66574D - Holmes

CAMA /❑ DREDGE & FILL A B
�f.NERAL PERMIT Previous permit#
New ❑Modification El Complete Reissue El Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources +
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC fj (�❑
1 ❑ Rules attached.
Name Y'% Project Location: County V\.:ty-3y",;
WA'1 v k. Street Address/ State Road/ Lot #(s)
aw— �A{ State ZIP &I b k� LI W 0 ` C-4 � �,t_� 'r 'ice ti :\ -.
O Q) M E-Mail Subdivision t ,
;d Agent Q City 0, t/1 � 1 ZIP
❑ CW �EW A ❑ ES ❑ PTS Phone # ( River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A I V Adj. Wtr. Body
❑ PWS:
yes /� PNA yes ^� Closest Maj. Wtr. Body
Project/ Activity
11
)
(Scale: ' __A4
k) length n ' IL cam.
Yorm(s)
5�
r
'latform(s) X
gth
fiber
I Riprap length
distance offshc
distance offfssp
innel /
P
Ildozing
not sure yes ( no
Im: n/a yes Ano
yes
ttached: yes
g permit may be required by: H OCUA/I UUCL ❑ See note on back regarding River Basin rt
.ocal Planning Jurisdiction) N � . I I ,

IC Division of Coastal Mgt. Habitat Impact Computer Sheet
pplicant: pp�` �r' �-Permit #: l.X , �nq
IN lr
ate: lX,
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
fund in your Habitat code sheet.
abitat 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/oi
temp impact
amount)
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 ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both E:1 Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

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0allbion of CiiO "_ !lt
F. Eaft. Goymmor 4m" IL QmFm it OG Roo
i�%tllAOrbed Agent CtrnsenR Alp nm ment
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c a L5 desadbed in tha a2loched sketch-
TIOM OF PPAIW:CT:
PER Y O MWk MAC ADDRESS:
t ", -_. i
r �
PHONE ma
of property Owner. (`�-'

i2/07/2004 19:20 9108429806
GREG HOLhEN PAGE 01
S
AWA RT QN OF COA STn r �.a
ARr�*d PRoFERTY nIDwra
Name Of Individual Applyi_ng For Permit: P %
Address -of Property: / Z�a S
(Lot 'or Street � g reef
y 6 County)
I hereby certify that T
ref eranced Own- property adjecent to the
described to met sy- The individual applying for this above -
they are shove orb the attached dravin permit has
should Proposing' A description or drawl g the development
Provided with this .latter. With dinens,ions,
-- I have no objections to this
Proposal.
i*1►lY�R 8 �mTn
I understand that a i
house, lift Per, dock, Mooring il, s
bust be net back P g ' braacwater, boat
from ay eras of'ri ek a minimue distance of 15•
to waive Feriae access unless waived by me. (If you wish
the setback, you
below.) Rust initial the appropriate blank
I do wish to waive the 15'setback requirement.
-- x S4-= Wish to waive the 15 r setback requirement.
sl
0"1-
r of Name

/67/2004 19:20 9108429606
DREG HOLDEH PAGE 01
Name Of Individual Applying For Permit:
Address"Of Property: \y
(Lot -or 5trimet , Street or Road, City & County)
I hereby certify that I own- property adjacent to the above -
referenced property_ The individual applying for this permit has
described to ne as shorn on the attached drawing the development
they are proposing. A description or drawing, with dimensions,
should be provided with this letter.
I have no objections to this proposal.
I understand that a pie~, dock, mooring pilings, breakwater, boat
house, lift _ must be set back a minim m distance of 15'
from my area of riparian access unless waived by me. (if you wish
to waive the setback, you Vust initial the appropriate blank
below. )
I: -do wish to waive the 15?setback rmquirement_
I do net wish to waive the 15'setback requirement.

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