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Home My WebLink About66525D - PacellaCAMA / C DREDGE &FILL WNERAL PERMIT Previous permit # A B New ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued ized by the State of North Carolina, Department of Environment and Natural Resources `` cc � 'oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC E"l . t l�Y ` (� j ��A ❑ R�ule/s� attach Name i/ii � L t�` _ Project Location: County 1r ?lf S1'Gt Street Address/ State Road/ Lot (s) State_ ZIP L! (P C � ` ` _i �J yL E-Mail Subdivision :d Agent CityZIP_C1 ❑ CW `(EW PTA ❑ ES ❑ PTS Phone # O River Basin ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body Ln a3r ❑ PWS: (es / no PNA yes / no Closest Maj. Wtr. Body. �A►!`'S1�1 rRGSQ�iT.i�►11\►N11�+�1� �� • w� wwww��w�. www_��www��.��ww�� (Scale:, ?-! ig permit may be Fequired by: _ocal Planning jurisdiction) , -- + 1 1 1 ('% See note on back regarding River Basin r 4C Division of Coastal Mgt. Habitat Impact Computer Sheet kpplicant:C��n(A/fj �j' [`(� Permit #: )ate: lescribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement )und in your Habitat code sheet. labitat 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/or temp impact amount) TOTAL Feet (Applied for. Disturbance total includes any anticipated restoration or temp impacts) FINAL Feet (Anticipated final disturbance. Excludes any restoration and/o temp impact amount) Dredge ❑ Fill ❑ Both ❑ Other Nk 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 [I Other ❑ Dredge ❑ Fill ❑ Both 171 Other ❑ I hereby certify that I own property adjacent to y,lt rS T-IX01111 s �of Ownerproperty located at�1 ve211. ) (Address.tt- Block.) on in 1�'ilLi1 N.C. (Wabwbody) (City own and/or County) The appfmmt has described to me, as shown below, the development proposed at the above 1 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 beilow 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.) o wish to waive the 15' setback requirement. `-I do not wish to waive the 15' setback requirement. (PrpRg11X0wner Information) (Adjacent Property Owner Information) Si#Qalure Beanrk Pit o TI a N8 it P t r yp Jame Majlinlp Address Mailino Addres!f _ P� '7� pw��, Ta-ak' -S I hereby certify that I own property adjacent to 111GrtW/ property rty located at 1 lQ} A Wcfj0M A \) e -- 7(W e. roperty Owner) o (Address, t, Blocic d, a .) `� on - � , in t V��S N.C. (Waterbody) (City own and/or County) The applicant has described to me, as shown below, the development proposed at the above location L�' I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must R111n description below or attach a site drawing) Cl 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.) tf_i1�do wish to waive the 15' setback requirement I do not wish to waive the 15' setback requirement. (Property Owner Information) , (Ad acent Property Owner Information) SiKalure i to Pri o T e Name Pnnt r Ty ame q� \ Il "A"T9 Addne I hereby certify that I own property adjacent to T0,CU)L 's ( a e of roperty Owner) property located at ��U�m �e Z(o (Address, L,pt, Block d, a c.) `� on , in Vti'i�15 N.C. (Waterbody) (City own and/or County) The applicant has described to me, as shown below, the development proposed at the above loc io I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must Hit 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. (Property Owner Information) djacent Property Owner Information) Signature •nat rc Pn%o T e Name, � Print or e Name L t� Cot IVty 7 k4ii V Adams i l 1r 7 S��lr <<- Maiknq AVdr�, d��.. � ;� � . fir. rr ., .� � . � ,� ,,, 1 .. r* � � � '- �. ��j CVeeL 'o �l w�- aStYel c�n,nlc 28�1�5