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Home My WebLink About66598D - Alderson.LAMA/ C-DREDGE & FILL K�� GENERAL PERMIT I Previous P ermit# A B New ❑Modification El Complete Reissue ❑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 ,, (( 1 % ❑ Rules a hed. Name ��((L� S` ` 6 N1 Project Location: County �`� 4 �✓�l S % VI- �I kr A fur a • Street Address/ State Road/ Lot #(s) 0 , VA State ZIP () (� �) I E-Mail —�� Subdivision �— :d Agent 1�� cp, Cov,6-\ 1,y City .Ex, A ZIP ,^,, ❑ CW ElEW ❑ PTA XES )I PTS Phone # (` (;) �' �� River Basin L UY A' ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A Adj. Wtr. Body Cck v\ Cl (nat ❑ PWS: (es / no PNA yes C "� Closest Maj. Wtr. Body W Project/ Activity k) length tform(s) I/ Riprap length Ij U distance offshore — distance offshore U ti annel ip ;e/ illdozin Length not sure yes um: n/a yes yes stached: yes `J (Scale: ( --) ig permit may be required by: (�rr� s uM� (.} �� ❑ See note on back regarding River Basin rt _ocal Planning jurisdiction) NC Division of Coastal Mgt. Habitat Impact Com Applicant: VL ,(� 1k bes li-t- /M c,,-�c ✓, Date: �S�as/i�0( 4 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 FII (Applied for. (Anticipated final (Applied for. (Ai DISTURB TYPE Disturbance total disturbance. Disturbance dis Habitat Name Choose One includes any Excludes any total includes Ex anticipated restoration any anticipated re,, restoration or and/or temp restoration or ter ternimpacts) impact amount) temp impacts) arr Dredge ❑ Fill `!P Both ❑ Other ❑ 000 ( u 0 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 ❑ NCDENR North Carolina Department of Environment and Division of Coastal Management McCrory Braxton C. Davis vemor Director Natural Resources John E. Skvarla, III Secretary AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FUKM Date: e of Property Owner Applying for Permit: er's Mailing Address: ie Number (ZW) 3?3 ''5// / N7mec-t ofAuthorized Agent for this project: Agent's Mailing Address: ( ,6 ( � &(—,ch (�)r- sw clzkQn `�s� �e�c►� !�t C z� Phone Number A V (o(l :ify that I have authorized the agent listed above to act on my behalf, for the purpose of applying rid obtaining all CAMA Permits necessary to install or construct the following (activity): ny property located at -1 i 1 _Tl� S NS�� T-2�OC4 IJ c certification is valid thru (date) Property Owner Signature Date ete items'! ", -I', and 3. A. a ore cur name and address on the reverse X Agent we can return the card to you. ❑ Addressee this card to the back of the mailpiece, ved by inted Na e) G.Date of Delivery he front if space permits. A 4 - I P, - ILA Wdressed to: D. Is d cil tem 1? ❑ Yes If S�ente res w: 1�j No Z`6c�� APR 19 1016 3. IC ❑ Pegis iIII'I I'II IIII� III III III IIIII III I II III I I III ❑ dolt n tyrre@�+ ered MOTTrMss® ❑ Adult Si Restricted Dolly Registered Mail Restricted 590 9403 0603 5183 4336 43 ertified tr ; �- Delivery ❑ Certified Mail ❑ Return Receipt for ❑ Collect on Delivery ❑ Collect on Delivery Restricted Delivery Merchandise ff Signature ConfirrnationTM Jumhwr ffransfer from service label) ❑ Signature Confirmation 7 015 0640 0006 3682 2291 Restricted Delivery Restricted Delivery 3811, April 2015 PSN 7530-02-000-9053 Domestic Return Receipt ; I.S. Postal Service TM ERTIFIED MAIL° RECEIPT omestic Mail only t Jervices & Fees (check bc. , ad, tetum Receipt (hardcopy) $ letum Receipt (electronic) $ %rtified Mail Restricted Delivery S dult Signature Required tlutt Signature Restrictetl Delivery tge O. `i 7 Postage and Fees 1c,L1 Postal r� CERTIFIED a RECEIPT DomesticMail Oniv m rU ru For CUI B ' d GP .0 _11 Certified Mail Fee $3.30 f► I $ Extra Services & Fees check ❑ Re[um Receipt (ha,dcopo a $ lee a$ `O�s ti 0 ❑ Return Receipt (electronic) $ An1L` M ❑ certified Mail ReaMcted DelWery $ { 1 ` 0 ❑ Adult Signature Required $ Here ❑ Adult Signature Restricted DelWery $ C3 -I- Postage $0.47 0 $ Total Postage and Fees $ $6.47 Ln sent U.Sp�01 1 5 ?Qo 11 1 rri1�...:'1� .- :Z;--?________________________ CERTIFIED MAIL • RETURN RECgI T REQUESTED - DtViSION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner:--- 1 �� S �cc?�c f�ntici� Address of Property: � �_i�� _ (Lot or Street #, Street efr Rodd, City & Cotmly�— � W `lC,�l� allin Address: uw `g _ �`'� Agent's Name #: T _ 9� d f r- Agent's phone ✓1—�t71 Q GC Z�llt}�{ I hereby certify that I own property adjacent to the above referenced property. The individual apptyirlg for this ermit has described to me as shown on the attacheddrawingthe development they are proposing. I have no objections to this proposal. _ I have objections to this proposlnl. if you have objections to what. is being proposed, you must -notify the Division of Coastal Management (I)CM) in writing within 10 days of recolpt of this notice. Corresgpnplenae..should be mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-9846. DCM represent4fives can also be contacted at (910) 796-7215. No response is considered the salve as no objection if you try beef) notified by Certified Mail. WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin 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.) do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property OwnUr nformati(i a) - (Adjacent P erty nor Information) +lllflllY[.' J iglIallll •e Print or Type Narno d Print of ype Name p ttiling Address Mailing Address City/State/Zlp City/stfate2lp .-Ab -Ma-_5 I-elephone Numltor Telephone Number CERTIFIEDMAIL. RETURN RE_:CElPT REQt1ESTED —EHWSION OF COASTAL. MANAGEMENT ADJACEN Name of Property Own( Address of Property: Agent's Name IGJ� Agent's phone #: _ ao I heroby certify that 1 own property adjacent to the above referenced property. The individual applying for this permit has described to me as shown on the attached-drawtnq.the development they are proposing. �_�es 1tt��r��r.�tii�►Ia�a�4i►I:#�-�#Yap` ' �lf�rifi�. �l�'br=�.�t)i� ryouave no objections to this proposal,I have objections to this proposal,e objections to what, is being proposed, you must --notify the Division of Coastal Management (4)CM) In writing within 10 days of receipt of this notice. Corresgpndence:should be mallod to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3846. DCM represent4ove$ can also be contacted at (910) 796-7215. No response Is considered the same as no objection If you h been notified by Certified Mall. - WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin 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 95' setback requirement. I do not wish to waive the 15' setback requiremont. Property Own r nformation) • ,na rrre Print or Type Name ailing Address Crt ylstatelZip 1 olephar►o Number �J d acont Pr party Owner Information) Print or Type Name Mailing Address �p City/state/zip _ 6- 7 r 2 ..._ e_?? 3_... _. Tole hone umber t