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Home My WebLink About67204D - Burton.LAMA / ❑ DREDGE & FILL iL F12' 12/)� _ : q g I I,ENERAL PERMIT Previous permit# Oew ❑Modification ❑❑ Complete Reissue Partial Reissue Date previous permit issued ized by the State of North Carolina, Department of Environment and Natural Resources coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC V I ❑ Rules attached. Name VA-0 0 2- Kw StateULZIP_oIStIL 8 )ISO- (4 QV3 E-Mail ed Agent �\V �. ❑ CW !TA ❑ ES ❑ PTS ❑ OEA !?❑ HHF `❑ IH ❑ USA ❑ N/A ❑ PWS: f Project/ Activity atform(s) ► l Attached: Project Location: County- Z�'&v(' Street Address/ State Road/ Lqt #(s) Subdivision - ( ` - City 4I )C.�% �� -l�J� f 4 zip-1514 Phone # () River Basin Adj. Wtr. Body G vi �nat Closest Maj. Wtr. Body ling permit may be required by:�� Local Planning lurisdiction) ., , .., {1 IN r ❑ See note on back regarding River Basin SCAMA /❑ DREDGE & FILL M 67204 A B C GENERAL PERMIT Previous permit # xlew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued :horzed by the State of North Carolina, Department of Environment and Natural Resources l ie Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC � t; r ❑ PUN ammElmd- :ant Name sty C- f� Project Location: County �, «,� —7^s 4s Ms % l t t— Street Address/ State Road/ Lot #(s) r -� State ZIP �'14 !ryyAybc,, . Q�"-.,? E-Mail _ --_..........._ Subdivision razed Agent t `� � „' A City �1 f A8 I �''t c ens,.• ty �r=L�1 _ ZIP��t ed ❑ Cw LfTA ❑ ES ❑ PTS Phone # () River Basin ❑ OEA ❑ HHF '❑ IH ❑ UIs3A ❑ WA Adj. Wtr. Body_ ❑ PWS: Closest Ma Wtr. Bod..-. _ yes / rp) PNA yes /,inol Mal. y of Project/ Activity s, E S I. Jr 1 . (Scale: (dock) length, 1 Platform(s) ins Platform($) _ ;r pier(s) , n length number read/ Riprap length avg distance offshor max distance offsh L i. channel cubic yards ! j t :1 k i ✓'' ramp house/ Bo�thft j j e h h Bulldozing-- - ilding permit may be required by: (Lt. l L Y' Cke—anr� t i 11 ❑ See note on back regarding River Basin to Local Planning Jurisdiction) (� } q ;s/ Special Conditions L" 1i v 1 IT % f i y;`�t ] ("• ti�. � 1.1, i�d h .(' NC Division of Coastal Management Cashier's Official Receipt . ."�� Received From: ,, 4 —0A Permit No.: Applicant's Name: Project Address: 2561 AB Date:'` 20 $ Check No.: County: 611y� Please retain receipt for your records as proof of payment for permit issued. Signature of Agent or Applicant: PT - Signature of Field Representative: Date: Date: NC Division of Coastal Mgt. Habitat Impact Computer Sheet Applicant: JCtCUIo C- Permit #: Date: l/ A l.{ Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement Found in your Habitat code sheet. labitat 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 FINAL Feet (Applied for. (Anticipated final Disturbance disturbance. total includes Excludes any any anticipated restoration and/or restoration or temp impact temp impacts. amount 1 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 [I Both [] Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ N.C. DIVISION OF COASTAL MANAGEMENT AGENT AUTHORIZATION FORM Date 5" - 1 C Name of Property Owner Applying for Permit: Mailing Address: I certify that I have authorized (agent) C-, c -,, n ('-C K � m;::. r� to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity) j at (my property located at) This certification is valid thru (date) /(- - i - i � -- I Owner Signature Date Postal • i MAILO RECEIPT Q Domestic Mail Oniy m� CARY o ?W M9 ", Po , 0470 Ce,vSe Fee 10 C3 . 1-1 7i Retum Receipt Fee -- *rY "it�r — Postmark C7 {EmdorsementRequred}(t.[!il Here Q _ Restr cted DalI ry Fee j u {Emdyrssmemt Raqutredj Fees i Cr TOW Postage 8 Fees A__ 08/23/2016 Ln t o or PO au NO, f7 1 Postal Service" CERTIFIED + • i nu /• i njy tT • � ,.'. r,sr ems- Pos4 0470 o 'CardC'alFee Ct 10 O Return Receipt Fee tt.tttfi — Q (Endorsemant Required) �! 1, 01) Postmark Here Restricted 04 ivery Fee . . O {EYaorsam" RegWre,* ru . Ir Total Postage & Fees 0 08/23/2016 sent o i `; SAO X�G�"S. _ _ ------ h�1... ti or PoZvo. !' A n �� .n i--•- • 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 mailplece. or on the front if space permits. 1. Article Addressed to: Kj H IIIIIII IIIII 1111 IN I IT 1111111111111111111 9590 9403 0235 5146 9759 16 2, Article Number (fransferfrom SBMce tat-l) 7015 0920 0000 7611 6496 PS Form 3811, April 2015 PSN 7530-02-000-9053 • 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: A, ❑ Agent e. eived by (Pri tied Name) I C. Date of Delivery D. Is delivery address different from item 1? 0 Yes If YES, enter delivery address below: ❑ No 3, Service Type O Priority Mail Expresa D Adult Signature 0 Registered MaiiTO ❑ Adult Signature Restricted DOlIvery G Registered Mail Restricted E) Ceetifled Maile certified Mail Restricted Delivery Delivery Q Return Receipt for Q collect an Delvery ❑ Cot?ect on Derive Restricted De�wery Merchandise Q Signature ConfirmationTM Mai Q Signature Confirmation Mail Restricted Delivery Restricted Def^rery ioe Domestic Return Receipt X . - L; Addressee B elv ekdl by (P '¢red me) C. Dat of D )iv ry D. is delivery address different from item 1? Lu Ye: If YES, enter delivery address below: p No 3. Service Type ❑ Priority Mail axprma Q Adult Signature Q Registered Mail- 0 Adult Signature Restricted Delivery Q Registered Mail Restricted ery 9590 9403 0235 5146 9759 23 o certified Maw Detum Q Certified Mail Restricted Delivery pAeturh Receipt for Q collect on Delivery Mercha ifte z Grtiria tJiva�liar l rancr fmm snnriro 1nMt) Ct Collect on Delivery Resit''"ctec Delivery —C7 Signature ConfirrnationTBi r- Signature Confirmation ? 01, 5 0 9? 0 0000 76,11 6 4? 2 ;i Restricted Delivery Restr ated ivery PS Form 3811, April 2015 PSN 7530-02-000-9053 Domestic Return Receiot W ,5"