63253D LeCroy

CAMA / I DREDGE & FILL
31EN ERAL PERMIT Previous permit #
�Nevr :Modification El Complete Reissue El Partial Reissue Date previous permit issued
sized by the State of North Carolina, Department of Environment and Natural Resources
-oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC , ��
ules attached.
t Nanle L, Project Location: County B in
-% Street Address/ State Road/ Lot #(s)
i State ZIP'zgz G ! L L, b)Y\U-yA
Subdivision �i A
ed Agent tiN^ 155 City N� ZIP
❑ CWW ✓*TA ❑ ES ElPTS rho e # (tl!� It U River Basin
❑ OEA ❑ HHF LIH ❑ UBA ❑ N/A Adj. Wtr. Body OyLWA1A (nat /i
❑ PWS: ❑ FC:
yes no PNA yeso) Crit.Hab. yes no
Closest Maj. Wtr. Body W I
Project/ Activity I Lu&Jr ►UW q6
-k) length
■■■■■■■I.^,\'!M■MEN NNEPS■NC'■■■■
igth
nber
i/ Riprap li
distance
x distance
annel
do yards_
ip
se/ Boatlift
illdozing N
itp�M ice' • A j io
ig permit may be required by: `UWII ht L) fLWI N A D(&U-, ❑ See note on back regarding River Basin rt

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
63251D
5/6/2014
Maritime Builders
Rodrigues
2657
$200.00
GP 63254D
5/7/2014
Lara R. Milligan
LeCroy
5999
$200.00
GP 63253D

C Division of Coastal Mgt. Habitat impact Computer Sheet
5plicant: TA G�.
Le C 1 Permit #:
ate:
:scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremer
and in your Habitat code sheet.
ibitat 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 fin
disturbance.
Excludes any
restoration anc
temp impact
amount)
Dz:�
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 ❑

& A
North Carolina Department of Environment and Natural Resources
Division of CMW MwgpMent
Beverly Eaves Perdue Braxton C. Davis Dee Frem
Govemor Direct Secrets
AGENT AUTHORIZATION FORM
D.W. -3 f - (4
Name of Properly Owner Applying for Permit
M' o) d Cc
Owner's Mailyng dress:
S. e,.s ode- 6�-,
11 e V LI I-e 2, - v3
Phone Number
Name of Aut mtwd Agent for this p ojea
"h � no co i- fft4 ( ldh e-i�r.
Agents A fa&V Address:
Phone Number LU I r — q3 y
(q 16 ) -5-q6 - q -T-Va '
certify that 1 have authorized the agent listed above to act on my behalf, for the purpose of applying
'his certirication is valid thru (date).

Tg`IED M. TLTgNL Bg L TED
DMSION OF COASTAL 1vJi 2NAGEMI i'
AijACyN4-T RpAiuAIIN PROPERTY OWNER STATEMENT
dame of property owner, —�5
kddtess of Prope rt '-`-
(Lot or Street #,
/ '
kpplienat's phone : J f `� f - 31
or Road, City & Gonoty)
Mailing Address:
[ hereby certify that I own properiY adjacent to the above refercuced property. The individual applying for this permit
has described to me as shown oa the attached drawing the development they are proposing. i i �► d wing.
u�' h 'a ust be ovided wi le
T have no objections to this proposal. I have objections to this ptoposal-
If you shave objections to what is being piroposed, you must notify, the Divisiou of Coastal management MCK
in writnag within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ut.
'GV"ii mhtgton, NBC 2,8405,U41 DCM representatives c*u R)so be contacted at [phone]. No response is
considered the frame as no a 'ectian if von trove eeu notified by Certified l .
WA MR SECTIO
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must he set back a minimum distance of
15, from my area of riparian access unless waived by me. (if yc;u wish to waive the setback, you mast iniitiaA the
appropriate blank below.)'
I do vdsh to waive the 15' set back requirement
V� "-
I do not wish to waive the 15' setback requirement
(property Owner informatio
i
$agnaturc
Print or Type Name
32o-bAiiScN C. ST
Mailing Address
(tt pl gAan Property Owner Information)
I e 12LA I�tr�1
Signature
-- MAN U M 51t ^• 7l is Piro 7Y
Print or Type Name
Mailing Address W

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR -A PMWOORINGPILING&MATLIFTAOATHOUSLP
1 � i
I hereby certify that I own property adjacent to 1 's
(Name of Property Owner) .
property located at l 421 1 LLA ( 1- JMl LL 4
(Lot, Block, Road, etc-)
on 1(1 �,�1-L-= to 7U �-e- &,6
(Wa d?y) (Town and/or County)
#: J ' 2 ' Address: - Dr) Ve
Apphcaat s.phone n! � --
Ci � 7
He has described to me, as shown below, the development be is proposing at that location, and, I
have no objections to his proposal. l understand dwa pie ftooring pilings / boatlift / boathouse
must be set back a minimum distance of flea feet (151 from my area of r4 mian aeass unless -
waived by me. (If you wish to waive the setback, you mast initial thg appropriate blank
below.)
I do not wish to waive
do wish to waive that setback requirement -
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing dev+dWnwW)
%Ne- as-,e, p(z>pb s' �-� a i n &tall a_.n g'x /61
(�, Wy-`�nv.M -�I,c JOCL W 4 Cn QI U-Ml ntkf)i
Yzxff
0[r&rmatlon for Property owner Applying
for Permit)
Mailing Address

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