56653D - Sutton

CAMA / ❑ DREDGE & FILL
3"E N E RAL PERMIT Previous permit #
3New , ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
•
*zed 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 �fi • -2 0V, o ZJ, O j0"?
EE�Wes attached.
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❑ CW ❑ EW ❑ PTA ❑ ES
❑ PTS
OEA ❑ HHF ❑ IH UBA
❑ N/A
❑ PWS: ❑FC:
yes / no PNA yes /& Crit.Hab. yes / no
Project Location: County '� /2 a Nstvi c /(,
Street Address/ State Road/ Lot #(s) 1341 L 4eMIoe
Subdivision
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ng permit may be required by: _��lY P.� �/� C A ❑ See note on back regarding River Basin r

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CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner: ?e er S u 44 D Yi
Address of Property: 1- �- U PIA bar I,% S -(
(Lot or Street #, Street or Road, City & County)
Applicant's phone #:1 � - o2 9 S — 70Y Mailing Address: a. 0 0 5•> p i 40-r VA S
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this pe
has described to me as shown on the attached drawing the development they are proposing. A description of dram
with dimensions, must be provided with this letter.
I have no objections to this proposal. / I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DC
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection if von have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distanc
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 wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
W
O ner Informati
%TEW .51AT Tom,
Print or Type Name
5200 ?u,Q;+v,K
Mailing Ad resd s
(Riparian Property Owner Information)
Signature
Print or Type )(ame
//0 /20 G4.1 i
Mailing Address

plicant: Sv J�T o>✓/
Permit #:
te:
�
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremei
ind in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated fir
oitat Name
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration anc
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
amount)
L✓ I Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other$ 6'!
Dredge ❑ Fill ❑ Both ❑ Other
` • W v tom. �. _—
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a o
N N O
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nSECTIONETE THIS •MPLEYE THIS SECTION ON DELIVERY
1, 2, and 3. Also complete
.wu acted 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:
Vxvi � Lee r-b gybe s
5;. o gal\ y R � .
FqyeWv-'ll <.. ri - C-
I
I
2. Ardcb
A. Sign re
X 7t B. Received by (printed Name)
D. Is delivery address d'rf
If YES, enter delivery
2 g-10 S 3. Service Type
❑ Agent
❑ Addressee
C. Date of Delivery
fi ItermV ❑ Yes
below: ❑ No
0
❑ Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) y�
7011 0110 0000 8663 1045
BN
PS Form 3811, February 2004 Domestic Return Receipt
Dredge ❑ Fill ❑ Both ❑ Other ❑

HOLDEN DOCK & BULKHEADS
GREGORY A & DOROTHY HOLDEN
910-842-9732 HIS NCDL 4576438 HERS 5202642
1502 STONE CHIMNEY RD SW
SUPPLY, NC 28462
3982
66-1215/531 84
- / 840
v
WBANK
ACVAMAW
P5�53C-�
S. ly, NC 28462
wuw.waccamawbank.com M,
i:0531121S 21:800 575301150398
WILDLIFE P.FTR.IT.
Ha—d Clarke