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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.
SUPPLY, NC 28462
3 PAY TO THE
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C Division of Coastal Mgt. Habitat Impact Computer Sheet
>plicant: �, � -1 J L, � �� �� r C r r i l l L ff-. 2--3 p
ite:
:scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen
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 and,
temp impact
amount
Dredge ❑ Fill ❑ Both ❑ Other
I
1
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 ❑

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Aubvbdw ! Agent Cowent p4poe111-
&"uved
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in onbriO obtain � C. y for PVR'td botQwn
sPecft ac&ftwi!�in�eh_
1.ACATION OF PRCU�EM-:
a..NE MAiLWO ADDRESS:
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/2014 15:59 FAX [phone] DIRECTORS OFFICE IOD
14002
CERTIFIED lyiAii. — RED' ,URNREIPT REOUESTED
DIVION OF COASTAL MANAGEMENT
ADJACENT�tIPARiAN PROPERTY OWNER STATEMENT
Name of Property Owner:
&ddress of Property:
Applicant's phone #:
or Street #, Street or Road, City &
Mailing Address: i o ,
0 (r
I hereby brat I own property adjacent to the above refertaced property. The individual applying for this permi
has described to me as shown on the attached drawing the development they are proposing. A description of drams
with d' that.
I have no objections to this proposal. __ _ I have objections to this proposal.
If you have objectioes to what is being proposed, you must notify the Division of Coastal Management (DC I)
in writing within 10 days of receipt of this notice. Correspondexce should be mailed to 127 Cardiml Drive Ex
Wilmington, NC 28405-3845. DCM representatives can also be contacted at (910) 7%-7215. No response is
ooAddered the same as no obiadiox if w+oa have been notified by C.er#iW— Mail.
wA�R sECTtoK
1 Understand that a pier, dock, mooring Pilings, breakwater, boathouse or lift must be set back a ramunum datanceo
appropriate blank below.)15' room my area of riparian access uuk=*waived by me. (If you wish to waive the setback, you must initial the
.� aoyr'•cc� rco rd Tc� ii1 �o � a ,�'.fe.l'',�4�,.�c
s ---1 do wish to waive the 15' setback requirement
I do not wish to waive the 15, set back requirement.
irroperty Owner
RECEIV
Sig�ture G
p APR 0 8
AO
or T Name
=T DA 0 I;A
Mailing Address
(Riparian Property Owner
gD
T N)
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Print or Type Name
Z 1 O a�5e�o ar 4 1e a 4
Mailing Address
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08 14 00:46a Greg Holden
0429806 P.1
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