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Home My WebLink About67227D - Hooks"wnrvfwrrr ua:mu, iW MENEM ighm� 11im: NC Division of Coastal Mgt. Habitat Impact Computer Sheet Applicant: h.q� Date: - /&q Permit #: 6 7 a 0—� Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen found in your Habitat code sheet. Habitat Name DISTURB TYPE Choose One TOTAL Sq. Ft. (Applied for. Disturbance total includes any anticipated restoration or tempim acts) FINAL Sq. Ft. (Anticipated final disturbance. Excludes any restoration andlor temp impact amount TOTAL Feet (Applied for. Disturbance total includes any anticipated restoration or temp impacts FINAL Feet (Anticipated fins disturbance. Excludes any restoration and/ temp impact amount ' ,, I ow �1 Dredge ❑ Fill ❑ Both ❑ Other b 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 ❑ Other ❑ Dredge ❑ Fill 171 Both ❑ Other ❑ NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management McCrory Braxton C. Davis rernor Director John E. Skvarla, II Secretary AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FUKM i- Date: _ e of Property Owner A ply n for Permit: Te of Auth rized Agent for this project: Agent's Mailing Address: o� n Phone Number (InJ t _ —1� rtify that I have authorized the agent listed above to act on my behalf, for the purpose of applying 5nd IC all CAMA Permits necessary to install or construct the following (activity): my property located at 0 i certification is vali thru (date) Property Owner Signature M "--& LL Date CERTIFIED MAIL • RETURN RECEIPT REQUESTED --DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONANAIVER FORM Name of property Owner'M+� Address of property: _ (Lot or Street #, Set or Road, City & County � c Agent's Name ll jQ_^C��5_111�—�`l acting Address: _ v _C�1� Agent's phone Z�� 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 idrawin the development they are proposing. ,..,:, n a , me rt Xt 1 have no objections to this proposal. _ I have of icctions to this propost►I. i If you have objections to what. is being proposed, you must notify the Division of Coastal Management (OCM) in writing within 10 days of receipt of this notice. CorresponOence:shat� mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM representq>) 08 can also be G contacted at (910) 796-7215. No response is considered the same as no objection If you h" been notified by Certified Mail. -- - --- WAIVER SECTION I understand that wpieu, 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 9P _ setback, you must Initial the appropriate blank below.) 1 do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner n ormation) Sign fun? Print or Typip Name Mtailing Address � I cuyisrate/Zlp T olep I tie Mim�ber (Adjacent Property Owner Information) Srgnntur c n Prinr or Type Name Moiling Address cityist areizip 70 4 -- Telephone Number CERTIFIED R11 RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY\OWNER NOTIFICATION/WAIVER FORM Name of Property Owner:---- y 5 Address of Property:1--�- ` ___ �` .� � !- — -- !- (Lot or or Street #, Street or Road, City & CounlyT-- ��1 Agent's Name li• `'�k�(=vo\A6c)&a1llng Address: 'sAgent's phonen� J 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. 1 h1rve im objections to This proposal. ___ 1 have 01*etiwns to this propoml. 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. Corresponolence-shal--mod bW mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM represent4*08 can also be G contacted at (910) 796-7215. No response is considered the some as no objection If you h" been notlfled by Certlfled Mall. WAIVER SECTION I understand that a pier; dock, mooring pilings, breakwater, boathouse, lift, or groin lnttst be set_ back a rninimum distance of 15' from my area of riparlan 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. ,Vk;e— I do not wish to waive the 15' setback requirement. (Property Owneik n ormation) - _ (Adjacent Property gwraer i orrnatton) b'igitnlrmc, Signature Print or Typio Nome Print or Type Name Mailing Address Mailing Add � ss � - -�—•-� ice--__-_----_.F- �� City/State/zip Gify/Sty ip Telephone Number Telephone Number ■ 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: Cu 1--)-- "-I II I'IIIII I'll l'I I I I I I I I I III I' I II II II I it II I III 9590 9403 0603 5183 4328 68 2. Article Number (Transfer from service label) 7014 0510 0001 9271 PS Form 3811, April 2015 PSN 7530-02-000-9053 A. Signature <-::� Z' ❑ Agent B�e6ei e3'Fy (Printed Name) C. Dated L' Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: J9 No 3. Service Type ❑ Priority Mail Express@ ❑ Adult Signature ❑ Registered Mail— ❑ Adult Signature Restricted Delivery ElRegistered Mail Restricted ..Certified Mail@ Delivery ❑ Certified Mail Restricted Delivery JvReturn Receipt for ❑ Collect on Delivery Merchandise ❑ Collect on Delivery Restricted Delivery El Signature Confirmation"' ❑ Signature Confirmation 9036 restricted Delivery Restricted Delivery ' (Domestic Mail Only; No Insurance Coverage Provided) For delivery information visit our website at www.usps.com;., 1 p p ReturnReceipt Fee (Endorsement Required) $0.00 Postmark Here Restdcted Delivery Fee O (Endorsement Required) $0. u-I Total Postage & Fees $ 08/17/2016 O Se To o eer, Apr"No:;2` Jh �u C` or PO Box No. J �t(6L1 \4 1�1 C 2 '"� Domestic Return Receipt In CH C , ra rU rr�� GG fu Po>3tago Ir- Certified Fee $0.00 a . 66 13 Return Receipt Fee C3 (Endorsement Required) $0.00 f-3 Restricted Delivery Fee (Endorsement Required) C3 #fJ. rq Total Postage & Fees Lr) C3 Sen �- R c� ,-a Street, 4.1�0 M or PO Box No.-t) 1 S \ a h---------------------------------------------- ------ ■ 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: 111111111111111111111111111111111111111111111111111111111 9590 9403 0603 5183 4328 51 2. Artirlw Nnmhar Mransfer from service label) 7014 0510 0001 9271 A. Signature p X (La B. Received by D. Is delivery a( If YES, ente 3. Service Type ❑ Adult Signature ❑ Adult Signature F ❑ Certified MailQD ❑ Certified Mail Re ❑ Collect on Delive ❑ collect on Delive 9043 2� g2�5 11� 1� CG�ck a\"t'�11•e 7-TA A 0