67121D - Shaver

Cf4MA / - DREDGE & FILL t—� \Q1
A B
j E N E RAL PERMIT a Previous permit #
�lew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued_
rized by the State of North Carolina, Department of Environment and Natural Resources fifi
.oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
t Name f� � S Y iyy �M<V\;(
❑ Rules attac, hed.
Project Location: County K
Street Address/ State Road/ Lot #(s)
e iriGi �\ �'^� r� State + ` , 1 V
q 0 �n
( & �vt�{ 17 E-Mail Subdivision
ed Agent �/�,� � � �G �^ V1 ri(,V�� IN e City i ��� ZIP
❑ CVN �4W *A ❑ ES ❑ PTS / , Phone* (�I D) ���- � � � ver Basin
❑ OEA ElHHF ElIH ❑ URA El NIA
❑ PWS:
yes / ho PNA yes
' Project/ Activity
_k) length
itform(s)
ngth
nber
�Riprap length C', O
distance offshore 1
x distance offshore
�y�ye. no l "
stached: yes no—'
ig permit may be required by: _
focal Planning jurisdiction)
-,It 1 -
Adj. vvtr. Body (nat
Closest Maj. Wtr. Body

NiC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: ( , — IT S r l m"w
Date: 07A J 40\6 ( G
Permit #: G-o �'� -
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/ortemp .
impact amount)
TOTAL Feet,
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/c
temp impact
amount)
Dredge ❑ Fill Both ❑ Other ❑
160t
00
h2—
Dredge ❑ Fill Both ❑ Other ❑
0
1 1600
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 Ej Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

�C R
North Carolina Department of Environment and Natural Resources
Division dCoastal lOwne rent
Beverly Eaves Pmdw James H. GWon Dee Freeman
Governor jjimmr,
semeiary
AGENT AUTHt7RiZATfON FARM
m,a of=PtAppMng for Permit: Name of Authorized Agent for this project:
Owner's Wing Address: agents Afaifi'ng Address:
Phone Number (33f4 4S E •' ",q qj -Phone Numberpi 6
1 certify that I have audtnr"d the agent listed atwve to art on my behalf, for the purpose of applying
for and obtafnfng all LAMA Permits necessary to install or construct the following (adivity}
{rx►y prapertY located} at t _ c-
This eedification is valid thru (date) au a (, ,4 1s-a t)d,
Property Owner Signature Date 4�

=>---�> N
Canal
Existing Dock
13ft 10fbQ4ft 13ft
MA5 Properties LLC Brent Shaver Lloyd Nrlgl
131 Ocean Blvd. Nest 121 Tarpon Dr. 6145 5R 1
Holden Beach NO 25462 Holden Beach NC 28462 coolville O
Scope of kNork:
Replace Bulkhead Nall

in.4.jt-.• 8t kkeoj
CERTIM-1) MAIL- RIET UFUN RECEII?T REQUESTED
DIVISION OF COASTAL 'IYUNNAGEbU L
ADJAC .NT RIYARIA N PROPERTY UW.IER STATLiYIEti"T
hereby cerd!)r that I own properr! aejaceat to re n� �S hayCr s
piopezty located at ( I _ IQY �r. (Tame of Property Owner)
(T"nt, black, Road, etc.)t
on_ _1 Q11 _ . in_�' L N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:_- 310 - '05 - ►{) T Mailing Epruposi6ng
H�;Sbe bac described to me as shawn below the dcvclopmcat he/she iat that ovation,
and I have no obiections to the proposal.
DWRIP TFON AND/OR DR.AVIING OF PROPOSED DF VELOPNMNT: -�
andiy-idual proposing development must jW in deseripfion below or adaeh a site drawing)
--Replam &Akh� gall
If you have uhjertious to what i$ being proposed, you matt natify the Division of Coastal d4aeageuteal (DCI1S) ib erlting
within 10 daps otreteipt of" notice. Correspoudeuce should be mailed to 127 Cardinal Drive $it. Wamingtoo, NC
DCM reprexentatives eau also be contarted at (910) 79&7115_
No restwnse is cqustdered the same — no otriertidn i! you havc brew nstiGe3 by t.crti6ed'�fai1
e er to r tatun)
Signatttre
V4 t 11 1� t 41 ar -.5c n ( A t,,ty) A
Print or -Eype Name
Za 3 5 S, recut
Mailing Address _
1 �N
city / s zip%
Riparian Property Owner Information)
5tgtt =tore
Print or Type Nanrde
3 DZW .
Mailing Address
b1 &A,
City: Statc / Zip -
Telephone\cumber 6110 -AI.,-7- () 7-,'-7, ~ ,._,­ ., . 4 I!l _ Q LL-1 - iia-2a

CER'TMED N AIL - RETURN RECEIPT REQUESTED
DIVISION OF COAST A- L INUNNAGEMMNIT
ADJACENT RIPARIAN PROPERTY OW`YER STATFUMENT
I hereby certify that I own property adjacent to _ i6 re nt'S'Shaver 's
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on �GL YIIJ�� in
1�1C;Y� �1.1�[0.ck I.C.
(Waterbody) (Town and/or County)
Applicant's phone #: Mailing Address: __ ! a I I UyD�r1 'Or,
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(Individual proposing, development must fdI in description below or attach a site drawin j
.-R e.�la 6 u) kSuod 1kAl I I
If you have objections to what is bein; proposed, you must notify the Division of Coastal Management (DCW in Seri
within 10 days of receipt of this notice. Correspondence should be mailed to L7 Cardinal Drive Ext Wilmington, NI
DCM representatives can also be contacted at [phone]_
No response is considered the same as no obiection if you have been notified by Certified Mail
�9 ne rmation)
L.
Signature
(Atk�
Print or Type Name
_3a3 5 a0,Cr est ve
Mauling Address
n_.. vJL.L ,
(Riparian Property Owner Information
Signa �
L 1 N-�Ir
�,tPrint or T ame
t/IDS SW /yv
Mailing Address
r- A , l�� Vr-7�;L 7