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_33ENERAL PERMIT I� b Previous permit#
New ❑Modification Complete Reissue El Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Rules attached.
C.
t Name Project Location: County
Street Address/ State Road/ Lot #(s)
- s4
_State- _ —ZIP
- L Fax # ( ) _ Subdivision N ��
zed Agent
❑ CW EW _ PTA ES PTS
OEA HHF E IH UBA ❑ N/A
PWS: FC
yes / no PNA yes / no Crit.Hab. yes / no
if Project/ Activity
ock)length �7
m(s) i� L
ength
umber h i�
ad/ Riprap length GU
✓g distance offshore
iax distance offshore
:hannel
jbic yards
imp
,use/ Boatlift
Bulldozing
V
ne Length
not sure
yes no
f
gs: not sure
yes `no
mum: n/a
yes no
yes ( no
Attached:
yes'no
ling permit may be require(
city t Icl c �,, ��c�ct,, zip 2.ggb i
Phone # (�i C' )Ls ( River Basin
Adj. Wtr. Body CA \ (J. (nat
Closest Maj. Wtr. Body .. (A/ lJ
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The purpose of chi* tuna is to ap„dc Pry ewtiee to sou as an ad amt ,ti individtodi "UW bd"p The LAMA Genml Permit f n re U= g pfir m the irtdiviEusl or
Coastal Maaogwftnt confuWmdoa titer a writrce stp �pottc�tien Dr�edurte rogwro lM� ppPi jc provide etc Division or
Indicuting that teary hove ra commt boa bean obg4ied signori by the ad*I Mr >ipanit. properly avmcrs
by cortifiGO moil orthe �ocnon to the Kogosad wont 1 am the adj,m�d toxmg hWan prt�yatry oWncra ht+ra trp� notific4
contiacmt tar other indlvid tinQ an ;Wwrixed asct�an basubhal(oof the opp J�,�nt. �na PAY owMcrs by a raonnt
This foem Ww set t to you by
attlhordaod warroilowieg ladNrWuai or- carnpony delineated by the appllcpnr as are
Namc of Irldividual Applying For Pe tnic �� - ✓Yt (2 1
Addr^css of property: _\ \ `� cil I,
` or Smer It. SiR or Road)
C--%.
(City oad County)
I hereby ecrt* that I own p�ppny adjttt;eM to dtt abova-neficrenccd ro
has dcscr;bcd to me rr; shown oe the attt)ehed drawing the develflpmepitt they ere =individual A� description
for this permtt
with dimensions. should be v P po g. pt►ort or drawing,
idcd with this letter,
I haws 110 objections w this proposal,
If you have objections to what is befog proposed. pjCU3e write the Oivbi4n of Cossmf ?Maoo ,
C+tnlintsl Drive Extbn�tioaI W1"0ine[un, NC 2940S or coil 910.791*.yl15 within lO daysof gcmL t_ti
Ko �poaae ii eaoaidered the $ante as no objoctlon ifyou hove seen notified by Certiftod ,�,i pt of this notice.
WAIVER SEC nON
i and ntuad that u pitsr, dock wr ocing Pilot% breii1tw Ater. boat blouse or bout In
tzrinitnum dLszaacc Of 15' from my area or t•ipariaa accw toast be set bta:k w
. srtbaclr„ you mast ittftial the oPpropriaoe book MOW.)14im ty mo, (tr you wi$b to wtaiehe the
I do wish to waive the 1 S' setback mquiremc„t,
/ I9UMwish to waive the I.S' u•.ta�..►... --- AIMIVIWA
)3 13 03:23p Hardwick
+�
02 13 06:19a GregHolden S�CJ
_ 7703948827 p.1
9429906
PAJG-e3-2M7 10:02 From:
io = 8429MG
p.2
The p tpow of this forty is ro pmvide proper Mont to you 23 an % t t+Paion Re»y or,ncr id the individual or
btdiniduah 1lsied below. I%t CAMA GCncrW Permit ttMhc2dw pM%;VM rq require that nppliam" prvwitst ttu Qiviy
Comm Mamigmctrt co nfutnadot, that s wrftmn saacomcnt has boon obminvd signed by the odjaccw npw m pmpcny
i ndIcal nt that Ncy► hart rw objection to dw proposed work g= that the sdjacrnt ripatisA property ownaaa hays bcm rx
by coMfied stall of tine pn*ouW wont` 4Aen these ferias 3ro sabnliMA in, tint: adjx=w rWa imti ptoMM owes by a
conttaecor Or voter itttiivid=ft among as an au ttorized agemt an bchWf of the tpplkaw.
This form was scut to you by the 10104wittg lndkldttol or contpgay destttuted by at applicant as as
authorimm agent:
AntAo t d 4PM's S ipuiwt:
Dote
NAtnc of Zndividuai Applying For Pa mit: r
Addrt:ss of ProperT. \ `\ '�K ql
tTor Street 1. Sw6m or Road)
(City end County) .".—
I hereby certify chat i own prolmy adjuadto the above.referenced property. The individual sppiving forth
has descn'bed to me as shown On the attogched drawing the development shay arc Proposing_ A description or,
with dim siorts. should be provided whit this letter,
t nova no objections to this proposal,
lf'yow have objections to what b banal 139%"sed. pitasc -rite the Divlstbtt of Ce�tstta) ldstt::sgm
Cardinal Orive Extenaina, Wilmington. INC 28405 or emit 910•796-7215 within 10 days of reetipt o f th
Ka resttoauac is eaosidered that saa to os ao objecrion if you have bee* taotdlicd by Cortired Nbil.
WAIVER SECTION
t undcrstottd that a pier, dock. wworitK pilings, bivakwroter. beau koase or bout Oft toast be se
misimadt dkmasce of 15' r'Vm my area of ripartao gems RILIg w'slirsd h% ., (if you wish to
setb"k- Yon mast ieNiatt the 'appropriate blank betow.j
160 wish to waive the 13'setbock rtmquiremclIt_
I �W wish to woivt the 1 S Setback mquiremataL _ _ _ i 1
COUA---,_
le,plet C, t- /D n ' Z' "l
)plicant: f� �� ,n� ✓ Permit #:
ite:
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
TOTAL Sq. Ft. FINAL Sq. Ft. TOTAL Feet FINAL Feet
(Applied for. (Anticipated final (Applied for. (Anticipated final
�itat Name DISTURB TYPE Disturbance total disturbance. Disturbance disturbance.
Choose One includes any Excludes any total includes Excludes any
anticipated restoration any anticipated restoration and/or
restoration or and/or temp restoration or temp impact
ternimpacts) impact amount) temp impacts) ,mount)
Dredge ❑
FilllIN Both ❑
Other ❑
L OD
l ��
Dredge ❑
Fill Both El
Other ❑
O
Dredge ❑
Fill ❑ Both ❑
Other
5w
15ov
Dredge El
Fill ❑ Both ❑
Other
t012.
I- 1 Z
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 ❑
_DEN DOCK & BULKHEADS
iORY A. & DOROTHY HOLDEN
)L 4576438 HERS NCDL 5202642
PH. 910-842-9732
1502 STONE CHIMNEY RD.
SUPPLY, NC 28462
6V-129203
DATE 3
5082
-- --- --- C� i -- ---- DOLLARS
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