64687D - Moore

(CAMA / ❑ DREDGE & FILL 1 IA �'�� 6 � 64
f"INew
ENERAL PERMIT Previous permit #
❑Modification El Complete Reissue ❑Partial 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 I SA NCAC C�
, les attached.
` kA it Name �V6 Project Location: County T JI/ V i\,so i L'(4--
Stree Add!7ss/ State Road/ 10 #(s)
D r StateNC ziP 2 i � � �G.� tly61 Sl
t )_95Fax # () _ Subdivisi n
t �> r
'ed Agerrt 1,,�C%�j Y1L 1�(14ti. h�UWt�r wtr l / _ zip
❑ CW `® EW � PTA ❑ ES C PTS ne # (b) L1 C 1Z(-' River Basin i
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ; j r
❑ PWS: ❑FC:
yes if no PNA yes /, no
F Project/ Activity
)ck) length
angth
amber
rd/ Riprap length
g distance offshc
ax distance offish
Adj. vvtr. Body kJ&4! A (nat I
Closest Maj. Wtr. Body 0 (W
ling permit may be required by:
— I a 1
❑ See note on back regarding River Basin

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CC
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NC Division of Coastal Management
Cashier's Official Receipt 025
Received From: All Val g,,�,
Permit No.:
Applicant's Name:
4I�
Project Address: '
Date: 20
$ Zoo
Check No.:
County:e.V_
Please retain receipt for your records as proof of payment for permit issued.
Signature of Agent or Applicant:
p Date:
Signature of Field Representative: /
Date:

C Div sion of Coastal Mgt, Habitat impact Computer Sheet
)plicant: A came—
I Permit #: LI+w+t
ate:
;scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
abitat 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 0

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Applying for Permit:
Mailing address: /8,3 Mau" kAj
Phone Number:
I certify that I have authorized 1&('4^1 k
Agent / Contractor
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of
at my property located at
in 9-IrIt7s4-4c, �_ County.
This certification is valid through
Date
(Property Owner Information)
G&� r��
Signature
c
Print or Type Name
Title

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROP,,ERTY gWNERtf4OTIFICATk0N/WAIVER FORM
Name of Property Owner:
Address of Property: 1,n3 �cLn.. r k. t LL, � btc�. Qc� C r UV tsw \ C
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Agent's phone #:
Mailing Address:
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.
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. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. 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
wish to waive 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.
(Prop/e Owner Information)
Signature
A'e""".1
Print or Type Name
3L�,-2 A1�144.1
(Adjacent PropertyOwnerInformation)
Signature
Print or Type Name
,Z51L "ti ,(�
Mailing Address Mailing Address
e

der, Holley
n: John Havlin <[e-mail]>
t: Monday, July 06, 2015 11:22 AM
Snider, Holley
jest: Re: Holden Beach Property
ley ..... yes the X was used instead of my initial..... sorry
Mon, Jul 6, 2015 at 11:12 AM, Snider, Holley <holley.snider(2,ncdenr.gov> wrote:
A Morning John,
i in receipt of the attached adjacent riparian property owner notification/waiver form from Rickie Moog
is the owner of I I I Sanford Street in Holden Beach. Mr. Moore is requesting a waiver to the 15- setb
.urement. The attached form requires waiver line to be initialed by the property owner. In this case the
not initialed. I am writing to verify that you ARE waiving the setback requirement for your neighbor
they may install a boatlift. Please confirm at your convenience and feel free to call or email me if you
questions or I can be of assistance to you in any way.
Merely,
ley Snider
.d Representative
Department of Environment & Natural Resources
Division of Coastal Management
Cardinal Drive Extension
mington, NC 28405
ine: [phone], Fax: [phone]
rail correspondence to and from this address

Jun. 26. 2015 11:38AM No, 4558 P. 1
CERT(EI D MAIL RETURN R`EdOPT R QUESTED
'DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of'Property Owner: lerf \.k�k �
Address of Property: O `� 50.v��r SA
(Lot or Street #, Street or Road, City & County)
AgOnt'e Name #: _. Mal►IngAddress:
Agent's phone # .
J hereby cerilfy that I own property adjacent to the a,bave .fbferenced property. The 1ndivldual
applying for this permit has described ►o me 'as 'shown on the attached drawing the development
they are proposing. A descrlptlon or drawing. with dimensions, rnuet be nroylded with this IQller.
I have no_objeciions to tWs:proposal, I have objections to this proposal.
1t you 600.01Vetlons to what l8:being proposed, you muat nollfy'fho Dlvialph of CoasfalManagemoni (DCM) In
wrllirr��g Wllhln 10 daya of recolpi .of i'hls notice. Correspondence should be m9lled to 127 Cardinal Drive Ext.,
Mini npton, NC, 28405.3845. ACM representatives can elso be contacted at (910) 796•1215. No response is
cvn2/der 'the Mime as no oblec(lon N you have been notified by Certified Mall.
WAIVED SECTION
I understand that a pler, dock, mooring'pllings; breakwater, boathouse, lift, or groin must beset
back-6 minimum distance of 1 ti' from my area of rlp,arlan access unless waived by me. (if you
with to waive the setback, you must Initla the appropriate blank below.)
dp wish to waive the 16' sotbodk requlrement.
l do hot wish tooellve;lhe I5''•soibaok•:requlremeM.
(PropertyOwner informatlon)
2
Srgnarure
PrInf or Typo Name
(Adjacent property Ovvner Information)
X
Sr$na r.
rirrf or Type Na e
?'- i,i /./ /7_ of
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