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Home My WebLink About66679D - ChildsCAMA / ❑ DREDGE & FILL A B ENERAL PERMIT 1_ J� Previous permit# gNew ❑Modification ❑Complete Reissue [-]Partial Reissue Date previous permit issued rized by the State of North Carolina, Department of Environment and Natural Resources aA 1 ^(%� u l ) :oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC (,% + ❑ Rules attached t Name Project Location: County LC� , Street Address/ State Road/ Lot�1\1"ADV\itic ) 'A State ZIP l� 1 �0L v k- __.— Mail Subdivision �i :ed Agent City `'6y�/�" ZIP b! ❑ CW PTA ❑ E5 ❑ PTS Phone # ( �� River Basin ❑ OEA ❑ HHF ❑ IH ❑ URA ❑ N/A Adj. Wtr. Body , (.at ElPWS: yes no PNA yes no Closest Maj. Wtr. Body f Project/ Activity )ck) length_ latform(s) _ Platform(s) angth ember id/ Riprap rg distance iax distance :hannel jbic*ds MP/ us Boatli Bulldozing JWne Length not sure yes X-- >rium: n/a yes y Attached: y mg permit may be equired by: Local Planning jurisdiction) (Scale: � U.=-- ❑ See note on back regarding River Basin L-\ ,1, 1 1 . - ,. i l -1 t1 1--'I K,-I --, i iv 1. 1 C 1,4.-i--d rib Division of Coastal Mgt. Habitat impact Computer Sheet Applicant: tr � t Permit* QUO Date: jj 1Wj Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremei 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) 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 fir disturbance. Excludes any restoration anc temp impact amount) Dredge ❑ Fill ❑ Both ❑ Other J 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 [I Other ❑ Dredge ❑ Fill ❑ Both 0 Other ❑ V. N.C. DIVISION OF COASTAL MANAGEMENT AGENT AUTHORIZATION FORM Date / Name of Property Owner/1A/�pl Ding for Permit: Mailing Address: I certify that I have authorized (agent) S�aoe &OLO to act on my behalf, for the purpose of applying for and install or construct (activity) b v4- at (my property located at) ining all LAMA Permits necessary to i 7jocl� gr�hsw ItX Sk 90,A,r� This certification is valid thru (date) I /% Ire Property Owner Signature Date Y. ADJACENT RIPARIAN PROPERTY OWNER STATEMENT - r- I hereby certify that I own property adjacent to Avl —c_ dZ(Z� (�._ J /1.'s ��f�(Name of Property Ow er) property located at ✓t y murk a 6001c __i9Qg-Pct' 212 _ /address, Lot, Block, �yoad, etc. on NJ) IAC _)5146W ( in _ -—.50VA101a✓�") _., N.C. (Waterbody) (City own and/or County) The applicant has described to me, as shown below, the development proposed at the above location. I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, 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 u wish to waive the setback, you must initial the appropriate blank below.) L� 1 do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) /L� /G . A-1� -- - --- sizv- P 6 , � S Print or Type rrA � I e') 'I \ (Adjacent Property Owner Infor ation) Si Print orType,(V me 7+ zAJV w 'E, I � � ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to 14P_ _ __'s Name of Pro erty O ner property located at B1-1)wX. L - -4 66L q0`d Dece�e � ! , At�- (Address, Lot, Blockl�oad, tc.) on o6d v�CwT 6AS/iJ i JOcA ,oi - N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above to ation. 01,- 1 have no objection to this proposal. have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill in description below or attach a site drawing) WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, 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.) E/ �Ii\V I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner _Informa .on) igr ttu e n Pr' .U7t or Type Name M N I c> a - rf... (Adjacent Property Owner Information) Y-4" 4-- K Sign/ �an� � Pri Ptar Ty e Nag A �i� 1 v'v�L.sGc//mac t4sse112K f wtlaeno & ■ om w-mw comes mm w 4Asmg1rw 4 0ai�9 PC,7JR , MWAt7�• , wt �1P. ` II , rK MA <+ _ i • _ •u. 14, 2- LAM Nr"Mrw PK M /�� M 1 ■ �4l fry k4'� • `% 7�/L/• err. --err fLT yyp` . r. ,._,, ,,,,, ,_-- r r .-• ray ''w--' •-• •-� Y 174 /[_ a -• r � .�-+ .-� .-� .-' •--' r r .-+ .-� r� .---.}s-' enr 'E.slulf mac .•wm.ra. xr•.m.,ur+ .. a r e r r — — — r » 4w OC 7AAM 1: 441.0 q. Tr. ma ft PT, TAACT & WVA AA. R. n/1 4:P7 741M ft R. ,M l DUD AMOK 1MMM AApKir nc reimmm"a or now lMRy V. _ — - V -*M MAP - NOT TO WALE look l7k w��Mf L \ 4■ ■4 M• f w • noMo yiw�mvtrtsw '`ni. - nnwa aE.u�O�r caeica 11o�ifnl. aAa AMC— ------ Surveyed and Mapw By Tide Water Surveying P.O. Box 11506 802 North Howe Strut Southport, North Caro'ulo 28461 Phone 910-457-9580 MARY LOUISE HERRING CHILDS a► i�� 12 1 �t in i Irs 1