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Home My WebLink About63120_Pilings,wetslip_20180831CAMA / ❑DREDGE &-FILL �,. 0.4 -W3i�`� AC D GENERAL�•�_'PERM.IT - ' " Precious per mit `f ,New ❑Modification - ❑Complete Reissue ❑Partial'Reissue Date'previous permit issued w -, .`h,. As authorized by the State of North Carolina,.Department of Environmental Quality and the Coastal Resources Commissionin an area of environmental concern pursuant to 15A NCAC ules attached. 4.. Applicant'Name %�� - %�� / J� Project Location: County' Address !(r� Street Address/ State \Road/ Lot #(s) a, City F�� -��h � State/lk ZIP', CZ '/•��/ ot�%f r/�_ Phoned E-Mail, Subdivision • G> C//%G- �r7 Authorized. Agent /4W (. �c?�/ City. ��a/1 ZIP-�a'� - Affected ❑ cw , ' ❑ EW ,PTA ❑ ES. ElPTS Phone' # ( ) River Basin. l ❑ OEA ❑ HHF' ❑9H ❑ UBA ❑ N/A ��jj AEC(s): Adj. Wtr. Body �� P ��i 7, % e' %, at /man /unkn) ❑ PWS: ORW: yes /&o_,' PNA .yes no Closest Maj. Wtr. Body f MWA2MMEMMffi NMFAwJP. ON :■:■o■■:M■::■■■■■■N ■Y■e■■e■eke.euee�ere=e■■■■■■■■■■■■■■■■■■ ■.■e■ J■LrD ■]■y'�i■lZ�S ■■\�� ■■■iI�(I�J■■■■■■■■ ■r�eee�e�e�■�.ems■e!�e■i■■e�.��eree■■■■�■■e M. ■HEeMIUM■M■■?Y MEN ■■�i1■t :Iris■e■■■:4/J■■■■■■■■ ■w�►�ee■■■■■�ee■�■■■■■■■■e■■■■■seer■■■■■■■ iiil r a��l' M R MEMAMAI_■wE85.no-NEW OSEMMI■E . ��w�■rr�.a■■■■�■■■■■■ree■er�er�r�i�eer��ee _ � r read complianie statement on back of permit" Issuing Date Expiration Date - `- AlSplication Fee(s):( Check# ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to �o i a� d '-�4i 's (Name of Property Owner) property located at 5 �g� vil Dr. (Address, Lot, Block, Road, etc.) on , in 3e� h--y e.ti , N.C. (Waterbody) (City/Town and/or County) The applicant has 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 description below or attach a site drawing) � WAIVER SECTION I understand that a pier, dock, mooring pilings, 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) . Sign ture Le 4 L - R-. .'n. IM Print or TF"Name Mailing Address S,ekk.D' "< 1V J-781 City/State/Zip R19 - 492 -SS07 Telephone Number Date v� Telephonp Ni=be /C r Information) (Revised 611812012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to 4 G y . (Name of-Qrope! l Owner) property located at > 5(0 -F'CJ V^ -or- 'r tiP++-*-- - I - (Address, Lot Block, Road, etc.) on , in tS-e�h ��e� , N.C. (Waterbody) (City/Town and/or County) The applicant has 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 rill in description below or attach a site drawing) WAIVER SECTION I understand that a pier, dock, mooring pilings, 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) : (Adjacent Property 0 ner Information) Sig ature 9zoyL• z0.b��. Print or Type Name 3 ��o (��a�N•�%r. Mailing Address 3elhg'vC', NL a7S')0 City/State/Zip 0iij- i,`t1- 5so7 Telephone Number Date h t Prinror type Na e FZ.,,, Mailing AddresG d City/State/Zip Telephone Number Date G- (Revised 611812012) AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: l�,�y a.. Mailing Address: '� S (1. i�g l ►n �P- Phone Number: Email Address: I certify that I have authorized el k 7k10 °11q - (,`I 2 -SS'o- ru 0.h� l►14r. I h _ ` 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 35 (o �a� 17 r. � e� ��q c^ N in 3t4..�oPfi County. I furthermore certify that 1 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: Signa ure M T; /► 10.�' y n � Print or Type Name Title Date This certification is valid through I I NC Division of Coastal Mgt. Habitat Impact Computer Sheet Applicant: /� 4- Date: 3% General Permit #: -'21� 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 impacte 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 :: 1-888-4RC®AST :: www.nccoa3talmanagement.net revised:02/03/10