63255D - Bock

Date Received
Check From (Name)
Name of Permit
Holder
Check Number
Check amount
Permit Number/Comments
5/1/2014
Grice Construction of
Brunswick Co.
Hyatt/Bock
9591
$400.00
63234D-Hyatt & 63255D-
Bock
5/1/2014
NP Liles. Jr and JC Liles
6486
$200,00
63197D
5/1 /2014
Town of Holden Beach
026332
$400.00
63251 D
5/6/2014
Maritime Builders
Rodrigues
2657
$200.00
GP 63273D reissue 61596

Division of Coastal
)licant:
Mgt. Habitat Impact Computer Sheet
Permit #:
(�32�ZC
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
)itat 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 fina
disturbance.
Excludes any
restoration and/
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other
2 2
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 ❑
n 1 I i --? r,

NCDENR
North Carolina Department of Environment and
Division of Coastal Management
McCrory Braxton C. Davis
,vernor Director
Natural Resources
John E. Skvarla, II
Secretary
AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FuKm
Date: )-Ll — a o I q
e of Property Owner Applying for Permit: NAmP of Authorized Agent for this project:
Z,W\ I l 1,✓C..'� i � '' '� 1 1� L_ ( :
Br's Mailing Address:
GcclC
eNumber (M) 3 10 — $733'7
Agent's Mailing Address:
(; `As �h
A-3l -P \;gyp C ah NL
7 VI L-9
Phone Number ( (l)
ify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
id obtaining all CAMA Permits necessary to install or construct the following (activity):
ny property located at `1 C& aC-0A
;ertification is valid thru (date)
e - W.
Property Owner Signature Date

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: - OU _
Address of Property: G� )✓tco / \ > TC r eat Li
(Lot or Street #, Stre or Road, City & County)
Agent's Name #: Mailing Address:
Agent's phone #:
✓U0Swl
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.
(Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/StatwZip
(Adjacent Property Owner Information)
S:Tre., / 1
l lCf ��a ✓lC_
Print or Type Name
:192 --E':Z $5-
Mailing ddress
610 000✓Ci Ai C.
City/State/Zip — - -
-7/)li_ -7V 2 — c�- 1-)41

�l
V)Y444-5 C\q r\(-
9, c). 13z)x 5t.O%5
C,1 r\
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I \ 1
I QmcinC�U\L
1 Z'

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■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
IN Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
ODT,Am L_-4-
A. Si r� '
X t.
ddressee
B. Freived by ( Printed Name) C. Date of Delive
D. Is delivery address different from item 1? El Yes
If YES, enter delivery address below: ❑ No
3. Service Type
•Certified Mail ❑ Express Mail
❑ Registered eturn Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7 013 1710 0000 3 4 0 7 0 215
(Transfer from service labe.,
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
Ln
(Domestic Mail Only,
Fu
r delivery information visit our website at www.usps.come
. SHALLOTT£ NE28471)
rt
$0.0 0470
Postage $
m
E:3 Certified Fee $3.30 14
Postmark
� Return Receipt Fee $2.70 Here
O (Endorsement Required)
Restricted Delivery Fee #f,�f�(�
p (Endorsement Required)
r-3
Total Postage & Fees $ $6.44 02124I2014
------------------------------ -------------------------
or PO
PS Form
:rr August 2006 ` See Reverse for Instructions
CDaits
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MHCDO
17
Ronnie Smith
F7
...
CLPO
DW Review C
Scan to DMoye
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