54597D - Holley

CAMA / DREDGE & FILL 5z
,ENERAL PERMIT Previous permit #
.�w .--]Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources
.oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
t Name G D I l e
hilL
' ;n ' _State_ ZIP
Fax # ( )/
ed Agent
©'CW wCw 0 FTA ❑ ES ❑ PTS
,- OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
J PWS: ❑ FC:
/ no PNA yes Crit.Hab. yes / no
' Project/ Activity cc/ /yl�<rf^t i!x/lyv
:k) length t 7;P
ier(s)
-igth
nber
i/ Riprap length
distance offshore_
x distance offshore
annel
iic yards
ip
se/�oatl• k
dldozing
r ,
Length n1
not sure yes
not sure yes
im: n/a yes
yes
ttached: yes
❑ Rules attached.
Project Location: County 4w
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP 5�
Phone # ( ) !!�'t~ River Basin l'
Adj. Wtr. Body 11f1 1tO at r
Closest Maj. Wtr. Body
w (Scale: / �/
g permit may be required by: N of b. 47,, 7�-r$ f+, ❑ See note on back regarding River Basin ru
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
overly Eaves Perdue James H. Gregson
overnor Director
Dee Freema
Secretar
AGENT AUTHORIZATION FORM
Date: S
ime of Property Owner Applying for Permit: Name of Authorized Agent f his project:
Nner's Mailing Address: Agent's Mailing Address:
si
none Number (qlo) 5 I S- 3 L I S Phone Number (31o) 2 3 1— �? S/ ­/
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
)r and obtaining all CAMA Permits necessary to install or construct the following (activity):
-ny property located) at
"his certification is valid thru (date)
L
Property Owner Signature Date

DIVISION' OF'Cc;�nST� IviAN: ci_H NT
ADJACENT RIPARIAN PPQPERTY OWNER NOTIFICAT1ON'WAIVER FORM
Name of In;iividual Applying For Permit: &(zeSoJz'--) ►-�� I�F.k
Address of Property: kot // c�y q o tic, C ad
(Lot or Street #, Street or Road)
G✓i L tn+ vc •./ Alit,
,City and Ccunty)
I hereby ce-tify that I own property adjacent to the above -referenced property. The indivi
applying fo: this perrut 1:as described to me as shown or, the attached drawing the development
are proposing. A description or drawing, with dimensions, should be provided with this lette
have no objections to this proposal.
If you have objections to what Is being proposed, please write the Division of Coy
Managemcnt, 127 Cardinal Drive Extension, Wilmington, INC 28405 or call 910-" 96-'
within 10 clays of receipt of this notice. No response is considered the same as no objecti
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse or boat lift must b
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (h
wish to Ni­,.ive the setback, you must initial the appropriate blank below.)
S:Narn..
I do Wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback require:nert.
r
e,S
AV X_ ►A

DIVISION OF COASTAL NI:A1 AQ! i1 i�i-
ADJACENT RIPARIAN PROPERTY OWNh;R NOTIz=ICATIQN- WAIVER FOW f
Name of Individual Applying For Permit: r'e�
Address of Property: /- "f l! Fo yo L t+ye
(Lot or Str.-et #, Street or Road)
(City and Ccunty�)—
I hereby certify that I own prnp,:My adjacent .o the above -referenced propervy. The indivi
applying for this permit has described to me as shown on the attached drawing the development
are proposing. A description or d7a«ving, with dimensions, should be provided with this lette
V I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coy
Managemcnt, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 9104796-'
within 10 clays of receipt of this notice. No response is considered the same as no objecti
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must t
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (I:
wish to w.,Jve the setback, you must initial the appropriate blank below.)
I do witih to waive the I setback requirement.
I d o v-ish to waive tl.e 15' setback requirement.
31—WU 1lidi1T 711 y1444V
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NC Division of Coastal Mgt. Habitat Impact Computer Sleet
Applicant:`{ Permit
Date: J
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremer
found in your Habitat code sheet.
Habitat 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 fir
disturbance.
Excludes any
restoration anc
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other --r13,9
Dredge ❑ Fill ❑ Both ❑ Other
O�2
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 ❑

I .J I
R GREGORY HOLLEY 32-20110 Tx
JULIA S WORTH �1 P z v 807
925 WILD WI IINGDTON NCI28411�39 UNES CR�3615 Date
?ay to the "el7 $ OU
Is
)rder of� Dollars
,
Bankof America'�I
ACH R/f 111000025
For C- / '' 1
1: L L 10000 2 SI: 004 7 7 S 34
INS
7 3 111.0 IS i ��