69342D - Holsinger

i!eAMA'°/ -] DREDGE & FILL u I$ 5 A B
BEN ERAL PERMIT 1 Previous permit #
New .Modification ❑1Complete Reissue CPartial 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 (J/ f `OC;)
i El Rules attached.
t Name o v o OA N ' % (Y- Project Location: County_ j� 444 C
11100 D\J N - (0 l 0 rc+. � (1 Street Address/ State Road/ Lot #(s)
�C&\ -A So r StateG ZIP_-;-t. -1_ 1Z0i � es V 71' " Ss ,
"`' U j vl ` E-Mail Subdivision
edAgent wckyk � A GVNz_ city
0(ea h A �,-( l�t�C ZIP��
❑CW `4EW KTA El ES ❑FITS 6kbne # (�) 5-71-
I- IV15 River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
PWS: Adj. Wtr. Body C AYVCA (na
yes / j" PNA yes /C_% Closest Maj. Wtr.
■ ■■ ■■■�■■■ ®■■■■■■■■■■
igth
nber
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I/ jRiprap length
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is yards
■■■�■■■■■�i��■■WIN NOWNTIPPILI!

North Carolina Department of Environment and Natural Resources
Division of Coastal Management
t McCrory Braxton C. Davis
ovemor Director
John E. Skvaria, III
Secretary
AGENVTAUTHORIZATION FORM AGENT AUTHORIZATION FORM
Date: 6 `4 t! -
-ne of Property Owner Applying for Permit:
ner's Mailing Address:
�q I) C w(lt b'CQ
,Igo_3
me Number Oitv�-
me of Authorized Agent fo this project:
Agent's MailintZdress:
2-
Phone Number 5q c�' Q k�s c--,
�rtify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
and pbtaininq all
install or construct the following (activity):
my property located at ift
s certification is valid thru (date)
\0 A-C� - 7
Property Own6 Signature Date

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: �A_
Address of Property:
(Lot or Street #, Street oe Road, City & County)
Agent's Name #: �� icy�ruLi3�
Agent's phone #: %,0-
ctC.
Mailing Address:6I � BQQ6\ ►✓t` z3bi
S, c NC Z,%u
I hereby ceytifpr that I own property adjacent to the above referenced property. The individual applying for
this permit/hao described to me as shown on the attached drawing the development they are proposing.
l\I/ ha a no objections to this proposal. I have objections to this proposal.
if you have objections to what is being proposed, you must notify the Divis" n of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Corres ' e should be
mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM represenfii ► can also be
contacted at [phone]. No response is considered the same as no objection #WA" been
notified by Certified Mall.
r3 r,
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 wish to waive the
setback, you must Initial the appropriate blank below.)
do wish to waive the 15' setback requirement.
do not wish to waive the 15' setback requirement.
�A�An
(Property Owner Information)
ccnor)A�
Signature
1.�y6c) � � s R C-
Print R Type Name
W32-(sC�s)r,,,s-t\nr�'ct
Mailing Address
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City/State/Zip
Owner Information)
Print or Type Neime—
0O27
Mailing A dress
City/Stat&2ip 1911

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: ��� 1 k R� e
Address of Property: 1 �C�IS� 221 a, CtCN_
(Lot or Street #, Street oeRoad, City & County) t�
Agent's Name #: Gr icy. 3 ns6 uC,ki��1 Mailing Address:W �� �Ch ►✓(—
Agent's phone #:
I hereby certify that I own property adjacent to he above referenced property. The individual applying for
this hermit has described to me as shown on the attached drawing the development they are proposing.
X— I have no objections to this proposal. I have objections to this proposal
ff you have objections to what is being proposed, you must notify the Divf ' n of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Corr _nce should be
mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM representad4s am also be
contacted at [phone]. No response is considered the same as no objection #'y0** 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 wish to waive the
se tb ou us initial the appropriate blank below.) I <1 I
�- ✓'-) O J
I do wish to waive the 15' setback requiremert�- -
I do not wish to waive the 15' setback requirement. �Q j,poK- F�
(Property Owner Information)
i�R�d Cq��
Signature E
`
Print o Type Name
V 6Z'� Cn rw kt Q
Mailing Address
ly\v t4z-,:�->\ t\�q �t(2'W �;l
City/State/Zip
jacent o Informs
! n Lure
eCl (
Print or Type Name
0c) q 6-3
Mailing Address
City/State/Zip

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SENDER:1 •
• • ON DELIVERY
■ Complete items 1, 2, and 3.
A Signatur
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■ Print your name and address on the reverse
X ❑ Agent
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so that we can return the card to you.
❑ Addressee
■ Attach this card to the back of the mailpiece,
B. Received by (Printed Name)
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C �6ateMfD
2 2 2
or on the front if space permits.
IV pp �,
(n
1. Article Addressed to:
D. Is delivery address different from item 1? ❑ Ye
If YES, enter delivery address below: ❑ No
PI o t ax 063
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2'�33-1
I I I' III II I II I I I I II I I I I III
3. Service Type ❑ Priority Mail Expresso
❑ Adult Signature ❑ Registered Mail-
9590 9402 2219 6193 1028 95
0 Adult Signature Restricted Delivery ❑ Registered Mail Restricted
rtifled Mall® Delivery
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Certified Mail Restricted Delivery �fReturn Receipt for
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9 Artlrla Ni,mhor iTrancfpr from enniirp imhpn
❑ Collect on Delivery Merchandise
❑Collect nn Delivery Restricted Delivery 17 Signature ConfirmationTM
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la il El Signature Confirmation
7 017 0 6 6 0 0 0 0 0 7 4 8 7 0 9 0 0 Jail Restricted Delivery Restricted Delivery
D- a- a
(3 0 0
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PS Form 3811, July 2015 PSN 7530-02-000-9053
Domestic Return Receipt
0 0 0
0 0 0
0 0 0
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(V N N
Efl EA Efl
COMPLE'ETI: S SECTION ON DELIVERY
SENDER: COMPLETE THIS SECTION
'IT
■ Complete items 1, 2, and 3.
ur
❑Agent
CD
■ Print your name and address on the reverse
X ❑ Addressee
so that we can return the card to you.
B. eiv Printed Name)
C. Date of Delivery
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
D. Is delivery adhress different from item 1? ❑ Yes
If YES, enter delivery address bKfow: ❑ No
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I I I I I III II I II I I I I I I I I I I I I
3. Service Type ❑ Priority Mail Express
❑ Adult Signature El Registered MaiIT'"
❑ Adult Signature Restricted Delivery ❑ Registered Mail Restricted
a)
9590 9402 2218 6193 9338 10
ertifled Mail® Delivery
❑ Certified Mail Restricted Delivery $Return Receipt for
c
❑ Collect on Delivery Merchandise
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2. Article Number (Transfer from service label)
❑ Collect on Delivery Restricted Delivery ❑ Signature Confirmation
Signature Confirmation
7 017 0660 00 00 7486
7 69 6 icted Delivery Restricted Delivery
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PS Form 3811, July 2015 PSN 7530-02-000-9053
Domestic Return Receipt .
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Postal
CERTIFIED p RECEIPT
CERTIFIED D RECEIPT
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Domestic Mail Only
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ELIZABETHTOWNY NC 28337
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