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Home My WebLink About72175_extend pier_20180627lCAMA / ❑ DREDGE & FILL GENERAL PERMIT (New - El 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 Na 72'175/J/� �D D Previous' permit# � Date previous permit issued /li� kc Applicant Name C. / Project Location: County, /Jl�iO Address Street Address/ State Road/ Lot,(s)1 City State �ZIPi / G Phone # E-Mail Subdivision Authorized Agent �C/'/ // �/�/J>!� �� City + Affected ❑ CW - kEW ,�[XPTA ❑ ES ElPTS Phone # ( ) /Rives AEC(s): ❑ oEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body `Z:A ✓l 6 ❑ PWS: ORW: yes', / po '�) PNA es i�d Closest Maj.- Wtr. Body ZIP_ l Type of Project/ Activityi► .. ■s ■■■■ !J■ I. ! ■ ■■NEIMMIMMEMIMMEM ■■■�a1ri/MUN W■■�� ' l■■ ■®�..■ MEMO NONE ■■■■■■■��■■■■■■■■�a■■■■■ ■■■■■■■■■■■■■■■ ■■■►■■®■■■■■■■■■�a■��■ei■■■■■■■■■■■■■■■ ■ ■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■7�1■r��■■■�■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■_��■■■■u■■tea■■■■■■■■■■■i M. i �iiiil�i■■ii�ii■■■■■■■■■■■■■■■■■■■■■®■�lc�i�MR - y� ■ . /!119� ■■■■■■■ ilffifff'lL�t�'■■■■ ■■■■■■■■�:!>A�1ii1■■ ;gip ■ ■■ ■■■■■■M ■■RNMEM■:■■■MEEMEMMEN ■■■■■■■■�■�J■■■■■■■fl■■■■ ■■ ■■■■■■■■■■■■■ La W L R_(�� l N _ Agent or Applicant Printed Name y I I"1 rrD II+iA- Sigr�e „ Please ead compliance statement on back of permit • - - � ..9 Ap�licationFee(s) Check# Signature Date Eicpiration. Date ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to -cr Wl e s C &)t�, Le S / 1 s la / (Name of Property Owner) /n� property located at a Cs^� f u ; So 144& l Zr.5 -,n tqi, j— !! (Address, Lot Block, Road, etc on INi`;c j-�S C , in cs� d-,- , N.C. J (Waterbody) (City/Tow and/or County) IT9hee applicant has described to me, as shown below, the development proposed at the above A"'cL _ - - I have no objection- to this proposal. --- — - I have objections-te-this-pr-oposal. -- - DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT `(Irdivitlua!;p�Qp sin. afe e% en"t: � us�.filli �'s' ��`""` — r—.,X-4efJ lew k xs�, el c[%-k-d' Ivc) as s WAIVER SECTION 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) �j4 iggn tare - Print or Type Name Z.f-p- %Zc[. %ling Address IkC$L--- V\ /)z z r1b City/State/Zip -Number/emaffwcf Tess 12 /2b I ( r Date `Valid for one calendar year after signature* (Adjacent Property,Owner Information) A� Q gig �-IZ7EXU-D t ature* a T-CY-Ne--- -10o r Pri or Type Nano ® �F6 iling Address City State/Zi' Telephon um er emal -address �,�- --"- rao )r7 Date* (Revised Aug. 2014) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to w1 e5 �1'pcaJ n s _ (Name of Property Owner) property located at 1a 20 (Address, Lot, Block, Road, etc.) on W r'' �-1�-5 C tte a A, , in e emu. � � Cc�. N.C. (Waterbody) (Cit Gown and/or County) The applicant has described to me, as shown below, the development proposed at the above I catg, iop- I have no objection to this proposal. ^J I have objections to this proposal. -1 DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT y-4e� I- ',?4114, � -fir Q 6za* ) '1 �-�- fssd-S 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.) 't 1 do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) - Print or Type Name 1-/.5!J %a.+ed- jlinj� Address _ l�cav Y\ IJL 2,7210 Ci_ty_/State/Zip Telephone Number / email address ZZ)A?I/-7 Date (Adjacent Property Owner Information) /0 3f//7 Dare (Revised Aug. 2014) `Valid for one calendar year after signature* NC Division of Coastal Mgt. Habitat Impact Computer Sheet Applicant:2,L, Date: General Permit#:� Describe below 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 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.nccoast2imanagement.net revised. 02103/10