69212D - Hendrick

2PAMA / ❑ DREDGE & FILL
aENERAL PERMIT Previous permit # A B
]New :]Modification El Complete Reissue EPartial Reissue Date previous permit issued ,
rized by the State of North Carolina, Department of Environment and Natural Resources
-oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
I _
! i ❑ Rules attached.
t Name U,, �1.1 ,i.t -
—� Project Location: County�''�7�,1
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State ZIP
E-Mail
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ed Agent , 4 r" 14 r ;"— � _ �,a�7 ?
❑ CW NFTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH f-1 URA n MIA
❑ PWS:
yes /ono PNA - yes �/ no
' Project/ Activity "k srkt, v, fir*Ci
Street Address/ State Road/ Lot #(s)
f �
Subdivision
City. _ y J .. ✓'r '1 ZIP
Phone # O tit River Basin
Adj. Wtr. Body mat i
Closest Maj. Wtr. Body N -4
:k)length (Scale:
rtform(s)
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Platform(s)
er(s) i
igth
nber
I/ Riprap length_
distance offshore
K distance offshore
annel
is yards
P
,e/ Boatlift
Ildozing
Length
not sure
yes no
Im: n/a
yes
yes no
:tached:
yes no
f�l �, � I fin-
g permit may be required by: % - ❑ See note on back regarding River Basin ru
---I DL--- :...

6'-0" 14'-2"
Boat Lift Pilings
2
Normal Low Water
1
Normal High Water
20.0 ft —
Open PF
Gazebo
0
0
LO

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Holly Hendrick
Mailing Address: 131 Creeks Edge Dr
Sneads Ferry, NC 28460
Phone Number: 704-564-3568
Email Address: [e-mail]
I certify that I have authorized David Logan of Logan Marine, LLC
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
erect new private docking facility
at my property located at Lot 45 Everetts Creek Estates Sneads Ferry, NC 28460
in Onslow County.
1 furthermore certify that l am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
ignature
tint or Type Name

mplete items 1, 2, and 3.
it your name and address on the reverse
that we can return the card to you.
ach this card to the back of the mailpiece,
Dn the front if space permits.
-le Addressed to:
Ihnny 'FYeemarN
30W owy Mp
l-6V15 bn , GA B00%q
111111111111111111111111111111111111111111
9590 9402 2223 6193 6676 01
0910 0000 6063 8401
.m 3811, July 2015 PSN 7530-02-000-9053
)mplete items 1, 2, and 3.
int your name and address on the reverse
that we can return the card to you.
tach this card to the back of the mailpiece,
on the front if space permits.
icle Addressed to:—�
w4p. „Lift' Haynes
r 1pttA arc BQa+. 1.h
44S terry M zgybo
IIIIII IIII Il11111111111 III III II IIIII II II 111
3590 9402 2223 6193 6675 95
le Number (Transfer from service label)
110 0000 6063 8395
n 3811, July 2015 PSN 7530-02-000-9053
D. Ts delivery address different from item 1? tO Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Priority Mail Express®
❑ Adult Signature
❑ Registered MailTM
❑ Adult Signature Restricted Delivery
❑ Registered Mail Restricted
❑ Certified Mail@
Delivery
❑ Certified Mail Restricted Delivery
❑ Return Receipt for
❑ Collect on Delivery
Merchandise
❑ Collect on Delivery Restricted Delivery
0 Signature ConfirmationTM
❑ Insured Mail
El Signature Confirmation
❑ Insured Mail Restricted Delivery
Restricted Delivery
(over $500)
A.
X
Received by
Domestic Return Receipt
D. Is delivery address different from item
If YES, enter delivery address below: ❑ No
Adult vjuSig tynature pe
❑ Adult Sig
❑ Priority Mail Express®
El Adult Signature Restricted Delive
El Certified Mail® ry
� Registered Mail—
Registered Mail Restricted
❑ Certified Mail Restricted Delive
ElCollect on Delive ry
Delivery
Return Receipt for
❑ Collect on Delivery Restricted Delivery
❑ Insured Mail
Merchdise
❑ Sig ature ConfirmationTM
❑ Insured Mail Restricted Delivery
(over $500)
❑ Signature Confirmation
Restricted Delivery
(,
Domestic Return Receipt
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