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