67275D - Wood

4,CAMA / ❑ DREDGE & FILLA B
GENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue [-]Partial Reissue Date previous permit issued
-ized by the State of North Carolina, Department of Environment and Natural Resources ^7
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
A 1 j� �f ❑Rules attached.
o6^
t Name l IVI�f �1/�, Project Location: County►`�'(V>,1� (M�
-Z t Li W1(VAO1V1 5kllytS t�i Street Address/ State Road/ Lot #(s)
,i State ZIP 1
dk0 ) 5"AO- 0510 E-Mail '— ——`�-'-' _ Subdivision
ed Agent 6 City_( �(11A.V1 126 t` �1�(� ZIP TA
❑ Cw P�EW A ❑ ES ❑ PTS Phone # (70_�) I (v — Z 3Ri r Basin
❑ OEA ❑ HHF ❑ IH ❑ USA ❑ WA
❑ PWS:
yes / Fd'1 PNA yes
Project/ Activity
:k) length I
dform(s)
Platform(s) Y
igth
nber
V Riprap length
distance offshq
c distance offth
annel
Length
Adj. Wtr. Body l nat r
Closest Maj. Wtr. Body
rol
r�
(Scale:
g permit may be required by:
.ocal Planning jurisdiction)
I Owh o F��I-t 1 t
J A
❑ See note on back regarding River Basin
U —1 ► - I . - n

NC Division of Coastal Mgt. Habitat Impact Ccamputer Sheet
Applicant: Qua Permit #: (�-7 z7S_ 0
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.
IFINAL
TOTAL Feef
FINAL feet
(Ap'plied.for.
(Ah6dpated#final
(Appiiedfor.
(Anticipatedfinal
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
andlor temp .
restoration or
temp impact
tem impacts)
impact amount
temp impacts.)
amount)
Dredge ❑
Fill ❑
Both ❑
Other
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge..[]
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other
Dredge ❑
Fill ❑
Both [I
Other �
Dredge ❑
Fill ❑
Both ❑
Other 171
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑. Fill ❑ Both ❑ Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
-T--T-,
Dredge ❑
Fill ❑:
Both ❑
Other ❑
Dredge ❑
FiIE ❑
Both ❑
Other ❑ .
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
—f Dredge 0 Fill 0 Both [IOther 0

'ayment Proccessing Confirmation
)ate Received 11/4/2016
:heck From (Name) Holden Docks & Bulkheads
flame of Permit Holder Brad Wood
/endor CresCom Bank
:heck Number 3034
:heck amount $200.00
Jlultiple Permits No
Aajor/Minor
'ermit Number/Comments GP 67275D
teceipt or Refund/Reallocated 2837D

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2/07/2004 19:20 9108429806 GREG HOLDEN PACE 01
Name of Individual Applying For Permit:
Address -Of Property:
(Lot 'or Str�itset trect or Road, City & County)
I hereby cxrtify that I own- property adjacent to the above -
referenced property.. The individual applying for this permit has
da==Jbed to me as shown an the attached drawing the daveiopuent
they are proposing. A description or drawing, with dimensions,
should be provided with this latter.
I have no objections to this proposal.
I understand that a pier, dock, mooring pilings, breakwater, boat
house, lilt _ . must be not back a ininimn distance of 15,
from my area of riparian access unless waived by sue. : (If you wish
to valve the setback, you &Mat initial the appropriate blank
below.)
2::do Nish to waive the 15tsatback requirement_
I ao net Wish to waive the I5•setback requirement.

11 / b1/ lbl b 013: Qb 33bU41bZU4 VANN YUMK AU I U PA6L
OWxM
13YSaSTC)K OF
Name Of I>nAivi4aal Applying !or pa=jt: 6MA
WJ[Ld—
Mdress-of Property: YLIJ 0_ t
(Teat ` orst t , s!t Gr Road, C ty County)
I hereby certify tfiat I MM,- prgpmt:y aW jacent to -the above-
rardtbacad property- Vbw OWILY12W for this permit has
described to see as items eel the attacb" llxMI0fn3 the dtvelopftaat
Should be � With th" ]Kier. r With di mim►s ,
have no objeetiam to this proposal.
It tand thot a y1er, dbeh, vx ac-UM Pik I Arm
�, lfft >t■salt hw >~t 009* a twin �tuKM ofbout
s,
JE%,M s4 area of ripsrium &cows vs7 n= valved bw w- : (Z! YM Irish
to Maiw the sue. 7M MUM satti,al %be app r sox 4 me bL-U*
below.)
x,Aa vish to valve the 15feethack rrguireeent-
w_V__ I de-ppM wish to wive the ls•setback raquissa.ent.
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