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Home My WebLink About67273D - Broderick'L'`AMA / ❑DREDGE &FILL W/7 A B .ENERAL PERMIT l� `Previous permit # (New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued rized by the State of North Carolina, Department of Environment and Natural Resources .oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ❑ Rules attached. t Name Je X` - A. ' ,� Project Location: County i� �{a r)Oe.- .- �c„ «� --? �'t Street Address/ State Road/ Lot #(s) State ZIP 2801 •C �y y) q03�' / �� E-Mail Subdivision ;edAgent jAV. -!L� }�S City ` 11j6z4�1S', (�f �^ .�C�� ZIP IAJ ❑ CW XEW $(PTA ❑ ES ❑ PTS Phone # (�1! ) Z ��!' - 3 58 2(River Basin C ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A ❑ PWS: Adj. Wtr. Body yes no) PNA yes no Closest Maj. Wtr. Body -QVIL'-s C Lao-y ! �( � ' Project/ Activity � 1 Li I Im+C. -. (Scale: 1 ck) length_ atform(s) Platform(s) ngth tuber d/ Riprap length distance offshore x distance offshore cannel )ic yards_ ip se/ Boatlift NC Division of Coastal Mgt. Habitat impact Computer Sheet Applicant: Date: 0) Permit #: 2 73 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) Dredge ElFill [IBoth ElOther (t�.�/ Q 6 9 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 [I Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge [] Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Payment Proccessing Confirmation Date Received 12/14/2016 Check From (Name) Cape Charters LLC Name of Permit Holder Jeremy Broderick Vendor Bank of America Check Number 1105 Check amount $200.00 Multiple Permits No Major/Minor Permit Number/Comments GP 67273D Receipt or Refund/Reallocated BS/3426D AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: tit E / apt - I ( Mailing Address: s C `-' Phone Number: c ) - 9 fl 3 - p Email Address: - I~ of r I' C I certify that I have authorized Agent i Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: 13 /S 13a aT at my property located at _ i13 -f C ,1„ Log in IV f-(• County. 1 furthermore certify that I 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: J Signature Pant or Type Name Title CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner: 'G' re /,-,- `k 13r6 61 Address of Property: // 3 S C4- %^.e 1 0A, W. 13, b. g. (Lot or Street #, Street or Road, City & County) Agent's Name* uc� /'�� ci �'t-f Mailing Address: '71 9 Caro 1 � oe C, 0. Agent's phone #: 145 Z i 9 -3 s 8-L C. 6. 7-7 IYZ- � 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. Correspondence should be mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM representatives can also be contacted at (910) 796-7215. No response is considered the same as no objection if you have been 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.) I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) Signature Print or Type Name 7/ 91 Caps /,,�,. Ate. IV - Mailing Address r'_ — _/., .. L n r 7SyZk (Adjacent Property Owner Information) Signature Print or Type Name Mailing Address n7��✓�h ny?-Z)� F%j?I-OP ] Sr xhi Jd / a,,%4-O "`� r �-Il CERTIFIED MAIL - RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM Name of Property Owner: G' re ^-,, `L t3r6 J C r, G k Address of Property: 1C 3 5- C!,-a , . 1 13,e, W. 13, b. g. (Lot or Street #, Street or Road, City & County) Agent's Name #: QA 01 Agent's phone #: 9-1 e5 Zi 9 -35-8-L Mailing Address: '71 9 Corr o 1, Oe c C.13. 2FVZ-'F 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. Correspondence should be mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM representatives can also be contacted at (910) T96-7215. No response is considered the same as no objection if you have been 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.) I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) Signature l Print or Type Name (Adjacent Property Owner Information) Signature Print or Type Name 7/ 9, Co-/'- 1, Av. /V. Mailing Address Mailing Address 0'M I U.S. Postal ServiteT" CERTIFIED MAIL° RECEIPT Domestic Mail only 111 Certified Fee $ fl , (11_I (Endorsement Regiufred) $ tl , I I I I Postmark H ere Restricted Delivery Fee (Endorsement Requlr" $ f-1, Total Postage & Fees12/07/2016 Sent To �hCr� O x;-rtr-� PeeOi BaoAxP Ni. oN.o:- ----------------�-a--�-w---�----_ -l------.-J-n- ------ �/-S � ----------- ; 4- ZIP-0 r- . i3c •,A— rl , c , ■ 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: �.! e f' r y, A C 6.0 k- 3 Z- 11 06, r- / C I-- Or . IIIIIIIII IiIIIIIiIIIIIIII'll IIIIIIIIIIIIi IIIII 9590 9402 1715 6074 2883 06 2. Article Number (Transfer from service label) 7014 3490 0000 PAPU Postal CERTIFIEDRECEIPT r-i Domestic m rti ru $3. 11 I tl rO f1J Postage $ 12,70 111 E3 Certified Fee $ 11, (1I I AA 0 Return Receipt Fee (Endorsement Required) $I I , fl Il Postmark Hem O Restricted Delivery Fee O (Endorsement RequkW) Er Ll• r Total Postage & 1. 12/07/2016 m -. Sent To Co r- Street s Api No.; - or PO Box NoZls'r' 4�"r - city state. ZtPW A. Si nature X 1:7 Agent B. Received b y (Pn� Nam/ C. Addressee a e of De//livery D. Is delivery address different from item 1? 0 Yes If YES, enter delivery address below: ❑ No 3. Service Type ❑ Adult Signature ❑Priority Mail 6 press ❑ Adult Signature Restricted Delivery ❑ Registered MaiITM ❑ Registered Mail Restricted ertified Mail® ❑ ertified Mail Restricted Delivery Delivery ❑ Return Receipt for ❑ Collect on Delivery ❑ Collect on Delivery Restricted Delivery Merchandise ❑ Signature Confirmation- 0 Insured Mail ❑ Signature Confirmation •3 > 1 -1 lestricted Delivery Restricted Oelivary N' nGfaZ,0 b .Pa iano,7 ht xh I ,M 134n C4 �rj C 113 C—ka tee/ t)r-- I y X Ni cof,et ql I,zghv