17586D - Staley

• CAMA AND DREDGE AND FILL a ,
~.. GENERAL q. .
_...1�
PERM I T
as authorized by the State of North Carolina
I��y Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15A NCAC 7t t r//b0 71/ , /J 00
4�-1
Applicant Name 601011 St-A % .S41rn ✓APMk� Phone Numbe �W) SY�L V d 7
Address %D/U7 �1 MUod N -rfr PA-LA
City r%Pi 1' P.t-,lt-Q State /V e Zip .2 ' 36 y
Project Location (County, State Road, Water Body, etc.) _LW S447A Pd► DRiti r t- 4bA 1)C--74( Its 446�s4t5% t
4z10Vrv, 3,01.44Vi (a .
Type of Project Activity f4a-Chekt'gO' ' ha t< Piei v/t- p "0i EA ,4ivi 8gi/k4-rAD
l' 041214,04 ro Ar{ $E SC-t 3kK 4 ivs'tti+mrw• .15., ►=,Qa' g;PAP;Ar- c n AP;ae4 t
'' A-1( Cotih.fi aft I 0t 7f1 . 1100 Amato 'lit .1aou s441r A-PPly
PROJECT DESCRIPTION SKETCH (SCALE: / r1__ Zp / )
Pier(dock) length CATha
Groin length
t / 80 M,41 —rP e abF o c Ft"' A"1 (44,414'
number
d{l a:, fi t
Bulkhead length ��/ 7 { (%� ,
•
{ 0 /�
max. distance offshore P h 1) El l
I1 "Al 14• (orPY =_ : _
Basin,channel dimensions �r
t 'S'Mf'V'
cubic yards ?` +
Boat ramp dimensions 6 titri Q'CQ
Other L. —H&AD /J1}/4i. 17
,/r ' .
F/vAT ii1�/L' I Ni �` i i 1
L t' rr - /v xi y' t I
_.........--� w3 __
li
co' ,4t K Ap
14/ 504-1Acii oe D,fz. ! J i l
This permit is subject to compliance with this application, site
drawing and attached general and specific conditions. Any 414L
violation of these terms may subject the permittee to a fine, /g/L4,71,411
imprisonment or civil action; and may cause the permit to be applicant's signature
come null and void. nn 1
/ Cepl
This permit must be on the project site and accessible to the tY` J permit officer's signature
permit officer when the project is inspected for compliance.
The applicant certifies by signing this permit that 1) this pro- /9/yaY 7/041/
ject is consistent with the local land use plan and all local issuing date expiration date
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no //
objections to the proposed work. attachments 7 t-� /�UU 7>� r /� GO
. - . _ _ sn1

GENERAL PERMIT COMPUTER FORM
APPLICANT NAME: `0'/1/2 t/ SliVe t/ C)
ADDITIONAL NAMES: 54 01%- V Nvl v✓� 6
�/ (Y
AEC DESIG: Ti L �✓� C f 5 DEVELOP AREA: 0_.C.) l PROJ DESC:
(Will only take 6) (Will only take 1)
WORK: Pg `1J, b 6L (o, /'-/ _
(Will only take 4)
L joil. 1CS c- i f (.
MAINT:
(Will only take 4)
U
(will only take 6)
6w 51
ACTION EXPIRATION
DREDGE&FILL REQUIRED:CAMA MAJOR DEVEL REQUIRED: jf( ,i (fr
`z (* ( (1'

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
PIER/FLOATING DOCK
I hereby certify that I own property adjacent to
Saat___/.5+atgAi ' s, property located at
i 1 5c�v4-L1 rho& QrI t�2
( lot , block, road, etc. )
on 1nl 1,tf _
on Holden Beach
(water body)
North Carolina. 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 must be
set back a minimum distance o9f 15 feet from my area of
riparian access unless waived by me. I
Q nc wish to
(circle one)
waive that setback requirement .
Description and/or drawing of proposed development : (to
be filled in by individual propping development )
. rem
Si ature R.
P
Nam
Phone Number

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
PIER/FLOATING DOCK
I hereby certify that I own property adjacent to
G2C31-615- 4-------
TA 's, property located at
91 Soo 5h r
( lot , block, road, etc. )on 14
(water bogy) on Holden Beach
North Carolina. 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 must be
set back a minimum distance o9f 15 feet from my area of
riparian access unless waived by me. I d. .
_o to wish to
(circle one)
waive that setback requirement .
Description and/or drawing of
proposed envelopment : (to
be filled in by individual
propsing development )
Signature
Vie,lane K Ahr-liNe
Name
G
Phone Number

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VARNAM'S DOCKS & BULKHEADS
I86 VARNAM TOWN RD. • 66-112/531
DATE
SUPPLY, NC 28462 L q CN
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PAY b �' �dm , ORDER E H 0ORDER OF 111
Q�C� DOLLARS 121......° ,II
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3226 HSUPPLY,
OUPP Y NC 28462AD SW
FOR mI4 ?G tit l y1
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