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HomeMy WebLinkAbout63140_platform_20180906r ; X 1 11CAMA / El DREDGE & FILL. NO'':.�%243 8 . /S 4r GENERAL- ' PERMIT Previous permit X/V . 41 ,�y _- I'�INew ❑Mod'ification - ❑Complete Reissue, - '❑Partial Reissue Date previous pernidissued_ i, 'As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in' an area of environm htal co cern pursuant to 15A NCACfP. d�®( / \ �� / �r� � es attached. .Applicant Name in _ 1"GI/ 1 /1 / li l �/'� Project Location:: County , Address J 7 �Gi -11%' (% Street Address/ State Road/ Lot #(s) City 11'n ��/` State i ZIP 1 Ga Phone #AQ) �� E-Mail Authorized Agent 6� - ibyc�lS ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Affected AEC(s): ❑ 0' ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: ORW: yes / no PNA'- . yes Subdivision' "AY City (� ZIP Phone # ( ) �— River Basin- 7X Adj. Wtr. Body _ �/�C T G� �G na /m; Closest Maj. Win Body k4c" �i;k-1, ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■Ni�r�i�■■■�■•■■■i■■■■�i■��arli■■■■■■ ■■■■■■■■■■■■■■■■■■�■�■■■■■■■■I»1!�/L�■■■■■■ ■■■■■■■■����■i,� i��i■'ice■ ��■■■■�■■■■■C■■ _ ■■■■■■■■11�11i:Jn■■■ ■ ■■■■■■■■■■■►n■■■■ ■r■■■■■ ■■■■■■■■■■■■■■ MENNOZONAMMEMENE KMENEEMON■■■■■■. '■..■■ inted Name _ Signature Fjle; AppliS lion Fee(s) on back of permit ** Check# ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to F air-wiu (mliyek Mot- P~ 's (Name of Property Owner) property located at Z Z/7 r! L V C62, e-#49 E - (Address, Lot, Block, Road, etc.) on Si L. r/e!L it, A K6 , in N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above locati . I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT U, WOO%1� il'i�G TC7 �E ,f,-GJ1j`on Lip")( 7-0 0 PdaPtl+�) 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. (Pr e e nformation) Signature r-!z-4,uI,-Lr fJ A i Ne r2 P 'nt or Type Name V 0 GOY- r 11-3 Mailing Address City/Statemp -z. s z_-- L(c) 2 5 3 q-7 Telephone Number/ email address Date 8 J, j f 6_ Q5::;7= Signature* yo�� ,-���r�L1 S Pyr,am 4e �oZ� Mailing Address ,^ ` IDr_`y a Cc� C. o��l �ZO, City/StatetMp 01 Telephone Number/email address IC*NW'4- hor f- 09 P_''aPx'P' 1 Date* pro- 07 o � y 1 (Revised Aug. 2014) *Valid for one calendar year after- signature"` ADJACENT RIPARIAN PROPERTY OWNER STATEMENT hereby certify that I own property adjacent to RMi-WO 184100k / lit- PIAVE 's (Name of Property Owner) property located at ?_q 7 S '/ C. VCP, t.4K1E (Address, Lot, Block, Road, etc.) on �'i Cyt,� i- A Kj , in oc- (-Aco X 6 , 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 0 LJco I. ;f'e otl f'OA y' 'A 7-0` - �aE� CTMIw WAIVER S�R�vi;ECTION PRoP��2� I'oPZr+�► } I understand that a pier, clock, 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.) do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. V9'-e_ e information) Signature r-1ZAi t0_LJ P P. t 2A r,vi= P ' Type Name Tnt or Goy 1' z-3 Mailing Address _ 0 C i0_ A C o K,C r tic. `2- 7 i 6 C) City/StateMp j/02 _ S3q -7 Telephone Number/email address rl~+4 (2- 5-1�Azf1llnV-.Aek Daie *Valid for one calendar year after- signature* L a '�- 1<7 sO' CL ( -e--. N g Address n< S)� I r Yl e- 0 f ` Telephone Number/email address Date's / X12, � �0 f (Revised Aug. 2014) NC Division of Coastal Mgt. \\Habitat Impact Computer Sheet Applicant:�iilk�rl /�/k'S liilllJ °III Date: % General Permit #: •`7 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 tempimpacts FINAL Feet (Anticipated final disturbance. Excludes any restoration and/or temp impact amount Dredge El Fill El Both El Other d-�� 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 :: wwrw.nccoastaimanaaement.net revised:02/03/10