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Home My WebLink About66678D - RabonCAMA / ❑ DREDGE & FILL I � 1, s�> IENERAL PERMIT r�/ New ❑Modification ❑Complete Reissue El Partial Reissue A B Previous permit # Date previous permit issued zed by the State of North Carolina, Department of Environment and Natural ResourcesI� 1 :)astal Resources Commission in an area of environmental concern pursuant to 15A NCAC c t)y ❑ Rules attached. Name bl 111 ��% � Project Location: County ?xL Y ,` A `` Street Address/ State Road/ Lot #(s) " "� State ZIP `�tl ' �� 7►/ V' },;,.� �` � 10 Mail Subdivision ;d Agent City ,�',�'�a�?�•'� ZIP rkA ❑ CW 4TA ❑ ES ❑ PTS Phone # ( ) River Basin ❑ OEA ❑ HHF ❑ IH ❑ URA ❑ N/A C Adj. Wtr. Body J AEl PWS: ]i nat rr es I no 1 PNA Project/,A k) length form(s) 'latform(s) _ r gth fiber I Riprap length distance offshc : distance off sh innel 2 c yards Boatlift� Ildozing Length "— : not sure yes n im: n/a yes n yes p no (Scale: �� 2J ys n ttached: yes o g permit may be a ired by: `• ❑ See note on back regarding River Basin .ocal Planning Jurisdiction) NC Division of Coastal Mgt. Habitat Impact Computer Sheet Applicant: �I��; Permit #: DateLO a-�� Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement Found in your Habitat code sheet. iabitat Name DISTURB TYPE Choose One TOTAL Sq. Ft. (Applied for. Disturbance total includes any anticipated restoration or temp impacts) FINAL Sq. Ft. TOTAL Feet (Anticipated final (Applied for. disturbance. Disturbance Excludes any total includes restoration any anticipated and/or temp restoration or impact amount) temp impacts) FINAL feet (Anticipated final disturbance. Excludes any restoration and/or temp impact amount) Dredge ❑ Fill ❑ Both ❑ Other a�J 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 0 Both ❑ Other 171 WC Division of Coastal Mgt. Habitat Impact Computer Sheet Applicant: W&Mv) � Date: 0 Ira Permit #: (S U U-18 Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement `ound in your Habitat code sheet. iabitat 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/or temp impact amount) Dredge ❑ Fill ❑ Both ❑ Other L� 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 Q Other ❑ Dredge ❑ Fill ❑ . Both 0 Other ❑ N.C. DIVISION OF COASTAL MANAGEMENT AGENT AUTHORIZATION FORM Date '5 1(e 116 Name of Property Owner Applying for Permit: 1, IA&, AV P Z406i Mailing Address: I certify that I have authorized (agent) 66.1e JYI0.) to act on my behalf, for the purpose of applying for and obtainin[R 7,Jock- 11 LAMA Permits necessary to install or construct (activity) bvz� at (my property located at) 11) e lruo5wl cj< 4 This certification is valid thru (date) l 7 67-23 Property Owner Signature Date ?ERTY OWNER STATEMENT I hereby certify that I own property adjacent to__.(' (Name�Qf PrQp�erry Owner) property located at",,,wCN 5� TAT � �RGl boOC T (Address, Lot, Block- Road, etc.) on _ .� a _ i "+-- �; � - in J�Q(1q —, N.C. (Waterbody) (City/T wn and/or County) The applicant has described to me, as shown below, the development proposed at the above loca � 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) ® O 4 i� Pe - WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin must be se back a minimum distance of 15' from my area of riparian access unless waived by me. (If ish to waive the setback, you must initial the appropriate blank below.) V_ I do wish to waive the 15' setback requirement __ I do not wish to waive the 15' setback requirement. (Property Owner Information) Stu tA a, Prin or Type/N me y� ure P� or yypNam��7 Information) STA I hereby certify that I own property adjacent to M06-1 if— __-__ - {'111A3 s cL (N a of Property Owner property located at - Uy�S?t)l c��'�r-��Qt bCbK Q01 e ��Z (Address, Lot, Block, Road etc.) on --6t—b YAC� mt�i5�h1 -- �`' — -- ---------- sod?-i-� ----, N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above t?ion. fit_ _ 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) 1 � f i 1 ell �— 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) (Adjacent Property Owner Information) A/X"- � Si art rtur Si lZat ire"' PrPt of Type NarrW al Print or Type Name J wi, A. 1 ..✓..ri .�. 1 _- - . t