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Home My WebLink About71246A_Patricia Bray_20181106nCAMA / ❑ DREDGE & FILL GENERAL PERMIT New ❑Modification ❑Complete Reissue El 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 Applicant Name POA r , (-, r, Q44 Address y�� j5�� av st. City tyo'r State VA ZIP_ Phone # ( Ts}) 1 13—A5 & E-Mail Authorized Agent �►c�T,n.nc Nu r, �k C ✓�st i Affected ❑ Cw ❑ EW ❑ PTA XES ❑ PTS AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A ❑ PWs: ORW: yes /6D PNA yes 16D No 71246 Previous permit # Date previous permit issued_ q N.►lUL-) B C D $Rules attached. Project Location: County ��` Street Address/ State Road/ Lot #(s) I II Nosh Rc-I Subdivision We si City D" C- k ZIP ;t poi Li 9 Phone # ( ) River Basin uv Adj. Wtr. Bodti AlTa-D/man /unkn) Closest Maj. Wtr. Body CL, r } k t �-' tJ r pier(s) number avg distance offshore max distance offshore_411_10=mmmmmmmmm=mmmmmmmmmmulumiiiiiiiiimm cubic yards ram house/ Boatlift h Bulldozing line Length .-r Attached: es notsure yes yes no ON No MEN �. . V ` 0(1 L'l( Chi- Al{C'k Agent or Applic t Frosted Name Signature Please read compliance statement on back of permit" i G oc) , L)O 14 56 Application Fee(s) Check # ItU �/.'� � ✓�G � CI Permit0 N "rig —nature I1&11ole 3161a(1`j Issuing Date Expiration Date NC Division of Coastal Mgt. Habitat Impact Computer Sheet Applicant: &4f y j ��.;'� C Permit* Date: Describe belok,� 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) ljhod{ ��^4- Dredge ❑ Fill Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other S vv a 5-00 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 Name of Property Owner Requesting Permit: -7j�A �Y� CA- c-, _� ca:i: 1 Mailing Address: 2 ZZ I�ja.�-t CS oY-�v 11L, \j 2- Phone Number: % Email Address: I certify that I have authorized A ent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: QyI at my property located at in C� County I furthermore certify that / 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 Date This certification is valid through I I DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED I hereby certify that 1 own property adjacent to �D�� i - ,S L- -+(Name of Property Owner) property located at ( 3 N S �` (Project Site: Address, Lot, Block, Road, etc.) on �o �,�.ti�� P,-T-) in Uk-C, C_ , N.C. (Waterbody) //� ��(,,CC�ity/Town and/or County) Agent's Name #U k� i �A✓I h e bn 0a—H' ing Address: Agent's phone #: 2-5 Z -2yZ— t 3 � k-- �L 2-19(-49 He/She has described to me as shown below the development he/she is proposing at that location, and I have no objections to the proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill in description below or attach a site drawing) Cv �� S-4-n.� G�i �-,-. c � � ►�.Q.w V ► n� 1 b►,� 1C.I....e�o` . If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 401 S. Grim SL, Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264- 3901. No response Is considered the same as no objection if you have been notified by Certified Mail. (Property Owner Information) Signature Print or Type Name Mailing Address �J 0 r C6 K I \) City/State/Zip -7 S- i - -z 1-7 2-9 3 Telephone Number/Email Address Dale , 'Valid for one calendar year after signature* (AAacent Properoy Owner Information) Signature* Ll • 4 CY1r5. �o� o►� Print or Type Name Z 1�v1-�cM�- lL �—�-. Mailing Address City/State/Zip Telephone Number/Email Address Date* ( -5 A" 10 kv%(- Revised Jan. 2017 DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED i herebycertify that i own property �G�`4-�'� G`- fy p party adjacent to s (Name of Property Owner) property located at � 1 ?j �--5� on (Project Site: Address, Lot, Block, Road, otc.) jp c7 LA -mot-v ,..- in v� C �C.— _ N.C. (Waterbody) rr (City/Town and/or County) Agent's Name #: -+��`' "�"°� ` ^ r C""4 •Mailing Address3 (3 �yv i too q Agent's phone #: fZ' ZO - 'l 1 Y . IBC— ?.:I He/She has described to me as shown below the development he/she is proposing at that location, and I have no objections to the proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must till in description below or attach a site drawing) GLr�ts vu x: r L — ' A --too ve e—v—,. s h Y �S-t—�`r�a'f�.i t..c.y..� ci � `•-�'�c S c� �.-vt.,ot � �'�t< If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 401 S. GWIn St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264- 3901. No response Is considered the same as no objectlon if you have been notified by Certffled Mai! (Property Owner information) Signature Print or Type Name `1S2,2 151-1" Mailing Address h) o Y-JAx U A- Z3s� g CitylState/Zip _7 5-'t — `7 t ^7 — 2`R 5-3 Telephone Numberl Email Address Date lot I 1 x (Adjacent Property Owner Information) Signature• !� Print or Type Name d� s�- Mailing Address City/Statelzip bg-S-3 1 - 3 Telephone Number / Email Address Date' `Valid for one calendar year after signature' Revised Jan 2017 r