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Home My WebLink About68037D - AbernathyXCAMA / DREDGE & FILL n A B C ( GENERAL PERMIT Previous permit# XNew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environment and Natural Resources and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ❑Rules attached. Applicant Name >n � Project Location: County 0(vSItrLJ Address V 144.e Street Address/ State Road/ Lot #(s) City To State A3C ZIP Z�0 Phone # ( ) E-Mail Authorized Agent :57v 4 S%; Affected ❑ CW )(EW )(PTA jtS ❑ PTS AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: ORW: yet / no PNA l�s� no Type of Project/ Activity C.org4wLl Pier (dock) length S X 81 Fixed Platform(s) i b k IS Floating Platform(s) Finger pier(s) y 1i Groin length number Bulkhead/ Riprap length avg distance offshc max distance offish Basin, channel cubic yards Boat ramp Boathouse/ Boatlift Beach Bulldozing Other Z IS' syeti.j",, Shoreline Length SAV: not sure yes tn.' Moratorium: n/a yes Photos: ves no Subdivision City ZIP Phone # ( ) River Basin( ADI Adj. Wtr. Body S rn C� 4J nat m� an /unkn) Closest Maj. Wtr. Body Tw�J (Scale: I. = 2,d ) Waiver Attached: yes no 1 "A ''! 1 J t I ,l/A 0 W M! 1 1 1 I u 1- I t( 1 1 1 1 1 I I I I I A building permit may be required by: /V rn 11S� ( �� ❑ See note on back regarding River Basin rules. ( Note Local Planning jurisdiction) ;pJ Notes/ Special Conditions EV Lk f 2 G0 411 asoilabmmS aOPI�. J Agent Signature e read compliance statement on back of permit ** - 2oG7elsM n 36056gA6 Application Fee(s) Check # &D 4 S. . PevtOfficer's P nted Name Signature of/I�) 0�l�sl�� Issuing Date Expiration Date NC Division of Coastal Mgt. Habitat Impact Computer Sheet Applicant: kF Permit #: so Date: O Z 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 temp impacts) FINAL Feet (Anticipated final disturbance. Excludes any restoration and/or temp impact amount) // 4A b Dredge ❑ Fill ❑ Both ❑ Other O Z ( b l� W Dredge ❑ Fill ❑ Both ❑ Other j 1 Z fj Z Dredge ❑ Fill ❑ Both ❑ Other ❑ Is 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 Q Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ !C7_4ttft_'JAl1R •• 1_RRAII DI'•AACT ,. un.na� aarrn�cb-�1..�.�.................� ..off Date Date Check From Name of Permit Vendor Check Check Permit Receipt or Received Deposited (Name) Holder Number amount Number/ Refund/Reallocated Comments North American John Banking GP 2/15/2017 Cassidy Reed Abernathy PO 360504801 $200.00 68037D BS rct. 3449D AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Mailing Address: W4 1 S f CIA Vt c-",C Lyj P . iaescJ AC ZJ Lff c Phone Number: 25 Z- - Ll I Z t( I L Email Address:y—c- e A a h 19 4�1 ok 6p, G o wi I certify that I have authorized off''' Cfllivy //^'G� r". A nt / 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 Old V 1 1 1a4 .0- LVA Iy in OKSIOW County. / 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 `i4011" ce rk� e.,. vVxa t �y Print or Type Name 0 Grp Title tl / 2-7 / lb Date This certification is valid through i/ / 2 % / `", ;�-- C CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner: Re.c� t��'�'✓ h0.� �`'� Address of Property: is (0 1V� (�a �-� • _ I(� cu &2C, ran S �o(�COUn (Lot or Street #, reet or Road, City & Co nty) Agent's Name #: 5411 G/ lOY Mailing Address: /� % Agent's phone #: 3 76 - % -7a �1'Y�7 Li /CG/L/ % f�' C 49 51&-d 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. 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.netlwebicmistaff-listing orby calling 1-888-4RCOAST. No response is considered the same as no objection if you have been nofdred by CertMed 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.) J X— I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Ow r Inform n Signature A/ Print or Type Name A/ I o A/ CitylState&p Telephone Number/Email Address Il -Z7 I LDate - (Riparian Print or Type Name Information) Wauhty City/State2ip 111-2 Telephone Number/Email Address (Revised Aug_ 2014) CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT" ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner. Rec Address of Property: t S l C 1 J VJI O-g �— Li,,,. fy : ( ► Q &-c i oil s 14-Xc ,►," �y (Lot or Street #, reet or Road, City & Ca nty) f Agent's Name / --r Agent's phone #: Z?b ~ - -7d Mailing Address: 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 th oposing. A description or drawing, with dimensions, must be provided with this letter. ve4t 1)inve 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 v✓riting within 10 days of receipt of this notice. Contact information for DCM offices is available ai:u �,: ;r;c . �:�-;�: _ _ ::. ^ !per orby calling 1-888-4RCOAST. No response is considered the sarne 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 to wave the setback, you roust 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) �} T�irtiv�f�j� Signature 1 Print or Type Name / koe'o 1-) H-0,-,Ce C- i✓ e l `f eT 6: -,] U" (l,(-,,v Citylstate2ip r3v ( - -S-7`l ._ Telephone Number/Email Address Date (Riparian,F1?06rty Owner Information) Print or Type Name 4 Multhh f yh _AtAh cap ( • -, % t lam/ c Clty/State/Zip d,�-a-iZ�-/ Telephone Number/Email Address Du[e (Revised Auq. 2014)