57555D - Holladay

JCAMA / - DREDGE & FILL
ine Length
not sure
yes
ags: not sure
yes
Drium: n/a
yes
s:
yes
r Attached:
yes
ding permit may be required by:
Gt !
❑ See note on back regarding River Basin

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverty Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date �" C
Name of Property Owner Applying for Permit:
Mailing Address:
v
cep � � l� A'1 a- r,�—
I certify that I have authorized (agent) to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
This certification is valid thru (date) % XI 3 11 o—
Property Owner Signalure Date

i4

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORIIYG PILINdGS/BOATLIFTIBOATIIOUSE)
I he.�reby certify that I own property adjacent to l /a e�� . is
(Name of Proper Owner)
property, located at �`� L ��� /� h/� 'gf ✓ w
(Lot, Block, Road, etc.)
on in N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:
Mailing Address: 6Da- Sg// e d"Atr l�r�
$G o2 9a2ol
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boadift / boathouse
must be set back a minimum distance of fifteen feet (15) from my area of riparian access unless
waived by me. (If you wish to waive the setback, you mast initial the appropriate blank
below.)
_ I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be f" in by individual proposing development)
(Information for Property Owner Applying
(Riparian
for Permit)
Mailing: Address
C'.ity/RtsltP./7.in
Information)
Signature
Print or Tvne Name

t� L CNLLft'S"
licant: /J Permit#:
:vibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
Id in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
tat Name
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
temp impacts)
impact amount)
temp impacts
amount)
Dredge ❑ Fill ❑ Both ❑ Other
■ 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.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
G we.,
17iv Gd,h latti e-\ �U
f�Y c fKe ,/, N-1 /v�
A Signature
7`� 1 ❑Agent
brAddressee
BZived byf PrlbtrName) C. Date of Deliv
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
Z(3 3 � 13.
Type
Certified Mall ❑ Express Mall
❑ Reglst4md ❑ Return Receipt for Merchandise
❑ Insured Mall ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number
(Transfer from service labeo 7011 2000 0002 2764 7988 -
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
nrprinp F-1 Fill r1 Al ih n ,r)+h— r-1
/1
■ 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.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
❑�,yAgent
treddressee
B. R�6` � b (Pri Name) C. Date f I
D. s deliveryaddmss different from item 1? ❑ Yes
If YES, enter delivery address below: No

ALLIED MARINE CONTRACTORS, LLC 08-03
910-367-2159
92 HAROLD CT.
HAMPSTEAD, NC 28443
PAYTHE
ORDER OF
C-)P5 `75,55, C p5'755b, C, P5 9557
MEMO M.(Irrc✓ . orr", l!
lie 0048 7011■ 1:0 5 3000 1961:
Bank of America
ACH R/T 053000196
0 0 0 6 8 4 7 4 3 7 3 8 n■ A�HORI