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Home My WebLink About67257D - AllenICAMA / ❑ DREDGE & FILL �C� A B 'EN ERAL PERMIT t'� Previous permit # klew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued ized by the State of North Carolina, Department of Environment and Natural Resources ;oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC-f� �1 "i/,rr�I��- ❑ Rules attqcheEd. Project Location: County Name Street Address/ State Road/ Lot #(s) IVM A State ZIP E-Mail Subdivision C - Ok -Vr ad Agent ��, ` 0 Ytih n� City�1v NtY, �i ZIP "l ❑ CWEW XPTA ❑ ES ❑ PTS {[ 1 rho e # (� �Q ) l�r River Basin ❑ OEA I ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body S(� (0, (na El yes / r') PNA yes rn) ,� / Closest Maj. Wtr. Body Al�r jjl v Project/ Activity e Length not sure yes o ium: n/a yes yy C1*C ON yes kttached: yes f — ng permit maybe required by:(�IV�Svtij Local Planning jurisdiction) t ' ❑ See note on back regarding River Basin n NC Division of Coastal Mgt. Habitat tmPact Ce+mputer Sheet Applicant:'Permit #: Date: r04�Zac (� 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 andlor temp . impact amount) TOTAL Feet . FINAL Feet (Applied for.. (Anticipated final Disturbance disturbance. total includes Excludes any any anticipated restoration and/or restoration or temp impact I temp impacts.) amount) / Dredge ❑ Fill ❑ Both ❑ Other O g g g 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 ❑ Dredge ❑ Fill ❑ Both .171 Other ❑ AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Mailing Address: Phone Number: Email Address: I certify that I have authorized 0 2- 9 ? 7 g- �s3-3&vy Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: ®J��1lrC' lion pl e r /Ia/'J� at my property located at �� 5�0 (.^% SPCt / /fie (�a in County. l furthermore certify that 1 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 Print or Type Name Title /0/0/1 ■ 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: Z9277 ✓ SGLOGiGhT(?RII 5�1b y, �G 28 ► s"-o A. Signat 1-1 A ent X �/ ddressee B. Received by (Printed Name) C. Dat of Delivery D. Is delivery address different from item`1? ❑ Yes If YES, enter delivery address below: ❑ No II I IIIIII III'I I I III III II' I I I I II I I III I I 3. Service Type O Priority Mail Expresso ❑ Adult Signature ❑Registered MaiIT^' ❑ Adult Signature Restricted Delivery ❑ Registered Mail Restricted ❑ Certified Mail& Delivery 9590 9402 1364 5285 8266 73 ❑ Certified Mail Restricted Delivery ❑ Return Receipt for ❑ Collect on Delivery Merchandise n _ __. __ ^ .. ,ery Restricted Delivery Signature Confirmation' 2. Article Number (Transfer frnm —Iilo'^�^" ❑ Signature Confirmation 7 015 0920 0000 7606 9877 stricted Delivery Restricted Delivery over oo) PS 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. Article Addressed to: 36 S9 us you s . A. Signature ❑ Agent X , i ❑ Addressee B. Received by (Prinleed Name) C. Date of Delivery D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No IIIillIRIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIII ar,an gang 1364 5285 7724 06 3. Service Type ❑ Priority Mail Expresso ❑ Adult Signature El Registered MaiITM ❑ Adult Signature Restricted Delivery ❑ Registered Mail Restricted 0 Certified Mail& El Certified Mail Restricted Delivery Delivery ❑ Return Receipt for ■ 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: 2,92 Tr�II 5 /6 y� N/ 281 S "e) A. Signat X� A4't/-- B. Received by (Printed Name) C. D. Is delivery address different from item If YES, enter delivery address below: I�IlI'I�II�III'II��I) �I'll'III�II !) II��II�II 3. Service Type ❑RrioM ❑ Adult Signature ❑Regis ❑ Adult Signature Restricted Delivery 0 Regis 9590 9402 1364 5285 8266 73 Certfied Mai1C� Det ❑ Certified Mail Restricted Delivery ❑ Returur ❑ Collect on Delivery Merd 2. Article Number (Tiarrcfer Irnm ��.;ro ^1^^ - ,er Restricted Delivery 0 Sign ❑ Signa 7 015 0920 0000 7606 9 8 7 7 stricted Delivery Restr _ over PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic ■ Complete items 1, 2, and 3. ■ Print your name and address on the reverse A. so that we can return the card to you. X ■ Attach this card to the back of the mailpiece. or on the front if space permits. B. i. Article Addressed to: 36 89 us Z7�y6 by (Priitted Name) C l: D. Is delivery address diffe-erit from item 1, If YES, enter delivery address below: 3. Service Type ❑ Adutt Signature 0 Priority 9590 9402 1364 5285 7724 06 0 Adult Sgnalure Restr cted Delivery o ne C Ceri5ed Maim ❑ Certifiec . Mail Restricted Delivery 2. Article Number 0 Collect cn Delivery ee�na (TranS/er trbn7 SelVice lab, I) ❑ CdIeC on Delivery Restricted De:rvery ❑ Signatui _ 7015 0920 0000 7606 9860 aii cSgnatu ail Restricted Delivery Restrict PS Form 3$11, July 2015 PSN 753072-000_90 Domestic R ,�, , �aw i (v!�v��iT nth-.,��1� Skr�1°i,o aid ',1' T � 1 ,/alj��o0(�I rraU�asado/� - � `C917 9 It-) vn19-Y "`Gc ,a6? p/ h/u0 VQ/71is¢d 19WV5; aC/OY S' &?,,d r.-1/ pnowaf aq )�»M1WM 9hez 1A d� /v V35M 0_S'OZ mall f/ kf1 �t -4Q lgwj Jj r,mz 7 "v / 4/cl d-v7, IVwv,g /tip S 1-Vu-122 ! JO -0 5 ' M Noil a .buy sixes b