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67940D - Cox
1-CAMA / DREDGE & FILL 3ENERAL PERMIT lNew Modification ❑Complete Reissue ❑ Partial Reissue 97940 A B Previous permit # 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 15A NCAC j77 (� , L 0� t Name W A 1 ci A Co i/ Sc I 1y`{. State (c-1)0) 5_11-1015 E-Mail ed Agent &v1-Ck (()ASIW(61A ❑ CW OTA ❑ ES ❑ PTS ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A PWS: yes / CO) PNA yes / 9 ❑ Rules attached. Project Location: County Q ►1Msb,, C k Street Address/ State Road/ Lot l #(s) _fj � i Uvt (p r c Sr , Subdivision Cityou a vi &e tk Ox zip tL Phone # (�9T) `� 6- 115 G River Basin l� � 4 Adj. Wtr. Body C x �1 a (na Closest Maj. Wtr. Body Al VJw Project/ Activity ' Vl S �rx 011 f ti Pwc a h (i a i�►� r� v►' 1, :k len h (Scale:' ■�i■■i■�i■?�� igth mmmmmiiii■■I iii■�ii■ OMEN ■■■■■ MEMO ■■■H■■■NE■l�tr�71�i'�� r� ��irj1111M1l�1■!A�■■���I■ :■■■■■■■®■■_■■■■■■■PA"W■■■I■RNl7■■■ ■�■■■.►�■■■■L'iiii�r■I�■■■ distance of 4re MY distance off hore '�'�!�■l�A�wHI� ■LI�II.��I�Il�lr��i�■���■��i•���!■■��■�I�� i■■■■■ ■�■■GfI■:��,�at�■■■■ir��■■■ram■�:---- ■�ii.�� M;�1 O�J1;JEMqEJ-!11rwqJP I ■■ Ell1i■■ic ■ l■tom■,111M1�■■�ir■�1■■��■ yards jAmom■i��/rr— . --- �...�.�.� To 1MwwwM ■nl!■■� I■!■lip■■�11 ■■�■M■■■�'�I!■■■■■■■■�1'■■ ■ram■■� I■■■�■■■�� ■� I■■�■■■�■■■■■■n■■■■■ FF Length not sure yes . �■��■iiiaiiii�i ■■i:� :�iri�iiii:=: =:==■ ■■■■i®�■■■■■■■■■ ■■1■■■■■ n/a yes r:■■■ ■■■ sue■ ■■■t��r��■ ■■ iw ■ yes ttached: yes ■■■ M■■l-31MIiI�iWlLliii■■■®■■■■■■■ I�■■ g permit may be required by: (Qw✓l Q �t;Cu4t ,L,S �i11(. ❑ See note on back regarding River Basin ru .ocal Planning jurisdiction) NC Division of Coastal Mgt. Habitat Impact Computer Sheet Applicant: (�_^j l(, zvA^" C �C Date: I LIt'; /2- o ( (" Permit #: (-Z -t -co--� 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 FINAL feet (Applied for. (Anticipated final (Applied for. (Anticipated final Habitat Name DISTURB TYPE Disturbance total disturbance. Disturbance disturbance. Choose One includes any Excludes any total includes Excludes any anticipated restoration any anticipated restoration and/c restoration or and/or temp . restoration or temp impact temp impacts) impact amount) temp impacts amount 0 vV Dredge ❑ Fill ❑ Both ❑ Other 4 l C 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 p Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ 'ayment Proccessing Confirmation late Received 11/23/2016 heck From (Name) Grice Construction of Brunswick County Inc lame of Permit Holder William Cox /endor BB&T :heck Number 10886 :heck amount $1,000.00 Multiple Permits Yes Major/Minor 'ermit Number/Comments GP 67940D ($200) teceipt or Refund/Reallocated SF/2845D L B W&MEWAR North Carolina Department of Environment and Natural Resources Division of Coastal Management Pat McCrory Braxton C. Davis Governor Director John E. Skvarla, I Secretary AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FUKM Date: 10/12/16 ame of Property Owner Applying for Permit: Name of Authorized Agent for this project: lilliam C. Cox, IV ��� 9 0;1� XI\,51T(1XLtkD1-� wner's Mailing Address: 51 Concord Street Dcean isle Beach, NC 28469 lone Number 910 409-1856 Agent's Mailing Address: 4kD k% (-�e% 6A lk� fs� `ESL Phone Number At S C�' cmcp :ertify that I have authorized the agent listed above to act on my behalf, for the purpose of applying r and obtaining all CAMA Permits necessary to install or construct the following (activity): Boat Lift >r my property located at 51 Concord_ Street, Ocean Isle Beach, INC 28469 its certification is valid thru (date) 10/12/2016 roperty Owner Signature Date CERTIFIED MAIL • RETO RECEIPT REQUESTED --DIVISION OF COASTAL MANAGEMENT ADJACENT R PARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner: _ \\`\ Address of property: R: (Lot or Street #, Streeror Road, City & County` Agent's Name#:y`'\� �1�o`r1 Mailing Address. Agent's phone#: �- 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 draw* the development they are proposing. f_ ©ti dt ltytli 3 ? ? iB?I)Y I I All > UNIfi fYi ,f ll - have no objections to This proposal. - I have objections to this proposal. j 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 receipt of this notice. Corresp9noence. should be mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM represo0t40e9 can also be contacted at (910) 796-7215. No response is considered the same as no objection tf you h" been notified by Certified Mall. �.---- i 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 riparlan access unless waived by me. (If you wish to waive the pacl, yo ust Initial the appropriate blank below.) do wish to waive the 15' setback requirement. I do not wish to waive the 161 setback requirement. (Property Owner of rmation) - - (Adjacent Properly Owner Information) A'i�rtalrn'e ,nnlrrre Print or Type Name Print or' Typo Name eiling /Iddress -- - -Mra' i1J� f1 dclress City%State/Zip City/Stato/zip C 16lephone Number � �� r Telephone Number CERTIFIED MAIL - RETURN RECEIPT REQtJE$TEI) DIVISION OF COASTAL MANAGEMENT ADJACENT R PARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of property Owner: Address of Property: 1.: (�CuvrA b `--------- � (Lot or Street #, Straeror Road, City & CounryT Agent's Narmetl:y` ��,. L�On Malting Address:W Agent's phone #: ���' 5������5_ O�� v1 1 C A �- I hereby certify that I own property adjacent to the above referenced property. The individual apP"g for this hermit has described to me as shown on the attached-drawkita the development they are proposing. j /� t�''� Y+�•,;� 1ritl�Cjb�t9t�il't�ing5 i�ij��l�it1'i�i`t�tt���"_� :fit• I hove no objeotions to [his proposal. _. i have objections to this proposal. j If you have objections to what is being proposed, you must --notify the Division of Coastal Management (0CM) in writing within 10 days of receipt of this notice. Corres'ppn(lence.slrQuld be mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-8846. DCM represent#fives can also be contacted at (910) 796-7215. No response is considered the same as no objection If you h" been notified by .Certified Mail._ -. [ WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin roost 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. do not wish to waive the 15' setback requirement. (Property Owner of rmation) n `� (Adjacen Property Owner Information) h ignnrurc Sii;nrrRrre Print or Type Name Print or Type Nome 5� Cz5rw _ s�- 0 6 o x 15 -75 ailincd Address -�� --�---- Mailing Address �14< 2% t(o�p CitylStatelZlp City/State/Zip 7elephono Number Telephone Number ■ 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: 32- L ature � El Agent ❑ Addressee B. Rece'_ed by (Printed ame) C. Date of Delivery D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No II I IIIIII IIII III I I I I I I I I III II I II II I III III I I III 3. Service Type ❑ Priority Mail Express L7 Adult Signature ❑Registered MaiIT"' ❑ Adult Signature Restricted Delivery ❑ Registered Mail Restricted 9590 9403 0603 5183 4329 43 jji6l0ertified Mail8 Delivery • Certified Mail Restricted Delivery ;Return Receipt for ❑ Collect on Delivery Merchandise ❑ Collect on Delivery Restricted Delivery ❑ Signature Confirmation T 2 C Tula Niimhar r7ransler from service Zabel) ❑ Signature Confirmation 7 015 0 6 4.0 , 0'0 0 6 3662 2475 Restricted Delivery Restricted Delivery PS Form 3811, April 2015 PSN 7530-02-000-9053 Domestic Mail Only i For delivery information, visit our website at www.usps.com Domestic Return Receipt ruw ED Certified Mail Fee $3. 30 0470 m $ 10 Extra Services & Fees (check box, add tee glrprmte) ll�r r3 [I Return Receipt (hardoopy) $ ❑ Return Receipt (electronic) $ #Lr . Lr4J Postmark Q ❑ Certfied Mail Restricted Delivery $ fill _ (Ifl Here t-3 ❑ Adult Signature Required $ t []Adult Signature Restricted Delivery $ 0 Postage $0.47 09/08/2016 Total Postage and F �.47 p $ t.rl se 'Stieipta(td gpt. of P x Nq. S l� ■ 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, 11111111111111111111111111111111111111111111111111 9590 9403 0603 5183 4329 12 Article Number (Transfer from servire lahan A. Signature X \_ — ❑ Agent ❑ Addressee R. Recei v(PrintedName) C. Date of Delivery J er►n` '7*,, l5k?k, D. Is delivery address different from item 1? ❑ Yes If YES, enter deli�Ur ,a dress below: ❑ No �P N. Sep ^ 1 l 73 m 3. Service Type ❑ Priority Mail Expresso ❑ Adult Signature ❑ Registered Mail— ❑ Adult Signature Restricted Delivery ❑ Registered Mail Restricted mizaertified IVIZO Delivery ❑ Certified Mail Restricted Delivery Zeturn Receipt for ❑ Collect on Delivery erchandise n r.�u—f nelivery Restricted Delivery n Signature ConfirmationT" _. ❑ Signature Confirmation 7015 0640 0006 3682 2468 estricted Delivery Restricted Delivery PS Form 3811, April 2015 PSN 7530-02-000-9053 Domestic Return Receipt S. Postal Service'M ERTIFIED LF., MAIL° RECEIPT mestic Mail Onl delivery information. visit our wPhcifn rU ro —a m ..a 0 0 0 O `.a O LF1 rq O f� Q a