65184D - Lehrer

CAMA / ❑ DREDGE & FILL �•
iENERAL PERMIT Previous p ermit #
vew Modification El Complete Reissue ❑Partial Reissue Date previous permit issued _.
zed by the State of North Carolina, Department of Environment and Natural Resources �}
)astal Resources Commission in an area of environmental concern pursuant to I SA NCAC (jEj Ryles attached.
Name r' L.� ` Project Location: County ,gyp _(,�
Gk . � 1,' Street Address/ State Road/ Lot #(s)
iIQ
State ZIP r
4 Fax # (_) Subdivision
�- - TI ► 1c City ZIP 2 �5��
;d Agent � t /L^
CW X�W /AETA ❑ ES ❑ PTS Phone # O
—r--�- River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body Vti/.ATCL� S a
El PWS: ❑FC: '3T-,)& Qh1 12
(es/ PNA' ye / no, Crit.Hab. yes Closest Maj. Wtr. Body ��
Project/ Activity J/'JA ci
:k) length �{
(s) L4
er(s) o
igth
nber
i Riprap length
distance offshore
x distance offshore
Niannell
i
>ic yards
1p
se/ Boatlift
ulldozing —
e Length
not sure yes n
;s: not sure yes n
•ium: n/a yes no
yes
Attached: yes no
ing permit may be required by:
A
i aT7Dt01111
(Scale:
❑ See note on back regarding River Basin i

DENR CAMA Daily Check Log for WIRO
Date
Received
Check From (Name) Name ofPerm/t Holder
Vendor
Check Check
Number amount
I Permit Numbed(
4/9/2015
Coastal Marine Piers Bulkheads LLC !Willard Buffkin & Kevin Dolan
Double S Farms Jetter Lewis
Kim Quinn same
Beam & Associates Sea Mist Camping Resort, Inc.
Town of Holden Beach same (Holden Beach Harbor Maintenance, dredge)
Town of Holden Beach same (Harbor Acres, dredge)
Town of Holden Beach same (Heritage Harbor, dredge)
Richard A Lehrer/Anna Romero -Lehrer same
Wells Fargo Bank
20060 $400.00 GP 65180D & GP
4863! $250.00 major fee, BrCo.
1144 $475.00 major fee, PN Co
4790' $100.00 mod fee, MP 16V
27366 $100.00 renewal fee, MP 41
4/9/2015
First Bank
477/2015
First Citizens Bank
4/10/2015
BB &T
4/10/2015
BB &T
4/10/2015
88 &T
27370
$100.00
renewal fee, MP 1;
4/10/2015
BB &T
27369
$100.00
renewal fee, MP 11
4/13/2015
SunTrust
3617
$200.00
GP 65184D
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NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: �r ��V vry "� Perm it #.
Date: f t
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/o
temp impact
amount
©�
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 ❑
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 ❑

NCDENR
North Carolina Department of Environment and Natural Resources
at McCrory Donald R. van der
3ovemor Secretary
AGENT AUTHORIZATION FORM
me of Property Owner Applying for Permit:
A1C�l , 1 Z lf,4erl�
mer's Mailing Ad res/s'.
( /U r
me (!LQ�7 7 13 LI j
Name of Authorized Agen for this project:
� ) minza �-V
Agent's Mailing Address:
L/ IL 2
tv1 (-
Email:
Phone (9/ (2)
;rtify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
and obtaining all CAMA Permits necessary to install or construct the following (activity):
)ject Site Address:
S &I-1- 1 0-1 U-QI N
L: S
X17ZZ6
Property Owner Signature Da

3 - NM
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to R«H LCRRE(2 's
ame f Property Owner)
property located at 3 �� {�'(j� t ��p I ?o � n-T c �Lo i
./' (Address, Lot, Block, Road, etc.)
on �o�SRi .SouND , in N.C.
(Waterbody) (City/To n and/or County)
The applicant has described to me, as shown below, the development proposed at the above locati
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, breakwater, boathouse, lift, or groin must be set bal
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to w;
the setback, you must initial the appropriate blank below.)
� I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
A cL Leff 4Y
Print or Type Name
(Adjacent Property Owner Information)
Signat4re
\lArnF-S SP►c,Uizg
Print or Type Name
ZoZo

�Je 11
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to l (�, kk ` :H Iq(2 I
(Name of Pr Owner)
property located at
(Address, Lot, Blobk, Road, etc.)
on ir! 56i) C-�7// N.C.
(Waterbody) ( ity/Town a d/or County)
The applicant has described to me, as shown below, the development proposed at the above locati
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, breakwater, boathouse, lift, or groin must be set bai
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to w,
the setback, you must initial the appropriate blank below.)
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)
Signature
\c � 4 n Sjgnature
Prin T pe Name Print or Type N

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