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Home My WebLink About73691A_Slater, Michael & Lynda_20190730'k,CAMA / REDGE & FILL GENE L PERMIT New ❑ Modification ❑Complete Reissue ❑ Partial Reissue No. 73691 ✓ B C D Previous permit # 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 N . I I Oy i N • 1 uy TRules attached. Applicant Name M, L ar e SIG V- Project Location: County Address .S►5 a. Ott ol,� R cl City V1,4tt„a I"t h State Phone # Oyu- a(09S E-Mail — V r- ZIP :J'3)4J'\ Street Address/ State Road/ Lot #(s) a I 0 Sn,p t- R oc J Subdivision e-rouc &f_A k Authorized Agent !_64f, t' �,,11«..�c�-S City Cvrvl� ZIP na-4C1a.`� ❑ CW C (EW NJPTA ES ElPTS Phone # ( ) River BasinAffecte AEC(s)d ElOEA ElHHF ❑ IH to ❑ N/A y c I �nat�f r• t} kra ►3o �a�_nnkn� 1-1 PWS: Adj. Wtr. Bod ORW: yes /,,Ko_) PNA yes ,o Closest Maj. Wtr. Body C� r •,.. jC S �,� Type of Project/ Activity lod g„\t kAtrA curl Shoi(cl&r\A _ 16Xlo e r (Scale: 3,9 ) Fixed Float Finge Groir rulkh Basin Boat Boatl Bead Othe Shore SAV: Mora Photi Waiv cO length f 1- r 'Ai-* Platform(s) k ng Platform(s) ■i■■■■■i■■i■■w'YY��■■■�■■■�■^■■■■■■■■■ r pier(s) length ■■■■■■■■■■�■■l�J�■■■■■■■■��■■■■■■■■ number offshorei avg distance max distance • O ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■L�■■■■ cubic yards ramp ■■■■■■■■■■■■■■■■■!i■■�■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ��_ ■■■■�■■N■■■■■■■■■■ ■■.•-•�-.��■.•llllllll�J�,11111111111�� II��'■■■■■■■■■■■ Bulldozing i ■■■■■�5�(®i■■■■■■■■■C�Q=�1ii■■■■■■■■ MEMINUMIMEME■■■■�1■�.:■■VI'Z■■■■■ Jine Length Ion not sure N ME yes torium: ■■■■■■■■■■■■■�RTr'hA�7�■■■■ ■■■■■■■■■. -s: no M NEI 11MEHIMIMEMMEREM ismird"Mm"WE A building permit may be required by: C",t A V k ❑ See note on back regarding River Basin rules. ( Note Local Planning jurisdiction) Notes/ Special Conditions (1Q R.'\V V a 4a h1 r "! t vc, k d ann I'r.cJL , rI read on back of permit ** �n no,uQ VPt,lc rc eu.- 6Py1,-4.ib4L-A; 30I0,k doOs Application Fee(s) 33(.A x k Check# n �2 � Permit N na Issuing Date Expiration Date NC Division,of Coastal Mgt. Habitat Impact Computer Sheet Applicant: 5 )At A ! jy i y V, Date: Permit #: T36q ( A Describe belo',�t 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) S' 6. Dredge ❑ Fill Both ❑ Other ❑ Shy �e t •^'� Dredge ❑ Fill Both ❑ Other ❑ (� c O 0 Dredge ❑ Fill ❑ Both ❑ Other ° W Dredge ❑ Fill ❑ Both ❑ Other ❑ (p 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.nccoastaimanacieement.net revised: 02/03/10 ■ Complete items 1, 2, and 3. ■ Print ybur name and address on thexeverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. Article Addressed to: Jli ChrS��eiz� u,� Z33LZ (IIIIII III IIIIIIIIIIII II I IIIIIIIIIIIIII 9590 9402 4603 8278 9226 18 2. Article Number (Transfer from service label) 1 7015 3430 0000 2881 735'- PS Form 3811, July 2015 PSN 7530-02-000-9053 3. X❑ Agent 'J ❑ Addressee B. efv d b fin Name C. D to of liv D. Is del!4 , addfess different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No 010eszK1, �r l: eriority Mail Express® Ire ❑ Registered MaiIT" ire Restricted Delivery ..�I® ❑ Reeggistered Mail Restricted i Deivery + ,.flail Restricted Delivery ❑ Return Receipt for n Delivery Merchandise .a Delivery Restricted Delivery ❑ Signature ConfinnationTm t Mal ❑ Signature Confirmation f Nail Restricted Delivery Restricted Delivery Domestic Return Receipt AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Mailing Address: -�-51 c-;Z Phone Number: is i �-/72 — (4,9'S" f Email Address: rt{r� f Ic- -C F -le-. d ��dc��/ < <'orr I certify that I have authorized t3e4 d, Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all+LCf-AMA permits ` x i (a 11 � necessary for the following proposed development: I� c'�� (� Wei ( 5le-C rI I.YJ at my property located at a tea �I�`Z 5 in CY iCounty. I furthermore certify that I am authorizeOM giant, an o 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 l l,,g / LO< Date This certification is valid through 5 / ZJ /'90 0 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to M J {'64, 1 S I aT� is (Name of Property Owner) property located at 6�- 90 1 C9. i GZZ -�, (Lot, Bloch on CJ: C �� C� jo`;rtc� , in (Waterbody) r,�f Toj , Road, etc.) � G c C 0 C, , N.C. (Town and/or County) Applicant's phone #: 2�;2-Z2-622k Mailing Address: /d 6 -�)i" �o�F He has described to me, as shown below, the development he is proposing at that location, and, I have no objections to his proposal. ------------------------------------------------------------------------------------------------------------------ DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: (To be filled in by property owner proposing development) 1 `* S t� ^ 5Jrc- L -- (Information for Property Owner Applying (Riparian Property Owner Information) for Permit) S (SZ Ou�er RS, Mailing Address Signature v•.Y'iY��c. �j�eG,c�t l��r'��►G, -23 � �32,A��Y �. r��f �-�o�J City/to/Zip Print or Type Name -)5-?- y,-?g - zk-.-e7r �5� 3�f3 '{-7yo Telephone Number Telephone Number S Signature Date Date Tom. C/},,sA L_ S AMZ0 ?? t ►A-t-C-- L. Y /a o f-r. W=De� | L