64614D - Hollingsworth

rCAMA / DREDGE & FILL
;EN ERAL PERMIT Previous permit #
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
•ized by the State of North Carolina, Department of Environment and Natural Resources ) zel�
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC /"7
,r � Rules attached.
t Name irr41, w Project Location: County z i i �+d/!�r
Street Address/ State Road/ Lot #(s)
MW State ;?�7 Z. 3 A/�'I/.�l��Gr �.!/I"
el %�%' Fax # ( ) •---- Subdivision R1e d5L,%� e fi t/
. "*142 %+� �ii"�ZIP
ed Agent � City
❑ CW EJ EW ❑"PTA ❑ ES ❑ PTS Phone # O ^"" — River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body t1�"�/{/ W linat A
❑ PWS: ❑ FC:
Closest Maj. Wtr. Body
yes / PNA yes / no Crit.Hab. yes / no
no)
f Project/ Activity
(Scale: / r;
❑ See note on back regarding River Basin
>_.

rm Name Name of Permit Holder
Vendor
Check
Number
Check
amount
Permit NumbeNComments
Refund(Reallocated
Batten same First Citizens Bank
same NC State Employees' Credit Union
same B of A
same Piedmont Advantage Credit Union
)n_struction Co._ King First Federal _
or Carolyn Wilson same TD Bank
uction LLC Thompson CresCom Bank
Ikheads LLC Tatum Wells Fargo Bank
s, LLC McLeod B of A
same Marine Federal Credit Union
i Frank Pope - BB �T
t@on Inc
uction D Logan First Citizens Bank
Jam Properties/Dan Smith transferred from Lucien Ellison
;ors Inc. Williams PNC Bank
7941
$600.00
bulkhead permit
GP 65139D
GP 65185D
GP 65197D
GP 65198D
renewal fee, MP 38-12
GP boatlift 6393 Mazelle Tr. OIB
major fee, NHCo
major fee, TB, PN
GP 65170D
GP 64601D
GP 64612D @$200
MP 65-07 renewal @$100
GP 64611D _
3562
$200.00
719
$200.00
1029
$200.00
9"0
49361
2087
20158
7363
$200.00
$100.00
$200.00
$250.00
$250.00
185
$200.00
1889
$200.00
3779
$300.00
4450
$400.00
;on Town of Holden Beach
BB &T
5995
$2,000.00
GP 65122D @$400
_
James and Jane Warren
GP 65190D @$600
Mable Buchanan
GP 65191D Q$400
Elliott W. and Francis H. Shaver
GP 65192D Q$400
Judy H. and Paul C. Starks, Jr.
GP 65193D @$200
Inc. Thomas Besedin
B of A
3426
$200.00
NOV 15-06D
y Ken Kisler LLC William Critcher
CresCom Bank
3317
$200.00
GP 6206 E. Yacht, OI
n Grimes Donald Howell
Wells Fargo Bank
17-182261643
$300.00
GP 65182D ®$400
n Grimes Michael Kurich
Wells Fargo Bank
17-182261642
$500.00 1
GP 65183D @$400
nc.
ers Assoc., Inc
City of Wilmington -Heide Trask Bridge Walkway
Wells Fargo Bank
2159574 $400 0o major fee, NHCo _
394 $400.00 major fee, NHCo
26651 $100.00 mod fee, 46-92
1517_ $100.00,minor fee, Naylor, NTB
3372 $200.00 ?
1018 $260.00 1 GP for 996 Gaye Ave, TB
3767 $250.00 major fee, PNCO
115 $100 00 minor fee, NTB, Ons Jason Dail, returning check
917 $400.00 major fee, 579 Lewis Rd, Hampstead
20169 $200.00 GP 64613D _
same
North State Bank
al, Inc
Altamar Inc.
508 Tradewind appl.
PNC Bank
South State Bank
110 Sanford Street BB &T
same Charles Schwab Bank
Anthony Jeffs First Citizens Bank
same B of A
R. Baxley TD Bank
Paul Sommers Wells Fargo Bank
Robert and Rhea Allison First Citizens Bank
I Kevin Post North Amer. Banking Co
vction
LeMoirro
Harker 90
ilkheads LLC
8049
$100.00
minor fee, 6083 6th St., SC, Ons
n Grimes
347408688
$100.00
GP 65171D @$600
_
n Grimes
I Kevin Post
North Amer. Banking Co
347408687
$500.00
GP 65171D @$600
I Donna Jones
Bob Lee
PNC Bank
1702
$200.00
GP for 218 Simmon Road, Wilm
1 Raymond P. Sharp same
SunTrust
1713
$200.00
GP 65189D I
Barbara Zucker
First Citizens Bank
1859
$200.00
GP for 315 Summer Rest Rd, Wilm
_
Ashley Hollingsworth same
South State Bank
1608
$200.00
GP 64614D

NC Division of Coastal Mgt. Habitat impact Computer Sheet
pP
licant: dYa !1 �S IV vl Permit #: 0/
)ate:
)escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ound in your Habitat code sheet.
TOTAL Sq, Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
labitat Name
DISTURB TYPE
Disturbance total
includes any
disturbance.
Excludes any
Disturbance
total includes
disturbance.
Excludes any
Choose One
anticipated
restoration
any anticipated
restoration and/oi
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount
temp impacts)
amount
© w
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other
9
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 ❑
Wait -,-
MHCDO
Tyler Crumbley
LPO
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: ��� ; �+ • 1 ;
Address of Property: 21(Lot or or Street #, Street or Road, City & County)
Agent's Name #:
Mailing Address:
Agent's phone #:
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 have no objections to this proposal. I have objections to this proposal.
N 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. Correspondence should be mailed to 127 Cardinal Drive Ent,
Wilmington, NC, 28445-3845. DCM representatives can also be contacted at [phone]. No response is
considered the some 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
ess unless waived by me. (If you
back a minimum distance of 15' from my area of npanan acc
wish to waive the setback, you must initial the appropriate blank below.)
re
I do wish to waive the 15 setback requirement.
I do not wish to waive the 15' setback requirement.
(property Owner Information)
Signature
Pnnt o^ r Tip Name
Mailing Address
r.r..iCt�tu/7rn
(Adjacent Property Owner Information)
Signature
Pnnt or Type Name
Mailing Address
e-- C Z'9Zq$
City/State21p —�" V i= L)
l(`AA Ir,,

' ADJACENT RIPARIAN PROPERTY OWNER SJATEMENt
I hereby certify that I own property adjacent to �-"L (71 ^�i -"' ' �=— s
roams of Property Owner)
property located at c I P1-^ ` I'�`r l"� L-k— ------
(Address, Lot, Block, Road, etc.) N.C.
(Waterbody) (CityrTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above loca
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANDt DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must pJl in description below or attach a site d 810
RECEIVED
DCM WILMINGTON, NC
IJAY 0 12015
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set t
minimum distance of 15' from my area of riparian access unless waived by me. (if you wish to
the setback, you must initial the appropriate blank below.)
s I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
r- -'- " k L, - C�J� fi�a� eEure nature
t
-+ter
Print or Typ Name Print or Type Name
i-Je—..
�,.,..,� l�- 2is per..,
__ ___ A,4,4rnee

213 Peninsula
Print Date: 04/20/2015
Image Date:0310112008 27
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4M IS. 2:59 PM