Holland, David 88915C

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(0M-TqT❑CAMA ❑DREDGE&FILL 9 88915 A B C D
GENERAL PERMIT Prevlouspermit
Date previous permit issued
❑ 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:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name Authorized Agent
Address Project Location (County):
City State ZIP Street Address/State Road/Lot #(s)
Phone # (_ )
Email Subdivision
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length _
Access Length
Pier (dock) length
Fixed Platform(s) _
Floating Platform(!
Finger pier(s)
Total Platform arei
Groin length/#_
Bulkhead/ Riprap
Avg distance offsh
Breakwater/Sill _
Max distance/ len.
Basin, channel _
Cubic yards
Boat ramp
Boathouse/ Boatli
Beach Bulldozing.
Other
SAV observed:
Moratorium: n�
Site Photos:
Riparian Waiver A
A building permit
Permit Conditions
(Scale: )
JJ ❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See 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
Signature "Please read compliance statement on back of permit" Signature
Application Fee(s) Check #/Money Order Issuing Date
Expiration Date

1°1COM-T',Lc❑CAMA ❑ DREDGE & FILL N9 88915 A B C D
0
Previous permit
y = GENERAL PERMIT
Date previous permit issued
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:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # (_ )
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length
Pier(dock)length
Fixed Platform(s) _
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other_
v
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required
Permit Conditions
(Scale•I )
IN
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See 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
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #/Money Order
Signature
Issuing Date Expiration Date

Name of Property Owner Requesting Permit: A�d t 7alo e-441 440 1C�'t��
Mailing Address: _ (� Ul�L+k Do k Ca is i On
Swan <'dOYD , NC --9S5 D
Phone Number: 35a`72 E - 13 L9
Email Address: ezW1
I certify that I have authorized _ -�. � �� %(' . r1Ae5 cr a ,
gent i Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: bCL-k' Itom(
at my property located at LUG L- kQjDS51 t .SWC'Un s bom
9
in 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:
Signature
Print or Type Name
Title
Z,-Z,-
Date
This certification is valid through 1l

- /"� 1�� Uc W. U, 0 V
AaJACr -NE&RIAN-.MQPERTYOWtiERST--%KN—T
I hereby certify that I own property adjacent to //6 114"."61
(Narrte
of property
property located at 6 WItIlk. rlhk
(Addrar!s, Lot, Black, Road, etc.)
an g' & k ex-Z N.C.
(Waterbody) (CitylTown andVar Couift)
The applicant has described to me, as shown below, the development proposed at the above
I cation.
I have no objection to this proposal.
I have objections to this proposal.
(8 WARV S
I understand that a pier, dock, mooring Pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance ,of 16 from my area of riparian access unless waived by
me. (If you Nvish to Waive the, setback, you must initial the appropriate blank below-)
I do wish to waive the 15' seftiack
I do not wish to waive ffie IF setback requirement.
(Property Owner Informadon) (Adjacent Property OWner 10formationj
-J/
Print or Type Name )*W or Type
C/ Address
3-z- X) C,
CW
CRYISWOMP
,2 -3to -V 4C
Telephone Number/email address Telephone Numbef lemeff address
1/2- mod- ZY 9
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature
CZ

t\-JC(JtQ. Gov
ALXLAC-,F T RIPARIAN MQPERTY gMLER ST---L MENT
I hereby certify that I own property adjacent tooa-id
n 44A-t-c
(Addrese,
ok,0a6&
(Wate�dy)
The applicant has described to me, as shown below, the development proposed at the abo
location.
I have no objection to this proposal.
I I, WITTZ707 Mv rOTIM M* 1, 7 17 7, 79, 1 f =*- F I
MOVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or grin
must be set back a minimum distance of 16 from my area of riparian am-ess unless waived by
me. (if you wish to waNe the setback, you must inklaR the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Infonnation) (Adjacent Property OWnor firdormation)
Signalure
1,456�� 4&12�L
Print or Type Name
a vaz� /-Y/Y
Urn d
Citylse-&-lop
.Telephone Numberlemaff-a�ddress
Date'
*Valid for one calendar year after signature*
Date*
(ReWsedAug. 2014)
IvC,Chu,

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: qlm A (a
Address f i ti9jt Cl/tf RR�
Address of Property: / C"f ICL 6)5s6t tt'� i��.i�r3�'9. 6 ]t5 1' ! C—
Mailing Address of Owner. S-+fit c ff s a" /)y e .
Owner's email: eh -eta- lic[v1(:,1 Owner's Phone#: - 13
Agent's Name: c %L U e,(r d e. ( Agent Phone#:
Agent's Email: 0 iryie cr y I ce s CT �j -vak i+ai
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 drawinq, with dimensions must be provided with this letter. 'f-)a, s s-,, -,f- v, _ ,-;- ,
I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being
y J g 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 EX7; Wilmington, NC 28405. DCM representatives can also be contactedat
[phone]. No response is considered the same as no objection if you have been notified by
Certified Mail.
$T
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 to waive the setback, you must sign the
appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property Owner (ARPO)
I do not wish to wa' e the 15' setback requirement (initial the blank) c,J
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO: & S
ARPO's email:, + O' Phone#:
Date: _*waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

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