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Home My WebLink About66581D - VestalKCAMA / ❑ DREDGE & FILL I r� W% �E'IERAL PERMIT 1 Previous permit # A B New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued rized by the State of North Carolina, Department of Environment and Natural Resources II 11 �oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 4 �. p ❑ Rules attached. it Name `\ Project Location: County L""- ( K b] M Street Address/ State Road/ Lot #(s) 2 G1 �X -7(>nJ State ZIP ? \ 6 kJy ( 0 r^ r � ` �_. D) �C ' �3 E-Mail Subdivision :ed Agent City ` 1 ZIP ! ❑CW A DES ❑PTS Phone# SRiver Basin ❑ OEA ElHHF IH ❑ UBA ❑ N/A Adj. Wtr. Body o ✓1 G (nat ❑ PWS: Closest Maj. Wtr. Body 1�L1 yes / 6io) PNA yes r Project/ Activity _ /' I kk ck) length I atform(s) Platform(s)Q ngth tuber d/ Riprap length distance offs re uc distance shore cannel / sic s np Boatlift ulldozing ti,V MM �l La Rim N-VI (-r,(.{I (Scale: I": ►►Av►�.11ifl�1��lllllll�ISJI■�a��■ IN■■■-■■ri■li■UM Length ,a.►s.�r.►�ye:ram ��a�c�>•t•'��w�rwwww.S�rlla■ �►�1�/7■ %r!!1�1� 1 / ■ .. NC Division of Coastal Mgt. Habitat Impact Com Applicant:' � 6- / tal Date: V ( q /C G 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 FII (Applied for. (Anticipated final (Applied for. (Ai DISTURB TYPE Disturbance total disturbance. Disturbance dis Habitat Name Choose One includes any Excludes any total includes Ex anticipated restoration any anticipated re< restoration or and/or temp restoration or ter ternimpacts) impact amount) ternimpacts) arr Ov Dredge ❑ Fill ❑ Both ❑ Other g (� O Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other 0 �v.v. AGENT AUTHORIZATION FORM Date Name of Property Owner Applying for Permit: MWtmg AGIUC"% r--- to act on � I certify that I have authorized (agent)% e ' for and obtaining all CAMA Permits necessary to behalf, for the purpose of applY'n C LJ U Q-K. install or construct (activity) 1, t� U at (my property located at) thru at This �� is valid /�� CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner: c 4: T(Lot or Street #, Street or Road, City & County) Anant'c Name #; 4Jrs1 Ucc/`-5 f4 ciz-kksj Mailing Address: r Agent's phone #: I hereby certify that I own property adjacent to the above referenced property. The individ applying for this permit has described to me as shown on the attached drawing the developm, they are proposing. A description or drawing, with dimensions must be provided with this lette have no objections to this proposal. I have objections to this proposal. Ifyou have objections to what is being proposed, you must notify the Division of Coastal Man agem (DCM) in writing within 10 days of receipt of this notice. Contact information for DCM office. - available aU. r,r,:,,www.nccoasrarmanagemenr.nevwerAlcrrvstatt-ustlna orbycalling 1-888-4RCOA 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. you wish to waive the setback, you must initial the appropriate blank below.) �s I do wish to waive the 15' setback requirement. t do not wish to waive the 15' setback requirement. (Property Owner Information) (Riparian Pr perry Owner Information U Signature Signature Print or Type Name Print or Type Name N 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: or Street #, Street or Road, City & County) Agent's Name #: ors ��'��5 l�, cl� sr✓ Mailing Address: 1� Z-- Agent's phone #: 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 ar� propo .ng. A description or drawing, with dimensions, must be provided with this letter. C 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. Contact Information for DCM offices is available at, I ttc:,; www.nccoastaimanagement.net/wetucnvstatt-itst/np or by calling 1-888-4RCOAST 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. (It you wish to 'aive the setback, you must initial the appropriate blank below.) 7 � I do wish to waive the 15 setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) Signature Print or Type Name / 3y 2 /--,\, �, L �-<,i AAnilirvv drWraoo (Riparian Property Ow r fgrmation) Signature Print or L7Name