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HOLDEN DOCK & BULKHEADS
GREGORY A. & DOROTHY HOLDEN
HIS NCDL 4576438 HERS NCDL 5202642
PH. 910-842-9732
1502 STONE CHIMNEY RD.
„y j/�/ J�J SUPPLY, NCC/28462
PAY TO THE Al d / l / �. I / 1 DRnFR !"1F 11
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Division of Coastal Mgt. Habitat Impact Computer Sheet
flicant: In , j ��,(L Permit #:
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;cribe 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
�A�
Dredge ❑ Fill ❑ Both ❑ Other
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Dredge ❑ Fill Both ❑ Other ❑
5(�
Dredge ❑ Fill Both ❑ Other ❑
Q
Dredge ❑ Fill ❑ Both ❑ Other
l N V
Va(7
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 ❑
- CZ, - 1- / 1.-? = 1 L�L-1

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in order to obtain mW CXMA pan*sj required for the propsiy ftftd below. The M"ftmtkm
tACA?IOI�i OF PRCLWcGT:
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PROPERTY OAR MAILWa ADDRESS:
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CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT- RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner: � `�' 1 V 1
Address of Property:,
(Lot or Street #, Street or Road, City & County)
Applicant's phone #:
Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permi
has described a as shown on the attached drawing the development they are proposing. A desed9fion of drawiru
w' dime must be pMyidedthis e e
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 Ex
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no oblec&n if you have been notified by Certified Mall
WAIVER SECTIOK
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance c
15' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the
a riate bl low.)
I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Information)
Signature
Print or Type Name
i`
Mailing Address i
i
City / State / Zip
Telephone Number
Print or Type Name
3 �o
Mailina Address
City / State / Zip
Telephone um r OtS'
,�T al 1

B3-2007 J IY
t T a' e
DIVISION OF s:'y;_ MANAQEhdENI
The purpose of this form is to provide proper notice to you as on adjacent riparian property owner to rho individual or
individuals listed below, The LAMA General Permit application pmzcdures require that applicants provide tho Division of
Coastal Management confirmation that a wriaee statement has been obtained signed by the adjacent riparian property owners
Indicnting that they have no objection to the proposed work gt that the adjacent riparian property owner have been notified
by cortifed mail ofthe proposed work Often throe forms are submitted to the adjacent riparian property owners by n marine
contractor or otW individuals acting as an authorized agent on bohalf of'the appilcant.
This form was sent to you by the following Indlvldual or company designated by the applicant as an
authorized agent:
Af "�, - d
Authors Agent's Signature Date
Name of Mdividuat Applying For Permit; r ,12
I
Address of Property- I tht o n,�.l r.
(Lot or Street-4, Street or Road)
(City and County) /
1 hereby certify that I awn progeny adjacent to the above -referenced property. The individual applying for this permit
has described to me as shown on the attgched drawing the development they are proposing. A description or drawing.
with dimensions, should be provided with this letter.
- _X, I have no objections to this proposal,
If 'you hove objections to what Is being proposed. please write the Division of Coastal klaoagement. 1.77
Cardinul Drive Extension, Wilmington. NC 28405 or call 910.796-7215 within 10 days of receipt of this notice.
No re3ponsc is considered the same as no objection if you have been ttutif el by Certified Mail.
WAVER SECTION
l understand that a pier. dock. mooring pilings. bmakwater. boat kouse or bout lift must be set back a
minimum d6tance of 15" from my area of riparian access -.unless waived by ine. (if you wish to waive the
setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback mquirD64nL L n
I r,#R.= wish to waive the 15' setback requirement.
L ( A ��_