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Home My WebLink About67936D - CainCRIM■I d woo■m 1m■■11 ■■■■■ 1■■■11 �i1■■■ lmmmt; lof mmo NC Division of Coastal Mgt. Habitat Impact Computer Sheet Applicant: hri'p- & �rt�1� Ca�v� Permit#: // o(.3�- lo Date: 1� I v7 a,. `2 o t (r Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremi 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)—1 FINAL Sq. Ft. (Anticipated final disturbance. Excludes any restoration and/or temp impact amountj TOTAL Feet (Applied for. Disturbance total includes any anticipated restoration or temp impacts FINAL Feet (Anticipated f disturbance. Excludes any restoration an temp impact amount) Dredge ❑ Fill ❑ Both ❑ Other [� Z 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 [I Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ , 'ayment Proccessing Confirmation )ate Received 11/23/2016 heck From (Name) Willie Clarence Richardson DBA Richardson Construction lame of Permit Holder Cain /endor BB&T :heck Number 6560 :heck amount $600.00 Multiple Permits Yes Major/Minor 'ermit Number/Comments GP 67936D ($200) teceipt or Refund/Reallocated SF/2844D HCDEHR North Carolina Department of Environment and Natural Resources Division of Coastal Management Beverly Eaves Perdue James H. Gregson Dee Freeman Governor Director Secretary AGENT AUTHORIZATION FORM Date_ 0 No o 2U ((e Aame of Pro ° a hg for Permit: Name a ppiyinuth ed Agent f r this project: �1he tr r C� cu- 5yt., Owner's Ma' 'ng Address: . Not h Je Lv,e p��j-C 2_ 00 , Phone Number ft :� I - 4 zsz Agent's Mailing Address: SeoLcres4 Ave. gi Sc&Q 1 v JA C 2 q(Q2 Phone NumberIC71 - SG ] ` O33S I certify that 1 have authorized the agent listed above to act on my behalf, for the purpose of applying for and obtaipjng all LAMA Perm (my property located) at i I s nec(,e�ssary to in/sl r _all or ns uct the following (activity): �G f,. This certificatio is valid thru (date) N�� Property Owner Signature Date Z(46 C) 29_1462 /18/2016 11:11 7047088033 LIBERTY BG PAGE 01/0! AI)JACENT JUPAR7AN PROPERTY OWNER SZ'ATE1V.tf$NT {FORA PM1?MOO,RMGI>H- NGSGBOATLa7lBOAT$•OUSE) I hereby certify that I own pzopeM ad}aceQt to Paul & Ann Gain Is t ame of Prop" Owb.er) property located at 121 Salisbury St (Lot, Block, Road, etc.) on CANAL , in Holden Beach (Wacerbody) (Town and/or County) AppUcaat'sphono#: 910-880-0088 MagingAddress: 1401 Burnside Lane Apex NC 27502 N.C. He has described to me, as shown below, the developmerrt he is proposing atthat location, and, I have no objections to his proposal. I understand That a pier/mooring pilings 1 boatlift / boathouse rraust be set back a minimum distance of fifteen feet (I5D from my area of riparian aco-= unless t,,aivcd by me. (If you wish to waive the setback, you must initial the appropriate blank below.) I do got wish to waive I do wish to waive that setback requirement. DESCRTMON ANDIORDRAWWG OF PROPOSED DEVELOPYaNT: (Tv be filled in hY Individual proposing dcveloptr "V Replacement of docking facility See drawing attached (Ztaformation for Property Owner Applying for Permit) 3235 Seacrest Ave SW Mailing Address —Supply NC 28462 City/sta-zip 910-367-0335 Telephone Number Property Owner Wormarion) � Print or Type Name P Telephone X ec ADJAOEM RIPARL4—w PROPERTY OWNER S'TATEM]M TOGA PIEBMOO.rttIIYGPLUIYGS/BOAHIFT/BOATKOUS]i) I hereby certify that I own property adjacent to Paul & Ann Cain is (Name of Property Owner) properly located at 121 Salisbury St .(Lot, Block, Road, etc.) on CANAL Holden Beach _ N.C. (Waterbody) (Town and/or County) A.pplicanf s phont #: 910-880-0088 Mailing Address. 1401 Burnside Lane Apex NC 27502 He has described to me, as shown below, the development he is proposing at that location, and, I have no objections to his proposal_ I understand that a pier/mooring pilings / boad ft / boathouse must be set back a minimum distance of fifteeu feet (I5D from my area of riparian access Unless waived by me. (If you wish to waive the setback, you must initial the appropriate 1;1aik below.) I do not wish to waive I do wish to Waive that setback regtgremenL DESCRIPTION AND/OR DRAWING of PltoPoSED DEVEI,0P1VfErrT: (To be filled in by individual proposing development) Replacement of docking facility See drawing attached (information for Property Owner Applying (Riparian P for Permit) roperty Owner Information) 3235 Seacrest Ave SW Maili� Address Supply NC 28462 City/Statezzip - Si�atu.�e �iT/-/LEE�iV t/gcKsoaJ Print or Type Name Scope of work; Remove existing pier and stationary dock Build new pier and stationary dock as drawn 1 New aluminum gangway Reinstall existing float as drawn Boat lift in same location CANAL Existing Boat Lift Existing floating UP 4x 16 New 114 —3l' _-f --- --- —__ .a. :r... .P -- ----- 119 Salisbury 5t 121 5alisbury 5t Kathleen Jackson Paul & ?inn Gain Earl Barnes q 1 CI-850-0055