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Home My WebLink About71107A_Kim Old_20180823J N CAMA / ❑ DREDGE & FILL NO 71107 .. B C D GENERAL PERMIT Previous permit# )New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued 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 I SA NCAC / A Rules attached. Applicant Name Y,w'N wProject Location: County Cu . A-- c t Address 104 Z.,11 Ivy O City,, L State ti L ZIP a_49.� 'g Phone # Q5) a0�-aa a3 E-Mail Authorized Agent h-46 y VIA_ 13u t - kN ❑ Cw NEW X PTA Affected AEC(s): ❑ OEA - HHF ❑ IH ❑ PWS: ORW: yes /Gd PNA ®/ no Street Address/ State Road/ Lot #(s) I 0 LI Tv la fj, y O r 5� i# jabs } Lit M 3 Subdivision 'Tv ll� I� u A�✓<� city Mo•lot k ZIP air V? ❑ ES ❑ PTS Phone # ( ) River Basin Po a }o„ K ❑ URA ❑ N/A 11 Adj. Wtr. Body u 11 S 3 �. •� dfZ/man /unkn) Closest Maj. Wtr. Body Cv-e or 15,..I-,, Type of Project/ Activity 3 g.� 1A Aa ✓� c`' F.,emu ✓ ?' / c i 1 , i t (Scale: �" = 3 a' ) Pia, / Fixes �Flloow C. , ,s, Groi Bulk Basil Boat Boat Beac Otb Shor SAV Mor Phoi wai, ■■■■■■■■■■■■■■NEE■■■ ■■�■■■■■■■■■� i length I/./.%JI ■■■■■■■■■■■■■■■■■ number■��■■■■■■■■■■■■■■■�� ■■r_■■■■■■■■■■■■■■■■� ��vui�■�m■■■■■■■■■ avg distance max distance offshore ■EiIN■■■■■■EiiuEr�■■■■ d ■iM■Ei■MME■MMIi■■MM■■■ ■■■■■■■■■■■■■■■■i�■■■■�■r�i�■■■■■■■■■■■■■■ ■■ E■E■E■EIOUs NOON ■ r �. �S �� ■ :■■■■■■ cubic yards ram ■■■■■■■■■■■■■■■■■■■■■fill►,11DI ��■■■N■■■ ■■■■c.i■■■■■■■■■■■■■■■ ■■■� �i ■■■rare■■■■■■ ,,,;: ■■■■■■■■■■■■■■■■■■■■■0■■■I�JI■■■■ EYE■■■■■■ Bulldozing ■■■■■■■■■■■■■■�■■■■■NsE■■N■■■■NE■■■■;■■w -line Length • :==■•��■■■®!��■■�■ F1 ■■■jR■■■/'/NOON■■■ not sure yes ,!p ■■■■■■■�■■■ ■■■■■■■■■■■■■■!1� NONE •■��nEE■■■■■■E■ENI■■■E■E■■■■d ww■mwr4v.?cked I VAC A building permit may be required by: (^.� r r • �.. c k ( Note Local Planning jurisdiction) Notes/ Special Conditions Agent or Applicant Printed Name Signature '"Please read compliance statement on back of permit" ,4;100.w k-48�S) Application Fee(s) it- Nato A Check # ❑ See note on back regarding River Basin rules. 0 r. \Css rw I Permit Officer' N Si6att re Si&3)aol$ �alas14,0l$ Issuing Date Expiration Date NC Division of Coastal Mgt. Habitat Impact Computer Sheet Applicant: v y� Date: Permit #: —+ ` 10 Describe belo'iq the HABITAT disturbances for the application. All values should match the name, and units of measurement 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 final disturbance. Excludes any restoration and/or temp impact amount) �i Vn,' Dredge ❑ Fill ❑ Both ❑ Other �U y 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 ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ 252-808-2808 :: 1-888-4RCOAST :: www.nccoastaImanagement.net revised:02/03/10 AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION P / Name of Property Owner Requesting Permit: -Za r-a e-e zt: y12 CJ Mailing Address: 1 u � 0�1-V c:,? 79�9 Phone Number: Email Address: kl I"Yl d l d� Fl®u�Gt-f��L!?/i Q • G'OI-l- 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 j oirf TK ll� bxy h l", in r' f`i l u_C k 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: r �% ' Mo.Me Signature >> a e, O/V, Print or Type Name &to>Ue-(� Title 7 Date This certification is valid through ADJACENT RIPARIAN PROPERTY OWNER STATEMENT r /' I hereby certify that I own property adjacent to 1 's AMO of property located at S roperty Owner) .—� ► (Address, Lot, lock, Road, tc.) on S , in m2 , N.C. (Waterbod) ( ity/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above locatiop I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must flit In description below or attach a site drawing) ,�� .-�'`� ,,�,r�..�% ;�.�`�✓�J`�,.cY'.�'^—tom �� ;�•��- WAIVER SECTION I understand that a 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. (If you wish to waive the setback, you must initial 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 Information) Date 'Valid for one calendar year after signature' (Adjacent Property Owner Information) Signqjture 1-22villsq AI" Print or �YPT-Uoj e Name lo n' r. p CiPA Ni Ir T ty/St Telephone Numb r/email address :7117 l �t Date" (Revised Aug. 2014) I hereby certify that I own property adjacent to property located at ! on l c/, (Address, Lot, / , in --14 (Waterbody) . ofETperty Owner) and/or County) I N.C. The applica as described to me, as shown below, the development proposed at the above location I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill In des�ccription below or attach a site drawing) - `e�l J'Ar .... WAIVER SECTION I understand that a 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. (If you wish to waive the setback, you must initial the appropriate blank below.) I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Prop rty Owner formation (Adjacent Pro e y Owner I format; n) Si n ture a ature tur t or Tym Pn r Type Name Fu Vaili d s A 7 M fyYng Address C Ck , ISLE-�,<5? t yip City/S te2i T- -7SP7 -3 7.3- 589 3 Telephone Number/em dress Telephone Number/email address Date Date* f *Valid for one calendar year after signature* (Revised Aug. 2014) i` i R, 1 f r r r ( #nY$ RIN :r y'i •� Y Ali, i � � �'� �lyySNN7�� 14' tk �• R q i a