85596D - Hollingsworth

e CAMA fl DREDGE & FILL NO 85596 A B gap
1 GENERAL PERMIT Previous permit
Date previous permit issued
Ifei New ❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized by the State of North Carolinya,Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I5A NCAC ._ D7 ff '• lO() 0 Rules attached. X General Permit Rules available at the following link:
ri
�// w,wtieQ.tx.govlCAMArttles
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Applicant Name h ryiWDI7 __. Authorized Agent N(/ ��y
Address 1 W b' PrL Project Location(County): W Ov
City OIrt475 State AI v ZIP i'r4fht3 Street Address/State Road/Lott�#(s) S'if # 5'�
Phone#( ) q to` 57 v 6cc'o LQ^ ,F! ' A reyexcow,tavrty
EmailLrr �AA r� +� Subdivision e..�
I j T City iiil t,57,l ,M,�� ZIP
Affected CW EW )�PTA ES PTS Adj.Wu Body-------./7"I2�ys�/'vi' "!'!►r t.-- �man/unk)
AEC(s): OEA IHA UW SPIMA E PWS Closest Maj.Wtr.Body 1 bf5 f4/L. p
ORW:yes/no PNA:yes/no
Type of Project/Activity ref f6LG k. �e .
.ram (Scale: firs )
Shoreline Length '!r' 1 O
Access Length /(
Pier(dock)length 'r/.—,f/v • • `Ai
Fixed Platform s)
Floating Platfor ) •
40
Finger pier(s) • •
Total Platform area •
Groin length/if
Bulkhead/Rlprap length • •
• a
Avg distance offshore °/
Breakwater/Sill G/
Max distance/length
Basin,channel r Cubic yards ii !
Boat ramp •
Boathous Zl aC /Z
Beach Bu mg
Other �. lb'• • ' yi-
t011411
SAY observed: yes d1.-/T C! )
Moratorium: n/a yes 40
Site Photos: yes .411A �l
Riparian Waiver Attached: ®`p•�( _ / Lr Apex-
# - a
A building permit/zoning permit may be required by: /✓yeti^ lI
_ ! TAR/PAM/NEUSE/BUFFER(circle one)
Permit Conditions
❑ See note on back regarding River Basin rules
! I See additional notes/conditions on back
I AM AWARE OF STATUTES,CRC RULES AND CONDITIONS THAT AP* 0 THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. ( A) I ,
.C/I l •1t4
„Agent or licant PRIN O N, . , I „ PermiE er's PRINTED Name
S:r e`•Pleas/r. .com• ace sta ment on b., of permit" ~ Signet
2a0 414�- t'74 • y 4. ,-,. .zv
Application Fee(s) Check tl/Money Order Issuing Date Expiration Date

S°``°'4' flCAMA fl DREDGE & FILL No 85596 ABC [
3 - GENERAL PERMIT Previous permit
Date previous permit issued
1 New Modification Complete Reissue Partial Reissue
As authorized by the State of North Carolina,Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
ISA NCAC • s Rules attached. n General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant Name t r If i 1 f l L,f/A''; '" ' Authorized Agent
Address 4i) L O/' P //t Project Location(County): i"i;'.,` -_-
City �'t7 f /..› State Ne
ZIP Xr ! - Street Address/State Road/Lot#(s) 51/, .F. $s
Phone#( ) 4 f 0 - c/7.- 6O5-O !`!Y 7/17E ( 60 fit 0 ciA:iy y L
Email k ✓"1 l4 tV 4 r r-3 C • 't`" Subdivision ,t
J City f�/1?f'1 4rt' D ZIP 1 a
Affected n CW EW PTA ES ❑PTS Adj.Wtr.Body 0 ii1J r-ee.g e- man/unk
AEC(s): ri OEA n IHA UW SPIMA 0 PWS Closest Maj.Wtr.Body '(,✓C1/C. 5-Ni)
ORW:yes/no PNA:yes/no ,Gt
Type of Project/Activity (s'r/A(C �,,.a./ 7/
(Scale: ,w,
Shoreline Length r. (5 t
Access Length la i
Pier(dock)length ! " t..- i
ENE
Fixed Platform(s) --^
I
IIIII
Floating Platform(s) ' IIIIIIIIMIIIIMNIIIIIIINIIIIIIMMIIIIIIIIIIrIMIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIMMIIIIINIMIIIIIII
■ IIIIIIIIM �
Finger pier(s)
} IIll I ,
Total Platform area 111111
11111
1 . ��
Groin length/ff , i
Bulkhead/Riprap length ;_ .._.... .... ._...r- ... ._..._.. min ____ __ ,
Avg distance offshore
rr 111111111111111111
Breakwater/Sill i� 1 : ��
Max distance/length
Basin,channel 7— -j _.-_
Cubic yards O . .. .......-. . . 1 ���� �� ������� NIEMI --
Boat
ramp a■ __
Boathouse/Boatlift ■ ■
Beach Bulldozing -3
Other
■ ■I ►1�iL 1L Z iiNIM
SAV observed: yes nod
Moratorium: n/a yes
Site Photos: yes - __.--Riparian Waiver Attached: yes no ''✓L.-
A building permit/zoning permit may be required by: ' A—l r( •
Permit Conditions n TAR/PAM/NEUSE/BUFFER(circle one)
nSee note on back regarding River Basin rule:
nSee additional notes/conditions on back
I AM AWARE OF STATUTES,CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name

statement of Compliance and Consistency
This permit is subject to compliance with this application and permit conditions. Any violation of these terms may
subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for
:ompliance. The applicant certifies by signing this permit that: 1) prior to undertaking any activities authorized by this
)ermit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the
ocal land use plan and all local ordinances, and 2) a written statement from the adjacent riparian property owner(s)
las been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(s).
"he State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
nformation and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
liver Basin Rules Applicable To Your Project:
Tar- Pamlico River Basin Buffer Rules Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules
for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the
NC Division of Water Resources. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
'lease ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
)ivision of Coastal Management Offices
Aorehead City Headquarters Washington District
100 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
52-808-2808/1-888-4RCOAST Fax: [phone] 252-946-6481
Serves:Carteret,Craven—south of the Neuse River, Onslow Fax: [phone]
;ounties) (Serves: Beaufort,Craven—north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
:lizabeth City District Wilmington District
.01 S.Griffin St.Ste. 300 127 Cardinal Drive Ext.Wilmington, NC 28405-3845
lizabeth City, NC 27909 910-796-7215
.52-264-3901 Fax: [phone]
Serves: Bertie, Camden, Chowan, Currituck, Dare,Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties)

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: -Tei ' . ��Dl L /l 5ic�or , l
Mailing Address: `�(� Lc.9j t Li Po nt I LL1
4--)A-fM► i A 2 SLl 4
Phone Number: (1( l D ) S 1 ? - LD D D
Email Address: e,r-f j v14&,/- e E,44
I certify that I have authorized
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at 1 4' 1-- , 35 , 48IJo? ZDN4I,w7;
in rPENDf.g. County.
I furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
1
Signature
12 D ; A 5u DAit
Print or Type Nam
Rao kv2-1 i t.4D1-1 rc
Title
t21 21 I Zr�2Z
Date
This certification is valid through I I

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their`agent)
Name of Property Owner: t e�" �. No�l: /1�5L0✓'(.4
Address of Property: B 1 )s l.Jfn 1 SS I -PP)4 '/i 25 zae,,g,,a- ;
Mailing Address of Owner: 5O Lfl4L,r /D a/T Li 11JA.04PsTs,4L ) C 2144.3
Owner's email: terr@MarrAc• ersf Owner's Phone#: (W )SJL-LOI SD
Agent's Name: Agent Phone#:
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing.
A description or drawing, with dimensions, must be provided with this letter.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 127 Cardinal Drive EXT, Wilmington,NC 28405.DCM representatives can also be contacted at
[phone]. No response is considered the same as no objection if you have been notified by
Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15'from my area of riparian access unless waived by me (this
does not apply to bulkheads or riprap revetments). (If you w. h to waive the setback, you must sign the
appropriate blank below.)
I DO wish to waive some/all of the 15' setback C��(�/
Signature of Adjacent Riparian Property Owner(ARPO)
-OR-
I do not wish to waive the 15' setback requirement(initia #be blank)
Signature of Adjacent Riparian Property Owner: ± J1140
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email: ARPO's Phone#:
Date: *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: -re{',�n 1�. )c !1Q 01,4401
Address of Property: rB 1 3 S LT SS ' .B 4 '/)2 g e.g„ -
Mailing Address of Owner: 5O LPJ14. /D,Air LA)I jjA.01R5M4j ,)JC 214413
Owner's email: te!'�r.(@I►lQfra1c•CAN Owner's Phone#: OW)S12-Co051�
Agent's Name: �Jj Agent Phone#:
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property.The individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing.
A description or drawing, with dimensions, must be provided with this letter.
XI DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management(DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 127 Cardinal Drive EXT, Wilmington,NC 28405.DCM representatives can also be contacted at
[phone]. No response is considered the same as no objection if you have been notified by
Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15'from my area of riparian access unless waived by me (this
does not apply to bulkheads or riprap revetments). (If you wish tgwaive the setback, you must sign the
appropriate blank below.)
I DO wish to waive some/all of the 15'setback
-OR- Signature of A jacen iparian Property Owner(ARPO)
I do not wish to waive the 15'setback requirement(initial the blank)
Signature of Adjacent Riparian Property Owner: A.I1
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email: ARPO's Phone#:
Date: *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

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Chink •
%ad Dap Donorhad Chock From(Na.,,.) Noma d Permit Holder _ Vendor Chock number amount Prmlt Number/Comments Roca/of or Rarund/RMBoupd
Calumn2 Column., Column/ Columns Gramme Column? Column8 Colmn9
322 John McClure Linda Warren 1Truist 837 $ 400.00 GP#86003D 'BB rct.16902
322 Sea Diiig Marine Construction Steven&Melanie Otwell First Bank 1647 $ 200.00 GP#86007D BB rct.17000
322 Hill Properties-1 of 2 David Hill First Citizens Bank 1387 $ 400.00 GP#86006D BB rct.16999
J22 Hill Properties-2 of 2 David Hills First Citizens Bank 1807 $ 200.00'GP#86006D BB rct.16999
322 ,Jill Kenley James and Jill Kenley State Employees CU 7873 $ 200.00 GP#85575D _BB rct.16993
322 Allen Murray patricia and Edmund Murray Benchmark Community bank 1036 $ 200.00 GP#16997D BB rct.16997
322 Terry Hollingsworth same Bank of America 4167 $ 200.00 GP#85596D JD rct.14883
322 David Ghee Money Order David Vandenberg USPS 2.6393E+10 $ 200.00 GP#85576D BB rct.16994
322 Lighthouse Marine Construction Inc Gerald Rhodes Coastal Bank and Trust 4157 $ 200.00 GP#85584D JD rct.16813
322 i Charles Fox Homes,LTD Callicutt Banch Banking&Trust 29073 $ 200.00 GP#85577D BB rct.16995
322 Benjamin Elliott same TD Bank 126 $ 200.00 GP#85550D Tmac rct.16280
322 DC Morse Inc. CMT3,LLC BB&T 6580 $ 200.00 BB rot.16903