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Home My WebLink About66558D - CoxfCAMA /.❑ DREDGE & FILL a�l FlorR VA A B ' EN ERAL PERMIT Previous permit # rNew ❑Modification [-]Complete Reissue El Partial Reissue Date previous permit issued •ized by the State of North Carolina, Department of Environment and Natural Resources zj Z�C� :oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC �j 7/7 i/ _ ules a hed. Name p �t'O " 4 ' COA Project Location: County -4'e*1" �7 / ►-t, ► l7 Street Address/ St/ate Road/ Lott #(_s) /IIf / State} ZIP WW Y fro ( ) 22 --� W E-Mawl /C X � � ��Ar, Subdivision 3d Agent �� Cityr ZIP��1� ❑ CW L�9TA O ES ❑ PTs Phone # (1/ / 7 River Basin ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A ❑ PWS. Adj. Wtr. BodyI,et S C. n� des t'no PNA yes no Closest Maj. Wtr. Body 6rrrrr,�r �srs Project/ Activity :k) length itform(s) 'latform(s) er(s) igth nber I/ Riprap length distance offsho (distance offs re annel is yards Length not sure yes im• / no ttached: yes /iic1 rrL-- g permit may be required by: "r�y//1 /f/` �yj/"%/�j/�/!/�� /�� _ ❑ See note on back regarding River Basin r .ocal Planning jurisdiction) NC Division of Coastal Wi9t. Habitat impact computer ShOOt Applicant: Permit #: " Date: I " Describe. below the HABITAT disturbances for the application. All values should match the name, and units of measurement found in your Habitat code sheet. [NAL Feet Habitat Name DISTURB TYPE Choose One TOTAL Sq. Ft. (Applied for. Disturbance total includes any anticipated restoration or temli iimpaacts) FINAL. (AntOlP Exd&l nasty a0 imevv 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 ❑ Dredge ❑ Dredge ❑ Dredge ❑ Dredge ❑ Dredge ❑ Fill ❑ Fill ❑ Fill ❑ Fill ❑ Fill ❑ Fill ❑ Both ❑ Both ❑ Both ❑ Both ❑ Both ❑ Both ❑ r1 Other [} Other ❑ Other ❑ Other ❑ Other ❑ Other ❑ n4k . n Sq. Ft. TOTAL Feet for. F final (Anticip aW ited final (Applied Dance. Disturbance total includes disturbance• Excludes any les any ration any anticipated restoration and/or _ rtemp restoration or temp impact I NCMHR North Carolina Department of Environment and Natural Resources Patuccrory Donald R. van der Vaart Govemor Secretary AGENT AUTHORIZATION FORM Name of Property Owner Applying for Permit: lyrias Co)g Owner's Mailing Address: q. 3 Pt l l (A.n Doi �L Wncl t, xoi14 Bc-&c1tttJL-2- IPin Email 4c.0/ &Ooiec/ ►-tan,— Phone (9.10)p� Name of Authorized A ent for this project Agent's Mailing Address: 1 Iq Fell 11 C 04 QYi JfC l tW1S�fiVt Lk SC&Cj, , NL a-aul3o Email. • r ( : % • c-w Phone LCI QJ_tg3CL]t-I L I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying for, and obtaining all LAMA Permits necessary to install or construct the following (activity): I3913 Root 144 wI q ptli -s Project Site Address: r A Pe II CA-n Dq W +1 kt3d � it�t3t� ►, Nc. rl-a�l� D ZJ-7 /6 Property Owner Signature/Date` *This certification is valid 1 year from date signed by property owner. N.C. D-:vision of Caaslal Management 127 Cardinal Drive Ext., Wilma gton, NC 28405 Phone:910.796.72151 FAX 910-395d964 Internet: w nccoastaknanagemenl.net pCM W ��'EI VED A D rNGT ON' NC R 2 5 2016 ♦n E*W erw� �M1 u 1ace. EffV-Ir --=uy �ertoy war town property adjacent to=fL)CMj S Cxy _ s (Name of roperty Owner) property located at u on (ii ✓ y%Lte- tS CJ�Address, �o1 Block, Road etc.) in ri�ttj3Vl(it BCf�QI� NC (Waterbody) (Cityrfown andlor County) The�I has described to me, as shown below, the development proposed at the above locat'on 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) S4:c- ct�au�tr� a44A ham( -jq5•- 13X 13 bea.t I4 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 riparian access unless waived by me. (If you wish to waive the setback, you must initial the appropriate blank below.) �_ I do wish to waive the 15' setback requirement /W..— 1 do not wish to waive the 15' setback requirement. Information) 'Wo mail ngAddess COI St te4'I'g L/ Z'7N 5; 3 79 Telephone N er Dare (Revised 6 IWO12) RECEV DCM WILMINC APR 2 5 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to MOM G.S UY s (Name of Yroperty Owner) property located at 4 'q pul;Cu,h Dr;� (Address, Lo Block, Roac( etc.) on 1G��%GISCU�- in l�►iIh'J,UiIc,- 6ega- NC. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. X I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must rill in description below or attach a site drawing) S;4-�-- ctra.ujte�r Afhu va-,d -/(3r- 13X 13 bear 14 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 riparian access unless waived by me. (If you wish to waive the setback, you must initial the appropriate blank below.) I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Adjacent Property Owner Information) Signature F12lz1 f? ✓ u Print or T e Name -By80 Ma ling Address J✓ /VG Z 7�d Ci"tateZ ��t7 7S6 i�o s R EC I Telephone N mber DCM WILM Dare APR 2 (Revised 6/1a/2012) � t',- 'c 0 K �(L 0 RE, DCM Wil AK