52043D - Holz

E]CAMA/ ❑DREDGE & FILL
GENERAL PERMIT Previous permit#
clew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
iorized by the State of North Carolina, Department of Environment and Natural Resources
e Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 1 H • I Z.-- —
›:Rules attached.
tnt Name '� L Li j L-_ L Project Location: County 11 c�>7 E I'L
s 41( lV[: ri iSzi I n' 1�1.,t-a C-6 Street Address/State Road/Lot#(s)
1 Z+-\►wti State A) ZIP 2-7"7J1 I :>3 ►; .>, \1 K f l 4 i
#(CI i()) 143/. ©�2-S Fax#( ) Subdivision
Agent 1\�-L-i i i� !city �i'
izedsi-a�L GE.r1z_ i\ ZIP _`3yi
,d IIICW CAW p.PTA ❑ES ❑PTS Phone# ( ) River Basic'.i-\pt
❑OEA ❑HHF ❑IH LI UBA ❑N/A ------ (L I,'-r-4-�
is Adj.Wtr. Body 1- _ i-\i t_ t (nat
❑ PWS: ❑FC: -------
yes /-nos; PNA yes /(r�„ Crit.Hab. yes / no Closest Maj.Wtr. Body �0'5 rU �j�L, I\
of Project/Activity is tz r.-. v _ 5 -,,i...;, `) ,>l>> s I-)(_- Z ir 5
,.>;—"I 1uNF Xc• 2 \'`_LZ C- � (Scale:
sock)length _rm(s) j-)C <X2 •S'X' ( 2I� 5 `
•pier(s) I
length }_ y , ) `
lumber `� Y
J
sad/Riprap length
svg distance offshore ! }
-flax distance offshore j � �
channel
I:ubic yards i j ! •
'amp '/
ouse/Boatlift� �
Bulldozing • i—
�J�1
I
line Length '
not sure yes nii.„) " 13--- g dat%4 I` i i
1
ags: not sure yes no) I I
:orium: n/a yes nod I
i , j i P
s: yes nq) - - i
I
:r Attached: no l i
ding permit may be required by: / 3 Ps XI-1 3 & p,c A U See note on back regarding River Basin

Bank of America 3203
ACH R/T 053000196
.IED MARINE CONTRACTORS, LLC 08-03 66-19/530 NC
910-367-2159 702
92 HAROLD CT.
HAMPSTEAD, NC 28443 l�J
DOLLARS
H.003 20 30 1:053000 L961: 0006E1474373811

Ar?rtviriSA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
F.Easley,Governor .Charles S.Jones,Director William G.Ross Jr.,Secret
Authorized Agent Consent Agreement
4/ll e 71 a r, ' e-- is hereby authorized to act on my behalf
(Printed Name of Agent)
to obtain any CAMA permit(s) required for the property listed below. The authorization is limited to the
activities described in the attached sketch.
ION OF PROJECT:
/O 3 Bo 1-�J i< P v e
T J P A/c__
RTY OWNER MAILING ADDRESS:
UJrV�a A/ (27 7D7 PHONE NO. - got -c(8,25
RIZED AGENT MAILING ADDRESS:
fl? tr, it CankCcGtbrS L C
fTu /moo�jse,wt 44 c, yeA,t"
12 ttetrOic C t:
0.415` a g`f 13 PHONE NO. PO -- 367- 21,5 'I
e of Properly Owner
of A rtuiri ,f e.,'e..4.

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
the purpose of this form is to provide proper notice to you as an adjacent riparian property owner to the individual or
ndividuals listed below. The CAMA General Permit application procedures require that applicants provide the Division of
:oastal Management confirmation that a written statement has been obtained signed by the adjacent riparian property owners
ndicating that they have no objection to the proposed work or that the adjacent riparian property owners have been notified
ly certified mail of the proposed work. Often these forms are submitted to the adjacent riparian property owners by a marine
ontractor or other individuals acting as an authorized agent on behalf of the applicant.
Fills form was sent to you by the following individual or company designated by the applicant as an
authorized agent:�7 n
3 .- ---c>s
uthorized Agent's Siiature Date
Jame of Individual Applying For Permit: ( ! /2) (Z
ddress of Property: 0 3
(Lot or Street#. Street or Road)
1 oP 'Pe c�
(City and County)
hereby certify that 1 own property adjacent to the above-referenced property. The individual applying for this permi
as described to me as shown on the attached drawing the development they are proposing. A description or drawing
ith dimensions, should be provided with this letter.
X.
I have no objections to this proposal.
f you have objections to what is being proposed, please write the Division of Coastal Management. 12
'ardinal Drive Extension,Wilmington,NC 28405 or call 910-796-7215 within 10 days of receipt of this notice
io response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be set back a
rininr:�:n distance of 15' from my area of riparian access - unless waived by me. (If you wish to waive the
etback, you must initial the appropriate blank below.)
X lei I do wish to waive the 15'setback requirement.
I do not wish to waive the I 5' setback requirement.

CE'‘ IFIED MAIL -RETURN RECEIPT REQUESTED
DIVISION OF COASTAL.MANAGEMENT
,1DIACENTBI ARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
l he purpose of this form is to pro :de proper notice to you as an adjacent riparian property owner to the individual or
individuals listed below. The CA A General Permit application procedures require that applicants provide the Division of
Coastal Management confirmation that a wrinen statement has been obtained signed by the adjacent riparian property owners
indicating that they have no object • to the proposed work or that the adjacent riparian property owners have been notified
by certified mail of the proposed . Often these forms are submitted to the adjacent riparian property owners by a marine
contractor or other individuals acti g as an authorized agent on behalf of the applicant.
This form was sent to you by •e following individual or company designated by the applicant as an
authorized agent?//(e', 4 c, C_ f^
sr .
Authorized Agent's `". attire Date
1
Name of Individual Applying Fe Permit: t (/
/2—
Address of Property. ( ,3 j O' ' ✓-e -
(Lot or .treet ff. Street or •oad)
(City . . Co my)
I hereby cenity that I own prope _ adjacent to the above-referenced property. The individual applying for this permit
has described to me as shown on • attached drawing the development they are proposing. A description or drawing,
with dimensions, should be prov . d with this letter.
I have no objections to this proposal.
If you have objections to wit is being proposed, please write the Division of Coastal Management, 127
Cardinal Drive Extension,Wil innion,NC 28405 or call 910-796-7215 within 10 days of receipt of this notice.
No response is considered the me as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that r pier. doe mooring pilings, breakwater, boat house or boat lift must be set back a
minimum distauce of 15' from my area of riparian access - unless waived by me. (If you wish to waive the
setb+tcL ou must initial the a ropriate blank below-.)
('P I do wi to waive the 15'setback requirement.
fTh _ I Jo not ish to waive the 15'setback requirement. AWPIPA

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