67944D - Fisher

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: J �IMc S �3 Permit #: G-71LM—D
Date: 17, /I 5 /2 e (�,
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremei
found in your Habitat code sheet.
TOTAL Sq. Ft
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated fin
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,
restoration or
and/or temp .
restoration or
temp impact
temp impacts)
impact amount
temp impacts)
amount)
W
Dredge ❑ Fill ❑ Both ❑ Other
O
4
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 ❑
❑. Fill ❑ Both ❑ Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both 0
Other ❑
Dredge 0
Fill 0
Both 0
Other ❑

'ayment Proccessing Confirmation
)ate Received 12/14/2016
:heck From (Name) Willie Clarence Richardson
DBA Richardson Construction
flame of Permit Holder James Fisher
✓endor BB&T
*heck Number 6576
heck amount $400.00
Multiple Permits Yes
Major/Minor
Permit Number/Comments GP 67944D ($200)
Zeceipt or Refund/Reallocated ISF/34791D

�A
North Carolina Department of Environment an
d Natural Resources
Beverly Eaves Pew I)Msion of Coastal Management
Govww James H, Gregson
Dee Freeman
DkeebrSecretary
AGENT AJTHORIZgTION FORM
Date: November 30th, 2016
Name of Property Owner Applying for Permit:
Name of Authorized Agent for this project:
Jim Fisher
WHI richardson
0wrW3 Malling Address:
PO ®ox 1224
Kannapolis NC 28082
Phone Number 305-1111
Agents Aialilng, Address:
3235 Seacrest Ave. SW
Supply NC 28492
Phone Number ( 910) 367-0335
I ce" that l have auaxxiied the agent fisted above to act on my behalf, for the
Purpose of applying
for and obtaining a' CAMMA Perrmta necessaryt to instab or consW the folbwi
MOdMCSVM8, maint. and repairs to wdstina dnrkinn IariL'i.e � �'
{PY PF*Pel at 3639 River Yew Lane Supply NC 28462
valid thrji( e)/L2-16
Signature

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CERTTi E ti RETURN RECEIPT RE UESTED
DIVISION, OF COAST-4L y1.4tiA GUMS T
A.DJA.CEtifi R315ARLAN PROPERTY OWNER STA TEIYI NT
I hmby certify that I own property adjacent to ,lames fisher
Property located at 3639 River View LN (; tnxnt o Property Owner)
on AIVM (Lot, Bloc4 Road, etc.)
M Brunswick County
(Yaterb o dy) (To_ ) N.C.
Applicant's phonic #: 704-305-1111 Mailing Address: PO BOX
Kannapolis NC 28082
He/She has described to me as shown below the development be/she is proposing at that Iocztion,
and I have no objections to the propos4.
DESCRIPTION A.1NVOR DRAW) NG OFPROPOSED AEVELOPIV NT:
(Xndividu¢l,Oroposing development must fill in description below or attach a site drawing)
Recondition existing docking facility in same location as existing
See attached drawing
If you have objections to what is befit; proposed, you mast notify the Dtvisioti of Coastat iN) Qa einent
Within 10 days of receipt of this notice. Correspondence should be mailed to 12'7 Cardinal Drrvc EA by agton IYC
DCM representative$ can also be contacted at (910) 796-72X5.
NO reS130ase is considered the same a5 no Oblertlon i oa bavc been notified b Ce "fieg Mail
j(Property__Owner IiiJjormation)
�/�uL�7.BX�Authorized Agent
Signature
Will richardson
Print or Type Name
3235 Seacrest Ave SW
MaW49 Address
Supply NC 28462
City / State / Zip
art 1�--i ktE'r,5
k'rmt or Type Name
_Rv6e Ia .
Mailiag Address
City / State I Zi

Scope of Work:
1: Removal and disposal of existing
floating dock and ramp.
2: Installation of bftx20ft float with
2x6ft extension and 3x1bft aluminum
ramp
3: Repairs to existing steps and gate
4: Removal and disposal of all
demolition debris
5: Permit package and permits from
DEQ/GAMMA
b:Level and support existing fish
cleaning station
T 5ister 30 damaged pilings.
6: dock extensions in two areas: See
contract
9:Installation of 20ft aluminum
walkbaord
10: New boat lift guides
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