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Home My WebLink About67274D - Mabry,I ;, LAMA / El DREDGE & FILL �� I a/i3�(e A B I iENERAL PERMIT Previous permit# Jew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued zed by the State of North Carolina, Department of Environment and Natural Resources )astal Resources Commission in an area of environmental concern pursuant to I SA NCAC �'r'f �• f f+ f ❑ Rules attached. Name V4 b<-v Project Location: County J E # a 'O VC -` �^a v ! E j-} n n State_ ZIP (4ff) 41 i ' 20 -'>� E-Mail :d Agent r, 0 lap i Y-\ ❑ CW ❑ EW ❑ PTA )(ES KPTS ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A Street Address/ State Road/ Lot #(s) Subdivision City simlrl-�411^ zip 28411, Phone # ( ) MALve1iBas. in — Adj. Wtr. Body_ ❑ PWS: Closest Maj. Wtr. Body 4S / no PNA yes /,'Ono AA, i � i �" Project/ Activity 2 n -rC -fin x A- F X' S-Lee Lu i kLX6 d 2 � f .� e �r t.Ja rci .� fi e�' S 6VXti J (Scale: I 0 ck) length — itform(s) I ❑ i J. Platform(s) ngth tuber d/ Riprap length �— g distance offshore ix distance offshore hannel I, bic yards_ mp use/ Boatlift 3ulldozing ne Length ioo I not sure yes I >rium: n/a yes no �✓ _..-..... - _.*-.-.... yes no Attached: yes' O> s X&+ Z , ling permit may be required by: tj C,,� A no% Local Planning Jurisdiction) S , ❑ See note on back regarding River Basin NC Division of Coastal Mgt. Habitat Impact Comp Applicant: �0.wErS� Date: ) Z 1 1 2 1 1 (� 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 FIN (Applied for. (Anticipated final (Applied for. (Anl DISTURB TYPE Disturbance total includes any disturbance. Excludes any Disturbance total includes disti Exc Habitat Name Choose One anticipated restoration any anticipated rest restoration or andlor temp restoration or tem ternimpacts) impact amount) ternimpacts) am( Dredge ❑ Fill Both ❑ Other ❑ O6 t�t Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ 'ayment Proccessing Confirmation )ate Received 12/12/2016 heck From (Name) Pippin Marine Construction LLC game of Permit Holder James Mabry ✓endor Wells Fargo Bank heck Number 4074 heck amount $400.00 Multiple Permits No Major/Minor 31ermit Number/Comments GP 67274D teceipt or Refund/Reallocated SF/3476D N.C. DIVISION OF COASTAL MANAGEMENT AGENT AUTHORIZATION FORM Date i 1',4' 1 (0 Name of Property Owner Applying for Permit: ONI 914gt Npl� 6 0 -5Q Olt 5 ��il �b o Mailing Address: ct-a l5rb�, S C. D9 y0! t certify that I have authorized (agent) ��' ,jh/7/� ; /V to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity) at (my property located at) I SDv S POI po ce (�v/ /►hlrt �1iN� Ak: ad W This certification is valid thru (date) i� 4w/p 14411 Property, _ ner Signature Date CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONiWAIVER FORM Name of Property Owner I Address of Property: ` � �x Agent's Dame #� � ��.� Mailing s4tfdreSS' //Zw Agent's phone #�l r 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 or the attached drawing the development they i are pr s _ing. 4 descr�otiort ar drav✓ir ,with dimensions, must sxovided with this letter. ,�_ have no objections to this proposal. 1 have objections to this proposal. If you have objections to what is being proposed, you must notify the Division of Coasts/ Management fDCMj in writing, wfthin 10 days of receipt of this notice. Contact information for DCM offices )s available at l7tW:11www.nccoastaimanagem mt neUweb/crn/staff-listing orby calling 1-888-4RCOAST, No response is considered the same as no 2 yection if you have been notified bE Certified )Mali, W AWER SECTION i understand that a pier, dock, mooring pilings, goat ramp, breakwater, boathouse, or lift must be set back a minimum distance of 15from my area of riparian access uniess waived by me. (it you wish tow a the setback, you r�,t ust inittal the appropriate blank Wow.) RECEIVE E ? do wish to waive the 15' setback requirement. DCM WILMINGTON i do not wish to waive the 4 5` setback requirement. (Property Owner lnformat)on) f, Signrd urc L Para# or Type Name � Cl v b, rzt,4 MeNng Address DEC 0 9 2016 (Riparian f-r,,operty Owner Information) Sigqature IJS-- 2 N eZ_ Prtr7t or Type Name �� 7 �15 c� E �D Mailing Address i, l CERTIFIED MAIL - RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Owner - Address of Property: (Lot or Street #, Street or Road. City & Agent's Name #: Agent's phone nty) Mailing /AddressQ,Q,� 112 � Y I hereby certify that I own property adjacent to the above referenced property. The individual applying for thi>I-Permit has described to me as shown on the attached drawing the development they are pro sing. A description or drawing,with dimensions. must be Provided. with this letter. 1 have na 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 (DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is available at„E:,,Iwww.nccoastaim_,anagentent.net/wehcny;faft-listinuorby calling1-888-4RCOAST. No response is considered the same as no objection if you have been notified by Certified Mail. WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.) 7do ish towaive the 15' setback requirement. ot wish to waive the 15' setback requirement. (Property Owner Information) Signcr ure Print or Type Name �! Cl y Mailing Address Crty/State/Lp (Riparian Property Owner Information) Sf,��natrrr- , Print or Type Name 15" S ov,..4,,-- Mailing Address v Crty/State2rp a `-n,47 �,) t)5 0 4t"-y 0 7s x'q ,)V.a m