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Home My WebLink About67226D - BentCAMA / ❑ DREDGE & FILL A B 4ENERAL PERMIT JP116 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 NCACr�, 1 �W El Rules attached. it Name (y�.�i,L�y�1.��.. �,LTL Project Location: County r0;15LJ;,c_k 3(1, 3Gz36 �� 4 /S'C+�f T; � <�u, Street Address/ State Road/ Lot #(s) t eoC , :SAC I'3CU_� State ,JC ZIP 28461 • (U) 508- 14S3 E-Mail Subdivision :ed Agent 6:r' (P �`_n ,��+-tV G ",o r, City(y 40 r, ZIP 1- 4 ❑Cw 'kEw { PTA DES ❑PTS hone# (90) 57a-bqS River Basin Lt.-� ❑ OEA ❑ HHF ❑ N ❑ URA ❑ N/A A , I ❑ PWS: I W yes / nog PNA yes / no r Project/ Activity 1:,g(ja�;ar^ p ck) length atform(s) _ Platform(s) ngth tuber d/ Riprap length distance offshc uc distance offsl� cannel / )ic np iset ulldozing 5 xi6' izowip e Length not sure yes ium: n/a yes no yes no kttached: yes ' no Adj. Wtr. Body (,.) (natVi Closest Maj. Wtr. Body k _�2' rl,:,+ (Scale: 3� rig permit may be required by: O c cA SSlc LXa( '' 1 ❑ See note on back regarding River Basin n Local Planning jurisdiction) NC Division of Coastal Mgt. Habitat Impact Computer Sheet Applicant: /(f - 1-�, hA Permit #; Date: Aq/� � 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 ternimpacts) 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) W 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 El Both 0 Other [IDredge ❑ Fill 171 Both ❑ Other 171 [27 Cardinal Drive Ext., Wilmington, NC 28405 ?hone: 910-796-7215 \ FAX: 910-395-3964 Internet: www.nccoastalmanagement.net ,A� an Equal Opportunity \ Affirmative Action Employer NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Pat McCrory Governor Braxton C. Dai John E. Skvarla, III Director Secretary AGENT_ AUTHORIZATION FORM AGENT AUTHORIZATION FORM NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Pat McCrory Governor Date: ILa i Braxton C. Dai John E. Skvarla, III Director Secretary lame of Property Owner Applying for Perrjnit- NaRe of Auth7ized Agent for this project: 3 S >w er's MailingAddressTe t d. �&y 'hone Number 10 1 ,Agent's M 'ling Adds: 7, s l (J , ,- 5 _ (:t.h IV Phone Numberq09S— certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying tr d obtaini all QV rmits necessary o install or construct the following (activity): �v1n0 -4' j��aCL r—L Oi M N C Dxj< or my property located at /U'C 0219q CERTIFIED MAIL -.RFT RN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of property Owner: �. ` )�� L —---- - Address of property: CA-Ttlo (Lot or Street #, Street or Road, City & County) ` Agent's Name #: �` \ W't\S� (l I l Ad `% ._C�-�_�y� � � �' � Mailing Address: Agent's phone #:\ I hereby 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 drawing the development they are proposing. I helve 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 (OCM) In writing within 10 days of receipt of this notice. Corresggnplence.should be mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3846. DCM representst/Ves can also be contacted at (910) 796-7216. No response is considered the same as no objectlorl If you Wo 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.) 1 do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) Si�;aalru•1� Pint or Type Name (affl.nglddress ._ �q,( Z��tb� City/state/Zip L.nhnnn Alunhnr ---- ( eat Property �ner nformation) S9�,narru•c n, Print or Type Name -- --- - offing Address lu it Stategip d - �� 5 --oo t _ - TeleDhone Number _ __ CERTIFIED MAIL • RETURN EC— P� T R9QU-STEQ --DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONfWAIVER FORM Name of Property Owner: Address of Property: �—i�__ `h► ��4C_.___ ��___ (1-cot or gtrwet A Street m Road, (, & CounTy)-- Agent's Name #: ��"lLQ �?��`�l� Mailing Address:._. Agent's phone N: v= `v�_ 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 drawin the development they are proposing. 1111vc 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 (I)CM) in writing within 1 o days of receipt of this notice. Correspondence. should be mailed to 127 Cardinal Drive Ext., Wilmington, NC, 2840.5-3845. DCM represeptgtl 0 can also be contacted at (910) 796-7215. No response is considered the same as no objection !f you h"l 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 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) Signature Print or Type Name �( ailing Address City/statelzip (Adjacent Property Owner Information) Si gn��rrrre ll �-- __ 1 Print or Type Name Mailing Address City/State/zip Tninnhnna Nhrmhor • torrlplete Hems I, z, ana 3. ■ Print your name and address on the reverse X so that we can return the card to you. ■ Attach this card to the back of the mailpiece, B. or on the front if space permits. L7K.� ��. L!,✓�-IL..CaC ❑ Agent ❑ Addressee �ceived by (Printed Name) C. Date of Delivery tin, visit • C 8 1. A Icle Addressed to: \ �(� D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No 1�1�� 1 CI c� �sxeL11 t V� XK add fee 9,Wp,t $ $f • fJIJ 411�_ I If iI Ifi Postmark 3ry $ Here rvery $ — } µ+__ II �IIIII I'll I'I I I I I I I III II I II II I III I II I III 3. ❑ Adult Signature gn turre ❑ Adult Signature Restricted Delivery ElRegistered lMaiPessO Mail- 7 08/1$12FIl 6 9590 9403 0603 5183 4329 36 ❑ Certified Mail® AFGerti Mail Restricted Delivery ❑ Collect on Delivery ❑ Registered Mail Restricted Delivery rn Receipt for Merchandise 7 ____________________________ 2. Article Number (Transfer from service label) 7 0 L 5 0 6 4 0 0 0 0 6 3 6 8 2 ❑ Collect on Delivery Restricted Delivery 1, 8 4 3 =stricted Delivery Signature Confirmation"' ❑ Signature Confirmation Restricted Delivery _ ----------------------- ox q kr t ,- , n the reverse to you. the mailpiece, \—IJy ------------- 7_ 64 PS Form 3811, April 2015 PSN 7530-02-000-9053 A. Signatur / _/� X yY/1Y 1V ❑Agent ❑ Ad_dressee B. R eiv y (Printed Name) C. Date of Delivery D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No II 111 I II II I I I J. Service Type ❑ Priority Mail Express® ❑ Adult Signature ❑ Registered Mail- ❑ Adult Signature Restricted Delivery ❑ Registered Mail Restricted 432929 ertified Mail® Delivery Certified Mail Restricted Delivery Yd6eturn Receipt for ❑ Collect on Delivery (Merchandise e label) ❑ Collect on Delivery Restricted Delivery ❑ Signature Confirmation— "-" ❑ Signature Confirmation 006 3682 1850 ricted Delivery Restricted Delivery Domestic Return Receipt Postal CERTIFIED o . • m Domestic LID r-9 AN ISLE BEACH+ NC 28469 fU cO Certified Mail Fee s3.30 1 0470 -D $ , 7- fTl Extra Services & Fees (check box, add tee ayygor te) ❑ Return Receipt (hardcopy) $ � ll�� ❑ Return Receipt (electronic) Postmark �❑CertiIied Mail Restricted Delivery $ . «_ _,'. �fll l Here E:3 ❑ Adult Signature Required $ 3�- ❑ Adutt Signature Restricted Delivery $ Postage C3 $ 08/18/2016 Total Postage and Fg . 47 Sent To _ r3 Yl �iaai2�" x Big" ii-ln ho)'A-z J m A7 u hncn �Y��'M