56621D - Sain

AMA / L DREDGE & FILL
3FNERAL PERMIT
New ❑Modification Complete Reissue ❑Partial Reissue
Previous permit #
Date prEvious permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources 71/ %2 GU
-ow,&al Resow ces Commission in an area of environmental concern pursuant to I SA NCAC /l7
les attached.
t Name r h' k
iy 4 a'2 Ile, )I e _ State__ ZIP 2
7
Fax # ()
:ed Agent e /Jl'/Z l �S 1?&& d -e
CW ❑ EW D PTA ICES ❑ PTS
i OEA ❑ HHF IH ❑ UBA ❑ N/A
C PWS: ❑FC:
Project Location: County ff& H-S6✓'CIC n
Street Address/ State Road/ Lot #(s) /�!�O V )L
Subdivision
City YV 4, ZIP
Phone # ( ) River Basin L ��
Adj. Wtr. Body CfI,J Ot (nat
,� Closest Maj. Wtr. Body W w
yes /. no PNA yes /� Crit.Hab. yes / no L
f Project/ Activity U a � P Pit ZflAI/G2
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ling permit may be required by: 1�'9 Id 12.1 46447c h
❑ See note on back regarding River Basin
C

ten/ A O t„U V VI-
.A.DJACENT ,RIPARIAN PROPERTY OWNER STATEMENT
(FORA PTF.R/MOORING PILIN(-,SlBoATLIFTBOATNOUSE)
I hereby certify that I. own property adjacent to Gotry --SaIn s
(Nance of Property Owner)
Property located at _130 _J3urlington St
(Lot, Block, .Road, etc.)
Oil Canal __ in Holden Beach _
N.C.
(Watcrl)ody) (Town and/or County)
Applicant's phone !l:CB_ �'i� 1,0_�7E , Mailing Address:_ �1" C7
1oxi tt! ��lt ., Az c�w
He has described to me, as shown below, the development he is proposin.g at that location, and, l
have no objections to his proposal. I understand that a pier/mooring pilings / boatl ift / boathouse
must be set back a minimum distance o.f .fifxccn feet (15') ,Croat my area of. riparian, access unless
waived by me. (If you wish to waive the setback, you must initial the it blank
hel.or•.) """
I do no wish to waive
itI do wish to waive that setback requirement.
-----------------------------------------
llt3CRXFTi4N ANll/OR .DRAW.iNC OF PROPOSTU 1)EvCLOPIVI.t, Nl,:
(To be filled in by individual proposing development)
6, _,—Existlno Floating Dock
(Informatiun for Property Owner Applying
for Permit)
17q LA �-t
Marling Address
City/State/Zip
Telephone Number
Boattlft
(Riparian operty Owner Information)
)AW 5ignature
01 Print or Type Name
CO (qP) -7 "s Y
TPIFnhni,e AI-1-e.

16 7jtt-y v4ll.
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FORA PIER/MOORING PILINGS/BOATLIFTBOATHOUSF_)
I hereby certify that I own property adjacent to Gary. Sain is
(Name of Property Owner)
property located at 130 Burlington St >
(Lot, Block, Road, etc.)
on Canal _ , in Holden Beach , N.C.
(Waterbody) (Town and/or County)
Applicant's phone 4:[phone] Mailing Address: pu ll ejh r
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 / boatlift / 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 must initial the appropriate blank
below.)
I do not wish to waive
/y I do wish to waive that setback requirement.
----------------------------------------------------------------------------------- -------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To he filled in by individual proposing development)
P
(Information for Property Owner Applying
for Permit) \
li
Mailing Address
ig Floating Dock
Ling Boatlif t
(Riparian Property Owner Information)
Signature
'fiAO-�7cn�� ;
0:4-1C...�.. 17.-. print nr Tvrw N[S1mP

Al
l r
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson Dee Free
Governor Director Secr(
AGENT AUTHORIZATION FORM
Date: -I�z6414? Z zo j )
Name of Property Owner Applying for Permit:
Mailing Address:
ff? q
62YO& I 10A-C 2-94 P
Number: 316— .3q,;)g
I certify that I have authorized (agent) rilij.-rI(es A44-6e- to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or
construct (activity) _ _ IR8'01U'f' f Pr-
at (my property located at) 3O gill" I ('tiG h vt
This certification is valid thru (date) Z Z
D�/2/W!/

Existing Floating Dock
12 , /---Existing Boattift
osed Dock
,2o P , L

,pplicant: G� 2'y s,�, �✓
late: ,
/3bl//
Permit #: t— /_ /_/— ;,
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurem
rund in your Habitat code sheet.
TOTAL Sq. Ft. FINAL Sq. Ft.
(Applied for. (Anticipated final
DISTURB TYPE Disturbance total disturbance.
abitat Name Choose One includes any Excludes any
anticipated restoration
restoration or and/or temp
temp impacts) impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feei
(Anticipated I
disturbance.
Excludes any
restoration ar
temp impact
amount)
/
Q W
Dredge ❑ Fill ❑ Both ❑ Other id
L
Dredge ❑ Fill ❑ Both ❑ Other
�D
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 ❑

Mareene Construction
P. O. Box 370
Supply, NC 28462
PAY
TO THE
ORDER OF
BRANCH BANKING AND TRUST COMPANY
1-800-BANK BBT BBT.com
FOR
o _
1190000 1 2 7 ln' 1:0 5 3 10 1 1 2
1271
66-112/531
DATE Q
11:000 5 104 2 13 3 18ne
$ Z0b _ Oo
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