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Home My WebLink About69056D Bush-Ames❑,LAMA / ❑ DREDGE & FILL 9 GENERAL PERMIT �'� H •�'�� Previous permit # A B C New Modification ❑Complete Reissue ❑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 I SA NCAC �� f i • �� R I hed Applicant Name Address City State ZIP1(60 Phone # V" KOPE-Mail �r Authorized Agent { Ol vi Affected ❑ Cw PolEW �.1TA El ES ElPTs AEC(s): ❑ OEA ElHHF /❑ IH ❑ UBA ❑ N/A ❑ PWs: ORW: yes / na , PNA yes / ❑ u es attac 9`A Project Location: County `sVV ►Z�— Street Address/ State Road/ Lot #(s) Subdivision City 11--b� A!/` f t( � ZIPy S i o� ne # (TO) L4 4 1f River Basin Adj. Wtr. Body 0 ,1 nat a unkn Closest Maj. Wtr. Body Type of Project/ Activity I i ■■■■■■■�■■■®■■■�■■� ■■■■■ ME 1111111111111111N IRA�IC��■■�■■■��■■■ NOON■ ■■■Li■li�■V' ■■■��llA!7■■■■■■V Yi�ril►'�■r�!il■■■■■■■■■■■■■ ' ' W■■■■■■■■■■■■■■ O® ■■ ■■■■ MMENQNEMMMMMEM■■■EMM■■■■■■■■ ■■■■■■■■■ ■■■■■■■■■■■■■�llS�l@O'Li�■■ ■��■�� ---_:��_�_ mac:. �,.. MINE � � ii'�Ei i■■M1110■i■�i iiy■i' ii■■ ■®NOON ■■■��r ��ll ■ � i ■■■ � �■�■■■■■■■■■■■■■■■■ �■■■■ �■ ■■■ a ��■ ��■■� u■®■■■■■■■■■■■■■■ ■■■■i■ ■■■■■mil ■EU ■ ■■�l�i71:j F� ■b1■■i■■�■I■■�■■N■■ ■G■R�Nil■ I ■�! ■■■ ■■■ ■■■ Ema F.J. t'_ ►:� ��.■� : C Y 1 ' NONE mom ■► ■■■■■�I!! ■■■ ► ■u W■EKA■ ■RNWIW■laMlt !S�l�lIR1l1l1!t!IL�11'J.' ■■ im �►■A■L NEW .ra_1I_■_!AN■_rA_�_�_cilm_�_►�M.�_�_�_�_�>fl ■ i■®� ■■■� ll l■■■■■■■■■■■■■ NOON■ ■ ■■■ MEN LEEAE11MENIMMIMEMOVIEN■NONE MEMO irEl■i■■■■®ii■�Ei■�Eii�Niii■EEEEE ,� i&! 1 • 1 i P d (-_.I0 I r'-> 5 Agent bfr Applicant Printed Nam. Signature ** Please readcompliance statement on back of permit Application Fee(s) Check # �r(A Permit Officer's Print" ame 4 Signature 6�14q 4mil a7 AAg A17 Issuing Datd E)Ipiratio�ate Date Date Check From Name of Vendor Check Check Permit Receipt # Received Deposited (Name) Permit Holder Number amount Number/ Comments Backwater Marine Suzanne Bush- 3/27/2017 Construction Inc. Ames/Lee Ames BB&T 2771 $200.00 GP 69056D SF rct. 3800D NC Division of Coastal Mgt. Habitat Impact Computer Sheet Applicant: Date: Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement found in your Habitat code sheet. TOTAL Sq. Ft. FINAL Sq. Ft. TOTAL Feet FINAL Feet (Applied for. (Anticipated final (Applied for. (Anticipated final DISTURB TYPE Disturbance total disturbance. Disturbance disturbance. Habitat Name Choose One includes any Excludes any total includes Excludes any anticipated restoration any anticipated restoration and/or restoration or and/or temp restoration or temp impact temp impacts) impact amount temp impacts) amount 6 V V Dredge [I Fill El Both ElOther v 'I 3 Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ ■ Complete items 1, 2, and 3. ■ Print your name and address on the reverse 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: B. ❑ Agent ❑ Addressee C. Date of Delivery t!�44V,T, K l 1 - D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No 3. Service Type ❑ Pft* Mail Express® II I II�I�I III II 0 Adult Signature 13 Registered Mail - I II I III I (IIII I IIII II I IIII I I Adult hft Signature ® Restricted Delivery ❑ D819 Mail Restricted ai wary 9590 9402 2021 6123 2957 00 ❑ Certified Mail Restricted Delivery ❑ Return Receipt for ❑ Collect on Delivery Merchandise - ----- .... _. _. it ^^s ^^,;^e r��n ❑ Collect on Delivery Restricted Delivery ❑ Signature Conflnnation— 71116 0 910 0002 1223 0927 Insured Mail insured Mail Restricted Delivery ❑ Signature Confirmation Restricted Delivery over $500► P6 Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt ; complete items 1, 2, and 3. Print your name and address on the reverse 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. 1. Article Addressed to: Ate'41�vezi c � IIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIII 9590 9402 2021 6123 2957 48 A. Si ure X �L Agent Addressee B. eived by (Printed Name) Date D Ivery I o 7 "ow:&INo D. Is delivery address different fIf YES, enter delivery addres 3. Service Type per, Expo® El Adult Signature O R Mail Adult Signature Restricted Delivery pew Mail Restricted ❑ Certified Mails ryery ❑ Certified Mail Restricted Delivery ❑ Return Receipt for ❑ Collect on Delivery Merchandise 2. 1 ❑ Collect on Delivery Restricted Delivery ❑ Signature Confirmatiop^' 7 016 0 910 0002 1223 1474 ❑ Signature ConfirmatiCn Restricted Delivery Restricted Delivery PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Rftrn Rdmpt i rw 7 �` l � ,Q5 ��I o rr � "�aN ` I �- u Am*esAuthorization.jpeg Page 1 of 1 R North Carolina Department of Environment and Natural Resources Division of Coastal fvlanagemeal Beverly Eaves Perdue ,farms H. Gregson Ne freeman Governor hector Secfelary SCENT AUTHORIZATION FORM Date I'> I Name of Property Owner Applying for Permit. Name of Authorized Agent for this project. Owner's Mailing Address J� �Pine PI. ss._ OvC. _ ).938`7 Ph" Number Agent's Mailing Address 3 -2 xS Phone Number (` / '� Y,'1 3 -' 4 Fr 1 certify that f have authorized the agent listed above to act on my behalf, for the purpose of applying for and obtaining all LAMA Permits necessary to install or construct the following (activity). Y'�r� 1 �,► r� �is-h� � � r�fr,k �- rzt rn A (my property located) at This certification is valid thru (date)%� A, Property owner Signature Date 127 Cardnwi Drive c<;_ VYAnmX101, W- 2MO5 Phorte9101%7215 , FA if 810-3ss3%4 lf"rKt wxw Mxua5t*m; ,►4n; oe eii bf-,.cLI ,�L Q_ r4ovi Carolina J�A MIlly https://mail.google.coml /scs/mail-static//jslk=gmail.main.en.Az9C4K3BfFw.O/m=m i,... 12/16/2016 (Property Own 50�'ati ) Signature 2ee- z /-:e Print or Type Name Agent's Name .1 Agent's phone tt CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Owner 7 Address of Property / /to ��,•=S (Lot or S!reel X Street or moaa. Lary a County) Mailing Address &/4 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 provideq with this letter �L t� - I have no objections to this prop-o,ai. havc objcctions to this proposal. t if you have objections to whit is boh►9 proposed. you musf nodly the Ohm0on a CoQsstal Managemom (DCU) in writing within 10 days of receipt of this notice. Correspondence should be rne►7ed to 127 Cardnal Drive Ext, tN9n►ington, NC. 28405-3845. DO W representatives can also be contacted at (910) 796-7215. No response is considered the same as no objection d you have boon notified by Car~ Alail. WAIVER SECTION I understand that a pier, dock, moonng pilings, breakwater, boathouse, lift, or groin must be se back a minimum distance of 15' from my area of ripanan access unless waived by me. (If you wish to wave the setback. you must initial the appropriate blank below) _ I do wish to waive the 15' setback requirement 1 d no t wish towae n, th i S' tba k r irement am YOJ` 0 a se c equ (Adjacent Property Owner Information) (j Xwi" \lur �, s, Mating Address �v L 7 �7 t Telephone Number P L !� TR r. ,.. �' af'� Vcv rim,