69168D - Dodd

NC Division of Coastal Mgt. Habitat Impact Computer St
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scribe belovG the HABITAT disturbances for the application.
I 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 fin<
DISTURB TYPE
Disturbance total
disturbance.
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disturbance.
abitat Name
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includes any
Excludes any
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any anticipated
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Dredge ❑ Fill ❑ Both ❑ Other
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Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both 0 Other ❑

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date April 3, 2017
Name of Property Owner Applying for Permit:
Karen Allred Dodd
Mailing Address:
6521 Hollow River Dr.
Oak Ridge, NC 27310-9788
I certify that I have authorized (agent)
Joel Klass
to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) install boat lift
at (my property located at) 111 Fayetteville St. Holden Beach, NC
This certification is valid thru (date) _

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Karen Allred Dodd s
(Name of Property Owner)
property located at 111 Fayetteville St.
(Address, Lot, Block, Road, etc.)
on , in Holden Beach N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
to on.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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.)
xI do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Karen Allred Dodd
Print or Type Name
(Adjacent Property Owner Informati n)
Signature * a
Thomas Massingale
Print or Type Name

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Karen Allred Dodd
Address of Property_ 111 Fayettevelle St. Holden Beach, NC Brunswick
(Lot or Street #, Street or Road. City & County)
Agent's Name #: Joel Klass
Mailing Address: P O Box 279
Agent's phone # [phone] Supply, NC 28462
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they
�are proposing. A description or drawing with dimensions must be provided with this letter.
i°P�N" 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. Contact information for DCM offices is
available at www.nccoastaimanaaement-net/coniact dcm.hbn or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail
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
�✓ish to waive the setback, you must initial the appropriate blank below.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Prope.ry Owner InformatIon)
Sigui�trn•e
Karen Allred Dodd
Print or Type Name
6521 Hollow River Dr.
Mailing Address
(Adjac nt Property Ow er Information)
<.;�z
Signalure
R & M Whitaker LLC
Print o,- Type Name
890 Loblolly Dr.
Mailing Address
Oak Ridge, NC 27310-9788
City/State/Zip
Vass, NC 28394
City/State2ip

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