50316D - Holt

-'CAMA / 'DREDGE & FILL
GENERAL PERMIT
Previous permit#
7New ❑Modification ❑Complete Reissue ❑Partial Reissue
Date previous permit issued
orized 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
,'l1�'t
j j ,
nt Name �'f rit
RuI attached.
Project Location: County , -`5� ( ('� � .
pp
s „ •X s) O
Street Address/ State RoAd/ Lot #(s)
State NC ZIP2��S
Jl(I.�
� �7 ri
# (_ ) s h
Fax # ( )
Subdwision
C
y
"-
rized Agent
Ci it/Y k ZIP
d CW _I EW ❑ PTA ❑ ES ❑ PTS
Phone #
River Basin
Ynai
OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body
�6�
❑ PWS: ❑ FC:
yes // no PNA yes Lno Crit.Hab. yes / no
Closest Maj. Wtr. Body
of Project/ Activity
(dock) length
)rm(s)
r pier(s) X Z c
i length
number
lead/ Riprap length
avg distance offshore
max distance offshore
,channel
cubic yards
ramp
louse/ Boatl
i Bulldozing
r
Z'x ►1
dine Length
not sure yes
gags: not s yes no
:orium: n/a no
,Sf -�/I)
!r Attached: yes no
(Scale:
'ding permit may be requiredA 1 id by: L/ llk � /A
k J f. El See note on back regarding River Basin
c/ C--i [`. -A.+:..... �f . I d l) f I A A A F F !1 WA f L.-t 1 f / /i I n 1 •% A. (—Of It , . i ./mod - . I . I - — ,. %

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lun 29 09 01:29P
rAut 17L/ 17:
p.4
NCDENR
North Carolina Department of Environment and N3IUral Resources
Division of Coastal Management
Michael r. Easley, Governor Chutes S. Jones, Director tiuliam G. Ross Jr., Secretary
Authorized Agent Consent Agreement
11 is hereby authorized to act on my behalf
(Pnn►ed Nome of A9enq
in order to obtain any CAMA permit(s) required for the property listed below. The authorization is limited to the
specifir activities described in the attached sketch.
LOCATION OF PROJECT:
q113 r-ii N 67
PROPERTY OWNER MAILING ADDRESS:
of 76� 5- PHONE NO. Ci 1 q — Clln:) 3Oq �
AUTHORIZED AGENT MAILING ADDRESS:
PHONE NO. 9/D '-6La 7 3 `j '2—mj
Signature of Property owner.
Signature of Authorized Agent. A-6�'Z�
Date

17b/ J19/ ZVI U VU-. Ytl 717-7l7-17[717 caber L-uw r-mutruu i ;)
Jun 29 09 01:29P
rrKac vai K
P. S
AD,JACENT MA,RIAN PROPERTY OWNER STATEMENT
(FOR A pTEzmootUNG PILINC.SBOATUFTBOATHOVSE)
I hereby certify that I own property adjacent to ze"-14 n lx
.s
(Nance of Property Owner)
property located at _ q t I qml 5i —
(Lot, Block, Read, etc.)
on t-ITj CAi aL4, _— in L>[�r= CKY!R N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: 4119 - y ti l! ` I Mailing Addmo: �� �• Qo-A 5 IR
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 undctatand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (151 from my area of riparian access unless
waived by me. (if you wish to waive the setback, you most initial the appropriate blank
below.)
fI do n_Qi wish to waive
1. do wish to waive that setback requirement.
DIIESCRIPTIO14 AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing d~lopmenl)
(Informatian for Property Owner Applying
for Permit)
Mailing Address
P10E V%196
C-ity/State:Zip
x 611 q- q-bs- ::;O'+1 -
Teiephone Nuimber
.� arTi ✓ L. - z ,...
(Riparian Property Owner Information)
Signature
Print or Type Name
I. 9_2-
..Z7
Telephone Number

00r .30r ZVIV DO; LO 717-7I7-OL7q F41MrL AV rMULP-91113 rrn'c crw
Jun 29 09 01:29p P'5
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIEL MOORING PIUNGSBOATUT TBOATHOUSB)
I hereby certify that I own property adjacent to -VF 14 n, = .s
(Name of Property Owner)
property located at q�� clmH Si —
(Lot, Sock, Road, etc.)
on ,5,C; E rtT!j CEJMA 4,___, to �r C:1TY N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: C119"9 iai lb I Mailing Address: �� �• QoA
Ptuc tom" VE Nc_
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 / boatlitt / boathouse
must be Set back a minitnum distance of fifteen fcet 0 51 from my area of riparian access unless
waived by me. (If you •risk to waive the.etback, you most initial the appropriate blank
below_)
1�\ yC�_ I do ag wish to waive
I. do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To lie filled in 6y i►rdividnol proposing developnwnf)
(Information for Property Owner Applying (Riparfaa Property Owner Information)
for Permit)
X NO, r>'t
` Mailing Address y� Signature
X Qi N E ��+✓L,� �L 21 Sig Zc &
(buy/statezip (///�/ �((�� Print 000r[yT� ypc Name
Teelee h-oneN tuber Telephone Number

IC Division of Coastal Mgt. Habitat Impact Computer Sheet
ziplicanf je W, �4 t _� Permit #: �031 CP
ate: —3-Aq /
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
)und in your Habitat code sheet.
abitat 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 fina'
disturbance.
Excludes any
restoration and/c
temp impact
amount
�W
Dredge ❑ Fill ❑ Both ❑ Other Y
l Lm
1 W
ODredge
❑ Fill ❑ Both ❑ Other �,
I a
5
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 ❑

8541
Bank of America.
NORI CONSTRUCTION
ACH R/r 059000196
145 VIRGINIA LANE 66-19-530
SNE
ADS FERRY, NC 28460
[phone] ' 2
5
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�LNDQ�� CT DOLLARS
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55gpi p � �
3 p AUTHORIZED SIGN RE
ulooa 54 le e:0 5 3000 1961: 0006 50 5 2 1990i1'