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Home My WebLink About67934D - Jeffreys` .CAMA/,ZDREDGE & FILL �� GENERAL PERMIT ILL, -New Modification El Complete Reissue El Partial Reissue 7934 A B Previous permit # Date previous permit issued Drized by the State of North Carolina, Department of Environment and Natural Resources / f Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC O 1 / /zUO . �(` ❑Ruhe�. nt Named 1Y Project Location: County �Z; s (jt�� Street Address/ State Road/ Lot # s) � ifV State C 'mP G W S— j 1 1 61 AAAy' E-Mail zed Agent V-r 4't'�rrl d ❑ CW VIEW �CTAS ElPTS ❑ OEA //❑ HHF ❑ IH ❑ URA ❑ N/A ❑ PWS: Subdivision City 4'" t' _ ZIP Phone # ( ) River Basin Adj. Wtr. Body Yell✓,, i�" AL 7 I! Gt.ift/�iC, (� kacaie: 0 ■:■■■■■■■■■:■■1� 1ws�nT�■�►..■■cy� ■■■■■■■■■■■■m■ oil y1►t■�/■■■�r��rl�■■0 NNE length urnber vg distance offshore■Lil�il■i�ii%li5iii■■:■■I .-tax distance offshore sqnnel ■■■■■■■■■■■■�■■I■:■11■■■1r■■■■w■UK■■■ ■■■■■■■M■■■:E■IN■::11■■W a Oi3a�1,'LI■■■ EN OM■1 ■■■■■ N■■■1 ii■MG■■■■■■■■■■■ ■�I■■■t�■■■■�■■I ��■11■■■�■■■■■■■■■■■ �IONE ■■■�■■■MEMO0111■■�MEE ■■E ■■■■■ NNE ER lubic yards' ME ME ME M EEO ■■■■■■■■■■■��t■■■� 1■11■■N■■■:1■■■■■■■ ■■■■■■■■■■■E1:N■■■M I■11■:■:■■M■■■■■■■■ ■■■■■�■■■ F' ■■■M1■11■■ ►rrr5 J7-Y■),rFwT!I■■■ ■■■■ ■■tom■■■■11■11■■/J�i■it■■■■■■■■■ ■�■■■■■�_- mmop■�■■■ ----------- -- - -� -_�_- �._._.�___ ■MMONS ■ram ■i■ ■■i��;i ne Length not sure yes �41MWMFI ■n■■1��■En■■ f■®■■■■■■ ■o.��:�i■ ■�■■■■Swiss li■®■■■1�7■■I�H■■■�■■Lim■ ■f■ ":■■■■■■■III 1::��'J■■■■■■■■■■ ('-_�l --- ing permit may be required by: See note on back regarding River Basin I nral Plannina hiristiirrinn) NC Division a) Applicant: Date: d - Describe below the HABITAT disturbances for the application.: L All values should match the name, and units of measurement found in. your Habitat code shoot. TOTAL Sq. Ft. for. FINAL Sq. Ft. (Anticipated final TOTAL Feet (Applied for. FIN (Ani DISTURl3 TYPEDisturbancetotal (Applied inclades any disturbance. Excludes any Disturbance total includes. disti Exc, Habitat Name Choose One anticipated restoration any anticipated restoration or rest tern. restoration or temp im • acts) and/or temp impact amount temp irri acts amc O� Dredge ❑ Fill ❑ Both ❑ Other Dredge ❑ Fill Both. ❑ Other [] Dredge ❑ Fill Both .❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other F1 Dredge ❑ Fill❑. Both ❑ Other ❑ Dredge. ❑. Fill ❑ : Both ❑ Other. ❑ .. Dredge ❑�F!�Bo❑' '..;:. Other 3ayment Proccessing Confirmation Date Received 11/14/2016 heck From (Name) Jane D. Jeffreys Name of Permit Holder Jane Jeffreys Vendor BB&T Check Number 9350 Check amount $600.00 Multiple Permits No Major/Minor Permit Number/Comments GP 67934D Receipt or Refund/Reallocated JD/3404D NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Pat McCrory Braxton C. Davis John E. Ski Governor Director Secre AGENT AUTHORIZATION FORM Date: Name of Property Owner Applying for Permit: Name of Authorized Agent for this project: J ij tie D. tight house .Muliu avu l E i Owner's Mailing Address: 604- Phone Number p gf1l) Agent's Mailing Address: Phone Number�r� �d I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct the following (activity): For my property located at tu Maw( T`Pvrace SuY4 This certification is valid thru (date) 1 Property 0-4nekkigna4re Date ADJACENT RIPARIAN PROPERTY OWNER STATEMENT hereby certify that I own property adjacent to Alin e-- -9, f q Svc ((N me of Pr perty Owner) property located at mV) Cry fi` f I Tt' (Address, Lot, Block, Road, etc.) on , in �,(�l' ) &(— , N.C. (Waterbody) (City/TownAnd/or County) The applicant has described to me, as shown below, the development proposed at the abov( location. I have no objection to this proposal. 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 understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groi must be set back a minimum distance of 15' from my area of riparian access unless waived b me. (If you wish to waive the setback, you must initial the appropriate blank below.) %t I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) Si a ure T' Jam. Print nr Ti/no Alamo (Adjacent Property Owner Information) i Q ure 2ff400" rint nr Tvna lama ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to 1 )��`�i�i�i��J f T"I ► `� U� 's (Name of Property Owner) property located at O t I'o yace (Address, Lot, Block, Ro d, etc.) on , in Lot, 4 N.C. (Waterbody) (City/To n and/or County) The applicant has described to me, as shown below, the development proposed at the above loca n. 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 groi must be set back a minimum distance of 15' from my area of riparian access unless waived b me. (If you wish to waive the setback, you must initial the appropriate blank below.) do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) (Adjacent Property Owner Information) &-yd 1 SiIture Signe �.- �� Jane