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Home My WebLink About72520A_Sharon & Alan Rosen_20190214!CAMA / ---'DREDGE & FILL NO. 72520 —. c�JP 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 15A NCAC 2r Rules attached. Applicant Name 5ko r o r+ ` Address '4$06 Cros�Ic.,d 1Zc� City i?,u 1 moJ C StateFN J�_ ZIP a I.\ 05-< Phone # ( ) E-Mail Authorized Agent L. , n ❑ CW f �' ElEW ❑ PTA ES OTS _URA Affected AEC(s): ❑ OEA ElHHF ❑ IH '❑ ❑ N/A ❑ PWS: ORW: yes / Co PNA yes / 6) Project Location: County L7o , Street Address/ State Road/ Lot #(s) Subdivision ---- City S0"J+Kk V'-' ZIP A_ic, 9 Phone # O River Basin Adj. Wtr. Body 01f f.wJZ so.w�cl (!�/man /unkn) Closest Maj. Wtr. Body Svc V A Z ONE ONE CMENEIM111mommoomm ■®■■■■■!■■■■■Rr�!■■!TES■r`�N■■■■I/I■L'!�/I■■■■■! ■■��►•�■■■■ice■c�■N■ �a■■■��r�►�■■■■■■■■■■■■ ME MEMO! so/5m oom 0 NO■NIMEMENNEEN M. F■1ommommo , • i=iiiiMV_ V"ffl% .5i��iiiiiiiiii ■■■N■■■■l NONE 1111■r:'W0121" HIMENI ■N■■ ■■■�■■■■!I NOON■ �l■■■N■■■N■■■■■N■ l immimov; 011IMMEENEEIRSEEM � - OOOr■■■O■ON■NO■■NI`�.�■■■1EB■■Or■rO■■OWN■■O ONE - � ■■■■■■■■■■!NOON■\�■■i■��ti�t�oN■■■NN■■■■■! L,/Al. SAA Agent or Applidant Printed ame Signature a read compliance statem nt on back of permit A LN�xp. vL) 3L 13 (- y Application Fee(s) Check # Permit r s P ' ame , S ure A'/)L,) A0 ►� t,�, ti� a �� Issuing Date Expiration Date NC Division of Coastal 1+ 9t. Habitat impact Computer Sheet Applicant: r\ ) 5htrrnn % A t& i` Permit ', J- .LU/4 Date: X/IH'1 .1 Describe belc'V 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 ternimpacts) FINAL Feet (Anticipated final disturbance. Excludes any restoration and/or temp impact amount Sha rA1 Dredge ❑ Fill �y Both ❑ Other ❑ I L4 v j Ly O 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 ❑ I 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 ravised:02/03/10 Lyn Small, Inc. MARINE CONSTRUCTION AGENT AUTHORIZATION FORM Date 01102f2019- Name of Property Owner Applying for Permit: Alan Rosen Mailing Address: 7806 Crossland Rd, Baltimore, MD 21208 I certify that I have authorized (agent) Lyn Small, Inc A K.A. LSX Marine Construction to act on my behalf, for the purpose of applying for and obtaining all permits necessary to install or construct (activity)_tiered bulkhead and stairs at (my property located at) 311 N. Dogwood Trl, Southern Shores, NC 27949 This certification is valid thru (date) july 2019 . Property Owner Signature 5 CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Owner: Alan and Sharon Rosen Address of Property: 311 N Dogwood Trail, Kitty Hawk, NC 27949 (Lot or Street #, Street or Road, City & County) Agent's Name #: Lyn Small, Inc Agent's phone #: 252.491.8562 Mailing Address: 113 Ballast Rock Dr Powells Point, NC 27966 I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit has described to me as shown on the attached drawing the development the are pr posing. A description or drawing, with dimensions, must be provided with this letter. I have no objections to this proposal. I have objections to this proposal. 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. Contact information for DCM offices is available at http://www.nccoastalmanagement.netlweb/cm/staff-listing or by calling 1-888-4RCOAST. No response is considered the same as no objection if you have been notified by Certified Mail. WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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) Signature Alan and Sharon Rosen Print or Type Name 311 N Dogwood Trail Mailing Address Kitty Hawk, NC 27949 City/State/Zip Telephone Number/Email Address Date (Riparian Property w er Information) -'e, Signature Lysle Ailstock Print or Type Name 309 N Dogwood Trail Mailing Address Kitty Hawk, NC 27949 City/State/Zip Telephone Number/Email Address Date (Revised Aug. 2014) CERTIFIED MAIL - RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Owner: Alan and Sharon Rosen Address of Property: Agent's Name # Agent's phone #: 311 N Dogwood Trail, Kitty Hawk, NC 27949 (Lot or Street #, Street or Road, City & County) Lyn Small, Inc 252.491.8562 Mailing Address: 113 Ballast Rock Dr Powells Point, NC 27966 I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit has described to me as shown on the attached drawing the development they are proposing. A description or drawing, with dimensions, must be provided with this letter. XI have no objections to this proposal. I have objections to this proposal. 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. Contact information for DCM offices is available at http://www. nccoastaimana_qement.netlweb/cm/staff-listing or by calling 1-888-4RCOAST. No response is considered the same as no objection if you have been notified by Certified Mail. WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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) (Riparian Pro Owner Information) c7a4-4-�- Signature i ature Alan and Sharon Rosen Jane Marshall Print or Type Name Print or Type Name 311 N Dogwood Trail PO Box 86 Mailing Address Mailing Address Kitty Hawk, NC 27949 Kitty Hawk, NC 27949 City/State/Zip City/State/Zip Telephone Number/Email Address Telephone Number/Email Address Date Date (Revised Aug. 2014) ;� ` �e �� q �.%�� i 4