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HomeMy WebLinkAbout67278D - Stout�CAMA DREDGE & FILL 3hENERAL PERMIT �Pr evious permit # New ❑Modification ❑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 15A NCAC ElRules attached. t Name Afr�, } �� Project Location: CountyA�1F',1,•-�Z�C Street Address/ State Road/ Lot #(s) State�Jc ZIP ' $ ��� -1D ! E-Mail - Subdivision edAgent ,,—\" M%'►�� city (,-ro 1 lAc tzrat k ZIP 2gqt, ❑ CW ❑ EW ❑ PTA XES ;-�PTS Phone # (ai o) -?Z Riv Basin (,-LA.& i ❑ OEA ❑ HHF ❑ IH ❑ URA ❑ N/A ❑ PWS: yes / '. l PNA yes / Project/ Activity 1l, ikk -i� c� `� v `Lh'► �v1 :k) length Platform(s) igth , nber 1 I/ Riprap length_ O t distance offshore K distance offshore__ annel sic yards ip ie/ Boat Adj. Wtr. Body (a b' �, at h Closest Maj. Wtr. Body ,M VAIV ✓, ��y7 L1 .s N�Hftwiki !'YAP Orm'.12? I & ( V ib1 SA.1 j�^_ (Scale: 1 :,- 4 ❑ See note on back regarding River Basin ri� NC Division of Coastal Mgt. Habitat Impact Computer Sheet Applicant: pt 5\-V J }— Date: Permit #: G-7 2-1 g—' Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremer found in your Habitat code sheet. TOTAL Sq. Ft. FINAL Sq. Ft. TOTAL Feet FINAL Feet (Applied for. (Anticipated final (Applied for. (Anticipated fin; Habitat Name DISTURB TYPE Disturbance total disturbance. Disturbance disturbance. Choose One includes any Excludes any total includes Excludes any anticipated restoration any anticipated restoration andl restoration or and/or temp restoration or temp impact temp impacts) impact amount) I temp impacts) amount) Dredge ❑ Fill Both ❑ Other ❑ 1 0 pc 66 D Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both [I 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 0 )ayment Proccessing Confirmation Date Received 11/30/2016 :heck From (Name) Jerry Mills Construction Inc Name of Permit Holder Mark Stout Vendor First Bank Check Number 1696 Check amount $400.00 Multiple Permits No Major/Minor Permit Number/Comments GP 67278D Receipt or Refund/Reallocated SF/2846D AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Weyie-t ►'�4-od- Mailing Address'.'-i w" Phone Number:��� - • �a� .� , Email Address: s I certify that I have authorized Agent / Contractor to act on my behalf, for the purpose of applying .for and obtaining all CAMA permits necessary for the following proposed development: 16ul k at my property located at in County. 1 furthermore certify that 1 am authorized to grant, and do in fact grant permission to Division of Coastal Management staff, the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information related to this permit application. Property Owner Information: Signature Print or Type Name CERTIFIED MAIL • RETURN RECQP T REQUESTE�0 DIVISION OF COASTAL MANAGEMENT ADJACENT 'RIRARiAIN PROPERTY OWNER NOTIFICATION/ AWER FORM Name of Property Owner: i' " ��G✓� Address of Property: (Lot or Street #, Street or Road, City & County) Agent's dame #: ?y ('--/ 1Mo.� �, Mailing Address: iv Agent's phone #: �� ' L'7� �'i3 • o 4i l hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit has described to me as shown on the attached drawing the development they are proposing. A description or drawing, with dimensions must be provided with this letter. I have no 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. Correspondence should be mailed to 127 Cardinal Drive Ext., Wilmington, PIC, 28405-3845. DCM representatives can also be contacted at (910) 796-7215. Ho response is considered the same as no objection if you have been notified by Certified Mail. WAIVER SECTION l understand that a pier, dock, mooring pilings, 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. (Proporty OwnT Ingortnation) �v jAd'acent Property Owner Information) U, C � � Signature Signature Print or Type Name Print or Type Name 0- 1 CERTIFIED MAIL - RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY 0WHER NOTIFICATIONIWAIVEa FORM Name of Property Owner: !NVY V-, -440U+ Address of Property: (Lot or Street #, Street or Road, City & County) Agent's Name #: Agent's phone #: �I'3• Mailing Address: yL�� G ocecr-� V\4c �U� .c� ��id 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 on the attached drawing the development they are proposing. A description or drawing, with dimensions, must be provided with this letter. I have no objections to this proposal. ^V I have objections to this proposal. If you have objections to whatis ,being proposed, you must notify the Division of Coastal !Management (DCM) in writing within 90 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext., Wilmington, INC, 28405-3845. .DCM representatives can also be contacted at (910) 796-7215. No response is considered the same as no objection if you have been notified by Certified Mail. WAIVER SECTION l understand that a pier, dock, mooring pilings, 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 trust initial the appropriate blank below.) I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Prop wrner Information) Signature Print or Type Name (Adtaqent Proper`ky ner Information) Signature Print or Type Name