(0 ?-te q - ,-71
Telephone Number

CERTIFIED MAIL - RETURK RECFIPT REQUESTED
--ANVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:
(Lot or Street /t, Street or Roed,
Agent's Name It: `�`�?�'.-`� �o `� Mailing Address: ���"�-� ""`_ e-�
Agent's phone It: ��� : �v-R5— �qA. A-�--- �`'- ---_—� 1�
S�
1 hereby certify that 1 own property adjacent to the above referenced property. The individual applying for
this permit has described to me as shown on the attachecl-drawing the development they are proposing.
-- . .. ... ... ....._.......,.�'�d�d'c\(tiuS`i''S
v/ I have no objections to this proposal. I have objections to this propusnl.
W +kA, S`t-% cW\C- 4to-;;
if you have objoctions to what, is being proposed, you must ratify the Division of Coastal
Management (QCM) !n writing within 10 days of receipt of this notice. Corres#.gnOence.should be
mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM represent�NVe can also be
contacted at [phone]. No response is considered the same as no objection if you hi�D0 Aleen
- - notified by Certified Mall.,
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.
do not wish to waive the 15' setback requirement.
(Property Owner I f rmation)
'i ;n�rhn•t� --
Print of 1 ype ame -
u's
ailing Address
Cil ylstatoalp
Telephone Number
- (Adjacent Property Owner Information)
Sil;nnlru•e
Print or Type Name
sCb'+tl e ac�t7ttX 7r
Mailing Address
y.� n�(kr C)Zg 35
City/state/Zip 7
Telephone Number
— 1-1 -

DomesticCO
m
ru For
©OI NqTOWN'r F'A <:1q3
ru
cO Certified Mail Fee - -
rp $ i. tlI II471I
$ m Extra Services & Fees (check box, add tee s I I I Ote) 11
❑ Return Receipt (hardcopy) $
❑ ❑ Return Receipt (electronic) $ s II I _ flfl_ fl0 Postmark
❑ ❑ Certified Mail Restricted Delivery $ 4 r_�� Here
❑ ❑ Adult Signature Required $
❑ Adult Signature Restricted Delivery
C3 Postage
=r $0.47
C3Total Postage and Fees 06/28/2016
$ $6.47
Ln Sent
a Q n11�e 5 C3 i a011 p C
❑ --
agca . (No., or box No.
1 a's `j� r�`�9►,/u(`r�----------------------------------------
■ 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,
or on the front if space permits.
1. Article Addressed to:
Domestic
m
r delivery information, visit our website
�'ru
.
10 Certified Mail Fee _ 3
$ m
Extra Services &Fees (check box, edd tee as )
El Return Receipt (hardcopy) $ • - -
❑ Return Receipt (electronic) $ iil I _ Aft
Q
C3❑ Certified Mail Restricted Delivery $ Goy__-_i 11 li 11 1
1:3 ❑ Adult Signature Required $ r
[-]Adult Signature Restricted Delivery $
C3 Postage
- $ $0.47
Total Postage and Fees
C3 $ $6.47
a 49,
C3 t-
r-
A. Signature 1 , -
X r�A� '� ❑ Agent
❑ Addre
B. Received by (Printed Nar7e)yl C. Datp of Del
FRAglL D EA ry Jn I30 )
D. Is delivery address different from item 17 ❑ Yes
If YES, enter delivery address below: ❑ No
Postm
Her,
116f 2$/
3. Service Type ❑ Priority Mail Express®
❑ Adult Signature ❑ Registered Mail-
0 Adult Signature Restricted Delivery 0 Registered Mail Restricted

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