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Home My WebLink About66631D - Wagnera. 1 �a*MA / ❑DREDGE &FILL 'ENERAL PERMIT Previous permit# A B N Qew ❑Modification ❑Complete Reissue El Partial eissue Date previous permit issued rized by the State of North Carolina, Department of Environment and Natural Resources � L -oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ; }C t �� ❑Rules attached. t Name �/k%t I 1 A�'� j�� Project Location: County 6, %V\ Ck A- Y\ �� V�Q 1 Street Address/ State Road/ Lot #(s) State,\J t ZIP��11 E-Mail Subdivision :ed Agent City ` a zip �f ❑ Cw"F01 El ❑ PTS Phone # (1�) 7 ' iver Basin LV (V El OEA ❑ USA ❑ N/A PW ❑ PWS: Adj. Wtr. Body_ &V\ (nat /I yes / t'° ) PNA yes / no Closest Maj. Wtr. Body Project/ Activity ck) length atform(s) Platform(s)�L ier(s) ngth tuber J/ Rip length dis ce offshore x d' ce offshore i nel sic yards ip se/ tli �\ Aldozing t C" L�� 1' I i �- CA 0. d (&A U'� 0 60 (k S (Scale: = c Length A G not sure yes no ium: n/a yes o v Y \ttached: � no ( 1 ig permit may be required by: 1G 0 * Oce ('L0 �SrC �� (ac Local Planning Jurisdiction) — — Al .,I—r — 11 I-\._. .li ❑ See note on back regarding River Basin rt WC Division of Coastal Mgt. Habitat Impact Computer Sleet Applicant: I�" "`��°� I Permit #: ) Date: Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen found in your Habitat code sheet. Habitat Name TOTAL Sq. Ft. (Applied for. DISTURB TYPE Disturbance total Choose One 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 fins disturbance. Excludes any restoration and/i temp impact amount) D W 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 ❑ Both ❑ Other [IDredge ❑ Fill ❑ Both ❑ Other ❑ A� d f) A NCDEN North Carolina Department of Environment and Natural Resources Division of Coastal Management everly Eaves Perdue Braxton C. Davis overnor Director Dee Freemar Secretary AGENT AUTHORIZATION FORM Date: La l L 'ne of Property Owner Applying for Permit: Narne of Authorized Agent for this project: y iIrVt ner's Mailing Address: uq fy IXI(+i A a U -P 1. 'aLY i Agent's Mailing Address: L to�- ►ne Number (q m) g I .� - 0 73 Phone Number (�qy )g 7/ �a T,;t— rtify that I have authorized the agent listed above to act on my behalf, for the purpose of applying and obtaining all CAMA Permits necessary to install or construct the following (activity): my property located at 1) 1 1 ,4 certification is valid thru (date) Property Owner Signature Dde (teach 2 gel HAND DELIVER ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER/MOORING PILINGSIBOATLIFTBOATHOUSE) I hereby certify that I own property adjacent to LVt 1 l ►g �- C n Ic�nLv,'s (Name of Property Owner) property located at , —3 I CLim b e r 1 C, i, / ST (Lot, Block, Road, etc.) / on , in o c eGn r�� 6t G(-h , N.C. (Waterbody) (Town and/or County) Applicant's phone 11: �t 3 Mailing Address: Y)tn� t� PL C He has described to me, as shown below, the development he is proposing at that location, and, I have no objections to his proposal. I understand that a pier/ nooring pilings / boatlift / boathouse must be set back a minimum distance of fifteen feet (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 not wish to waive I do wish to waive that setback requirement. ---------------------------------------------------------------------------------------------------------- - DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: (To be filled in by individual proposing development) Fo✓✓ Pi l r J �;,, L S J /,3 J CT c � wT Tv 13, xr l �c Ci C C_ 0 rCA r� ------------------------- ------------------------------------------------------------------------------------- (Information for Property Owner Applying (Riparian Property Owner Information) for Permit) Mailing Address Signature- �,- N c HAND DELIVER ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER/MOORING PILINGSIBOATLIFTIBOATNOUSE) I hereby certify that I own property adjacent to W, r, d Can 1f�+G 14� (Y.� 's (Name of Property Owne property located at (Lot, Block, Road, etc.) o n , in c Z ��' �� cc j , N.C. (Waterbody) (Town and/or County) �� pl t' bpi 7 Mailin Address: �`� /7'rarl ►nn�✓� PL Applicant's phone H. g He has described to me, as shown below, the development he is proposing at that location, and, I have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse must be set back a minimum distance of fifteen feet (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 not wish to waive Vz-I do wish to waive that setback requirement. ----------------------- ------------------------------------------------------------------- DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: (To be filled in by individual proposing development) Gi CGarc3(i r+� 1-00j,,Lie S �ro C lq /t"' 11 80cr L, �-r ,-t 3 V lc--rl .;i 1 7- 6t I h frcdc-// ---------------------------------------------------------------------------------- (Information for Property Owner Applying (Riparian Property Owner Information) for Permit) i oy Mcw iniy U'L )aL, --- Mailing Address ISO Signature