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Home My WebLink About66677D - HerringCAMA / ❑ DREDGE & FILL � L" IENERAL PERMIT I 1/) / I � Previous permit # New ❑Modification El Complete Reissue El Partial Reissue Date previous permit issued ized by the State of North Carolina, Department of Environment and Natural Resources oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC I., "LVV —ElRules attached. Name \ . ka f Project Location: County -)'V j/O\N �t 4AVV Street Address/ State Road/ Lot #(s) t State ZIPX4wI k IIV) E-Mail Subdivision ---"' Agent < d ... !!!'��,��,J�o,I�(�1 City'\�� / ZIP �� i ❑ CW )(EW �TA ❑ ES ❑ PTS Phone # ( ) River Basin ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body , . Vk nat n ❑ PWS: res / no PNA yes /� Closest Maj. Wtr. Body A B Project/ Activity k)length :form(s) gth fiber I Riprap length distance offs : distance off innel I is yards P X Boatlift 1 Ildozing Length I. — not sure yes no um: n/a yes no ttached: ye -� no ig permit may Y q red by: .ocal Planning Jurisdiction) \ E (Scale:' r III Viiii 1= I I I1`I I I 't' I 11 :' I l I I I! ��T ❑ See note on back regarding River Basin ru NC'C9visdon of Coastal Mgt. Habitat Impact Computer Sheet Applicant: U l� wl� J�- Permit #: 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. Habitat Name DISTURB TYPE Choose One TOTAL Sq. Ft. FINAL Sq. Ft. (Applied for. (Anticipated final Disturbance total disturbance. includes any Excludes any anticipated restoration restoration or and/or temp temp impacts) impact amount) TOTAL Feet (Applied for. Disturbance total includes any anticipated restoration or temp impacts) FINAL Feet (Anticipated final disturbance. Excludes any restoration and/or temp impact amount) 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 [I Both C] Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ NO ViVis!On of Coastal Mgt. Habitat Impact Computer Sheet Applicant Pe'rmit #. 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. 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/ortemp impact amount) TOTAL Feet (Applied for. Disturbance total includes any anticipated restoration or temp impacts) FINAL Feet (Anticipated final disturbance. Excludes any restoration and/or temp impact amount) 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 ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both 171 Other ❑ N.C. DIVISION OF COASTAL MANAGEMENT AGENT AUTHORIZATION FORM Date z 3 114 Name of Property Owner Applying for Permit: _ n 1i A Mailing Address: 00 &bet.4- &-k- AL &J41136k tic AYV I certify that I have authorized (agent) G�4nt- gno&) to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity) Al. bV 11f+ /d-o� , at (my property located at) 045� This certification is valid thru date 'l P Property Owner Signature Date CENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to,- EqceV_'s Jf(N me f Prgpe Owner} property located at ayyn51�[CX � e2 �a��2 e6aoK� f arse .�1Z (Address, Lot, Block, RQad, etrc.) on F% c r 13ASW -- - in --- so")+' k ov-f N.C. (Waterbody) (City own and/or County) The applicant has described to me, as shown below, the development proposed at the above location. 1 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 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. (Pro erty Owner Information) 1.5l �11 t re -All 5 C—A-04— A -- Print or Type a e _� AW'--t-/J/Z (Adjaceryi Propedy-Ownei:,JIn Print or Type Na,�e ) Flo W l�rUh-c uIICJ S ADJACENT RIPARIAN PROPERTY OWNER STATEMENT � I hereby certify that I own property adjacent to _. (✓� f— C H I U� "s (Name f Pr pe Owner) property located at 1rvt15w1�. � T__ - baitqui 2 2_ (Address, Lot, Block, Roaetc.) on O-)4KIAr- 541�1&F — - in -- -- Sau l)or�— N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above locatio _ �-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 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. (PropAerty Owner Information) (Adjacent Property ??Owner In mation) aw" 7d l S.I.Q11titar, Si Print or Ty e Nam ,� / Print or Type Name ?n! 2 �n� /!/ ��vlC_ C-1 0 a 1-4 I/.,�_ ice"« f -), a�► 4e 2 Aj e ,