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Home My WebLink About66504D - DavisX�EF / XEDGE & FILL � 7/ %(p N9 �j50JA B (L PERMIT ��/J/ Previous permit# [New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued •ized by the State of North Carolina, Department of Environment and Natural Resources 14 :oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC Q� _ ❑ Rules attached. :Name �/'�� affi 011\N �0 Project Location: County Street Address/ State Road/ Lot #(s) U,..V,�1\ ern State�l� ZIP (��//�) �"� E-Mail Subdivision -� ed Agent (--N-\ ce (C)V-1 S �1 b Yl City ZIP '�, '9 Ll ❑CW AW XPTA *S pTS Phone "# (;l )5 71-109S River Basin L—VM ❑ OEA ❑ HHF ❑ IH URA ❑ WA Adj. Wtr. Body C Q V-� a(nat /n ❑ PWS: yes / "no PNA yes / o Closest Maj. Wtr. Body Project/ Activity :k) length_ tform(s) :11atform(s) igth nber " Riprap length �01 distance offshore c distance offshore_ annel ��■�llllllll��ll��w�l��„��r� M1K1Fa1&1dU6 MEN, DOMINION • ■� MEN MOO ■SOMEN ■I�I�r��la�Ir�� m (Scale: �' ' - `'a t>4! No,c d lw,-A ❑ See note on back regarding River Basin rt� NC Division of Coastal Mgt. Habitat Impact Con Applicant: b&-a S Date: 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 F (Applied for. (Anticipated final (Applied for. (I DISTURB TYPE Disturbance total disturbance. Disturbance d Habitat Name Choose One includes any Excludes any total includes E anticipated restoration any anticipated rt restoration or and/or temp restoration or to ternimpacts) impact amount temp impacts) a Dredge ❑ Fillx Both ❑ Other ❑ 00 ( Ud 0 Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ .V k\\ O ,� A, -,A 'at McCrory Governor 'LIT 1FA 400 NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Braxton C. Davis Director John E. Skvarla, III Secretary AGENT AUTHORIZATION FORM Date:�?o/(� Iame of Property Owner Applying for Permit: m [e� �o�f A th�(``I orized-Agent \for this project: Nner's Mailing Address: & ? 4 (D- Cou,\A'r�tiomd l4nAltY,,,-ae, N` )-)31 lone Number U90 3 Lf �— I Y 13 Agent's Mailing Address: LUVIZ� �ggOh ��-SQ Phone Number S-19- -qo :ertify that I have authorized the agent listed above to act on my behalf, for the purpose of applying and obtaining all CAMA Permits necessary to install -or construct the following (activity): S�ac� �u.vv�o or my property located at yl, q _5u1\ s e MAV 1 +� S-i'r `eL is certification is valid thru (date) Property Owner Signature Date ----. _ - lrhplete items 1, 2, and 3. nt your name and address on the reverse that we can return the card to you. ach this card to the back of the mailpiece, OQdb front if space permits. t Iressed to: l air A. Signature X / G �� ❑ Agent ❑ Addre :B.Receiv d by (Printed Name) C Date of Deli D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No IIIIII IIII III i I I I I I i I III II I II III I III I I II III3. El a lTMess® 9590 9403 0603 5183 4327 45 AdultService Signature Restricted Delivery 1 Certified Mail® 0 Registered s eredl 11 Registered Mad Restricted Delivery rp_ Certified Mail Restricted Delivery ❑ Collect on Delivery return Receipt for 1 Merchandise 'in Ah rmhar (TranSfPr from seN%ce label) ❑ Collect on Delivery Restricted Delivery ❑ Signature Confiirmation- 7 015 0640 0006 3682 rstricted Delive 2154 ry Signature Confirmation ion Restricted Delivery m 3811, April 2015 PSN 7530-02-000-9053 Domestic Return Receipt U.S. Postal Service TM CERTIFIED MAIL° RECEIPT Domestic Mail Only DUf fiAli k_'yW, 71 ; Certified Mail Fee $3.45 0470 1 11 Extra Services & Fees (check box, add fee p te) ❑ Return Receipt (hardcopy) $ ❑ Ratum Receipt (electronic) $ Postmark ❑Certified Mail Restricted Delivery $ so 00 Here ❑Adult Signature Required $ $0 00 — El Signature Restricted Delivery $ Postage $0.49 Ol /27/201 Total Postage and F ��.74 s Sent To ---- ( 1 C' - ---- -- - - ---- -- $ox f_,I I ------------------ t_ C ` ------ ----------------- _1V ■ 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: —r-x— .o — - - T) - - ` . r� ru M _B CJ 0 C3 C3 O C3 rt Postal CERTIFIEDa RECEIPT Domestic _. � , -., Certified Mail Fee $3. 45 0470 $ it Extra Services & Fees (check bar, add fee atpp.,p�yipte) ❑ Retum Receipt (hardtop» $ LL�t ll�t VV ❑ Retum Receipt (electronic) $ I I ❑ Certified Mail Restricted Delivery $ $0 00 Postmark Here ❑ Adult Signature Required $ !! r— ❑Aduh signature Restricted Delivery $ Postage $0.49 $ 01 /27/201 d ostage andp Total P e� ib.74 $ Sent T51\ - --- � A�.-�� ; re tan o I r� =i''-ci 5 n A. Si nature ❑ Agent X ❑ Addressee B. Received by (Printed Name) I C. Date of Delivery D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: M No CERTIFIED MAIL • RETURN RECEIPT REgUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner: Address of Property: (Lott or Street #, Agent's Name Agent's phone or Road, City & C6un(ty��) Q I ' , l Mailing Address: li) U I ` ��Sw u n ct(,l 1 PVC 2,3 C( 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 drawing the development they are proposing. �alitfl��6w`8ti�'tA7fft'di�t►jfl��di��i� �sri"`�ICI �� r�i�l�` d�i'jhi�i,.(i�ff�r{. - _. I have no objections to this proposal. I have objections to this proposal. If you have objections to what. Is being proposed, you must notify the Division of Coastal Management (QCM) in writing within 10 days of receipt of this notice. Corresgonoence should be mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3846. DCM represent4 vets can also be contacted at (910) 796-7215. No response is considered the some as no objection !f you /t" been notified by Certified Mall. 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 requiren ient. do not wish to waive the 15' setback requirement. (Property Own r iformation) Signature Print & Type Name \d I Mailing Address .4�33a n is 2-13n City/state/Zip 33�-3�15�1�i3- (Adjacent Property Owner Info mation) Signalm e -�%f/W fp Print or Type Name a�Z Mailing Address RC/ 'L— 4 _ -- -City/state/Zip T f-h- hhtmhzw CERTIFIED MAIL • RIgTURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Owner: tY 1. r� 1 ��► „l.__ -- - Address of Property: 1L �._ I M,r-t Y �1 ' `_--- -- -- (ice (Lot or Street #, treet or Road, City & C unto— Agent's Name #4cS� U_'�C lli�l Mailing Address: `ll1, /UCYI l�(�SW - Agent's phone Ik: Mki d1 S M1 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 drawing the development they are proposing. - I hrtve no objections to this proposal. I have objections to this proposal. 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. Correspondence should be mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM represent#fve3s can also be contacted at (910) 796-7215. No response Is considered the some as no objection If you hit o been notified by Certified Mail. - 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.) lk 1 do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner fo�rnm^a�tion) (Adjacent Property Owner Information) Signal Wa ig�natru e Print drr Type Name Print or Type Name C VtC� 2-Ll08 Vi�1�_�.e ll -Dr✓e Mailing Address Mailing Ad rots �JC2`13C] �w�l�c�n Aj� ��c 277 City/State/Zip -City/State/Zip 33trJ-3�15�1�I13 _ _ go�-i�1 �-- 3 '' z� �u�� a� ��5 l�� C�� a�� n�-y �c� �Z� �Gr��15��511(1c5L>�