66691D - Jones

I CAMA / ❑ DREDGE & FILL j
VA W I� A B
��JAIERAL PERMIT Previous permit#
[]Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
•ized by the State of North Carolina, Department of Environment and Natural Resources �_� I �^
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC (� J
t ❑ Rules attach
t Name Cd (`Q �1 �hQ Project Location: County g r liv1Z
CA M'-? State
6 S E-Mail--
ed Agent `` a ( i/i aA [ 1�
❑CW XEW �WTA DES ❑PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
yes / no) PNA yes /1P
Project/ Activity, ( ()Y\'e4 (V
:k) length
tform(s) _
Natform(s)
igth
nber
offshore_
offshore
is
P
e/ Boatlift�
Iidozing
Length `" I 0
not sure yes
im: n/a yes
Street Address/ State `Road/ Lot #(s)
Subdivision —�
City —I y 1 CGI ZIPqr
{ C _J
Phone # (� () )10 �] (0[3� Ri�veBasin I�
Adj. Wtr. Body Gt � " `^ nat
Closest Maj. Wtr. Body ' VV , l
V1
(Scale:
mm
yes—
ttached: no ^�—
g permit may be required by: I (t/Y1 C '4 rj� ❑ See note on back regarding River Basin
ocal Planning jurisdiction) � ( y

NC Division Of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: C0 JCS .
Permit #;
Date:
Describe below 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
FINAL feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
Habitat Name
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp .
restoration or
temp impact
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 ❑ Eill ❑ 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 ❑

A��
w+ .NA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James K Ckepw Dee Freeman
Gommor Director Secretary
AGENT AUTHORIZATION FORM
Date: '7--/ !—
Name of Property Owner Applying for Permit Name of Authorized Agent for ttus project:
C�eA (A LL� 2�`c .Qrd.S�'--'
Owner's Mailing Address:
Phone Number (c#tq,, ati%l �v
Agent's Mailing Address:-
`) . u
Phone Number t D) 3�7 ti33
I certify that I have authorised the agent listed above to act on my behalf, for the purpose of applying
for and obtaining aU CAMA Permits necessary to install ormnstruct the following (activity):
This certficabon is id thru (date) / C`A IF
r
l! l2
p r re Date

DIVISION OF COASTAL NIANAG 2dFA 7
ADJACFN--T RIFARWN PROPERTY OWiYER STATEMNNT
I hereby cerfify that I own property adjacent to core. J c�-nx--)
property located at 3 ! -IX YA r�.m (;lame if Property Owner)
(Lot, Bio Road, etc.)
on ( 1� c in I C 1'1 a,UN
(Waterbody) (Town and/or Conn
Applicant's phone �h1affing Address:
He/She has described to me as shown below the development he/ is Prolm6at # location,
IRQ
and I have no objections to the proposal,
DESCRIPTION AND/OR DRAY NG OF PROPOSED DEVELOPA1FNT:
(7nd4ddudPr0p0sin9 development must. U in descripWon below or attach a site drawing)
Cam- acAAeA
J
If you have objections to what is being proposed, you must notify the Division of Coastal I nag ement within 10 days of receipt of this notice. Correspondence should be mailed to L7 Cardinal Drive Ext Wiimingtc�n,
11D in
DCK representatives can also be contacted at [phone].
No response is considered the same as no obiedion if you have been notified b4 Certified Mail
\er o Lion) (Riparian Property Own Information
C,
Signature
�j Signature
W I 1 1 �1 la�f�s ,li � 1,�i A �( �00
Print or Type Name Print or Type Name
V� Mailing Address
WIN

ADJACENT RIPARIAN' PROPERTY OWNER STATEMENT
(FOR A P.FEB MOORM PHXVGS/BO.A7LUT/BOATHDUSE)
I hereby certify that I own property adjacent to 's
(Name Property Owner)
property located at 135 D ur h Gtim S+.
.(Lot, Block, Road, etc.)
on Icoy c , in I-D UZA &4CA\ 'N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: q I0 - a 9 -7- b 13Mailing Address: (3 5 Y ha' S f .
-iv C 91$,
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatli$ / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
C C,�- I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
In 4a,l l bock " LA
D140-11 hater `pier .1-n
L
(Information for Property Owner Applying
for Permit)
3ass sk&o(esi Nve.
Mailing Address
Suppki . N 14(oo\
(Riparian Property Omer Information)
Signature
Cartt I4ufchknS
Print or Tym Name
City/%tealp

n W
II IIII II
Proposed
Pier li II
II 61124 II�
II II
II II
Proposed Lift
15X15
Scope of YVork:
Install boat lift
nstall finger pier to access boat
CANAL
Gory & Lindsey Jones
155 Durham 5t
Holden Beach NO 2b462
Adjacent Property Owne
Town of HB
Street End
i