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Home My WebLink About67150D - BatmanLAMA / ❑ DREDGE & FILL iEN ERAL PERMIT Previous permit # 1�ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued ized by the State of North Carolina, Department of Environment and Natural Resources � I' f 00 oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC V ri , I 1 Name t� ` � 1u V ` n ❑ Rules attached. Project Location: County !, OAS V' ' � j�- �„ Street Address/ State Road/ Lot #(s) ' �'� ✓ ` 6 State 1�) ZIP Subdivision Y .-d Agent Y a Q T - ( G o/ City Ua v\ iCA( ZIP ❑ CW �* A ❑ ES ❑ PTS S Phone # (9 10 ) L,{ ('1"T7 13 River Basin �' VVA ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ WA C a N nat Adj. Wtr. Body ❑ PWS: (es / AO-) PNA yes �o� Closest Maj. Wtr. Body. :k) length ll V tform(s)4. � 7 '4 latform(s) x � o igth nber I/ Riprap length distance offshc K distance offsh annel 4c: yards_ ip se/ Boatlik --� � - n1,M � Length notsure yes o - iurn: n/a yes yes \ttached: es no ig permit may be required by: _ Local Planning lurisdiction) 0100mr1im Amp avtd (Scale: ❑ See note on back regarding River Basin n NC Division of Coastal Mgt. Habitat Impact Computer Sheet Applicant: CG.V-ZA Permit #: 0 ( SU—b Date: 6 gr/6 �/X I 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. DISTURB TYPE Habitat Name Choose One TOTAL Sq. Ft FINAL Sq. Ft. (Applied for. (Anticipated final Disturbance total disturbance. includes any Excludes any anticipated restoration restoration or and/or temp temp impacts) impact amount) TOTAL Feet (Applied for. Disturbance total includes any anticipated restoration or temp impacts FINAL Feet (Anticipated final disturbance. Excludes any restoration and/o temp impact amount) Dredge ❑ Fill ❑ Both ❑ Other J �� 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 ❑ Other ❑ NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management cCrory Braxton C. Davis John E. Skvarla, III ;rnor Director Secretary AGENT AUTHORIZATION FORM Date: 1o,ff Property wner Applying for Permit: Name of Authorized A ent for this project: Address:'s Mailing u i �.lowo w1p o ►��'MWW v �- Agent's Mailing Address: Phone Number (7/�) ��3� ? %ll,3 that I have authorized the agent listed above to act on my behalf, for the purpose of applying obtaining all CAMA Permits necessary to install P7 property located at FU construct the following (activity): rtification is valid thru (date) J'zi / - "Of— 'ti Property Owner Signature Date ■ 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 ❑ Addressee C. Date of Delivery D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery addr ow: ❑ No 3. Service Type SAdult Signature S �� ereail ail — Express@ ❑ Adullit Si n aIr Restricted Deli Delivery Mail Restricted 9590 9402 1363 5285 8759 79 ❑ ertified Mail Restricted Delivery ❑ Return Receipt for ❑ Collect on Delivery Merchandise 2. Article Number (Transfer frnm oo..•r,._ — - " --- 1 Delivery Restricted Delivery ❑ Signature Confirmation- 7 015 0920 0000 7 610 3960 ail ❑ Signature Confirmation it Restricted Delivery Restricted Delivery _ (over 5500) PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt ■ Complete items 1, 2, and 3. A. ■ 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, e or on the front if space permits. 1. Article Addressed to: bre,,?,,,�Doro ❑ Agent ❑ Addressee by (Printed Name) C. Date of Delivery D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No 3. Service Type ❑ Priority Mail Express® I I I I III II I I II I i II I I I I II II III ❑ Adult Signature ❑Registered Mail*'^ ❑ dult Signature Restricted Delivery ElRegistered Mail Restricted 9590 9402 1363 5285 8759 86 ertified Mail® Certified Mail Restricted Delivery Delivery ❑ Return Receipt for ❑ Collect on Delivery Merchandise 2. Article Number (Transfer from service label) ❑ Collect on Delivery Restricted Delivery ❑ Signature Confirmation- 7 015 0920 0 0 0 0 7 610 3977 "'' Mail Mail Restricted Delivery ❑ Signature Confirmation Restricted Delivery PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt u" ��. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Individual Applying For Permit: v 1_ Address of Property: ,X 0 3 S7- (Lot or Street #, Street or Road) C f I -- (City and County) —i hereby c—e-r—t-ify that I own property adjacent to the above -referenced property. The indi applying for this permit has described to. me as shown on the attached drawing the developmei are proposing. A description or drawing. with dimensions, should be provided with this let r�11l I have no objections to this proposal. i If you have objections to what is being proposed, please write the Division of C Management, 127 'Cardinal Drive Extension, Wilmington, INC 23405 or call 910-79( to within 10 days -of receipt of this notice. No response is considered the same as no objec you have been notified by Certified Mail. WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift mus bek a minimum distance of 15' from my area of riparian access - unless waived by me. wish to waive the.setback,,you must initial the appropriate blank below.) I do wish to waive the 1 5' setback requirement. I do not wish to waive the 1 5' setback requirement. 2 - o2-�,v� lS`ian Name A. Date DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Individual Applying For Permit: Address of Property: Sf (Lot or Street #, Street or Road) (City and County) hereby certify -that I own property adjacent to the above -re erenced property. The indi applying for this permit has described to.me as shown on the attached drawing the developmei are proposing. A description or drawing, with dimensions, should be provided with this let I have no objections to this ro osal. J P P If you have objections to what is being proposed, please write the Division of C Management, 127 'Cardinal Drive Extension, Wilmington, INC 23403 or call 910-79t within 10 days -of receipt of this notice. No response is considered the same as no objec you have been notified by Certified Mail. WAIVER SECTION I understand that a pier, dock, mooring pilings, break-wnter, boat house or boat lift mus bek a minimum distance of 15' from my area of riparian access - unless waived by me. wish to waive the.setback,-you must initial the appropriate blank below., I do wish to waive the 1 5' setback requirement. I do not wish to waive the 1 5' setback requirement. 9-