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Home My WebLink About66520D - WickerCAMA / ❑ DREDGE & FILL t "! A B f iENERAL PERMIT Previous permit # flew ❑Modification ❑Complete Reissue I] Partial Reissue Date previous permit issued zed by the State of North Carolina, Department of Environment and Natural Resources �7cx>a )astal Resources Commission in an area of environmental concern pursuant to 15A NCAC Y Rules attached. Name tJi i'`t� G� '\V��` u\� f f Project Location: County Street Address/ State Road/ Lot #(s) Stattz ZIP 0 1'� 4^J . � O1 1�1 8`�) tl{C Ella I (mu r��`�` -�. Subdivision i /P► :d Agent 'ACity %x_-�( a^, C� ZIP v�, t C ❑ CVNEW '1 PTA ❑ ES ❑ PTS Phoi�}e 3Fk i b ) 6' L River Basin ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ WA Adj. Wtr. Body -� V) P t k nat n ❑ PWS: Closest Maj. Wtr. Body -f�� yes / no PNA yes / no,, Project/ Activity :k) length_ itform(s) _ Platform(s) ngth mber d/ Riprap length g distance offshc ix distance offsl- hannel bic yards_ mp ise/ Boatlift 3ulldozing w - - x ne Length not sure yes { no i i >rium: n/a Y no � es � y!V no Attached: yes no V 1 ling permit may be required by: m I nral Planning Iurisdictlon4% . 1 1 i 1 S/ i! (Scale: �� 1 ❑ See note on back regarding River Basin I W F: WE 6 IC Division of Coastal Mgt. Habitat Impact Computer Sbeet pplicant: I nd eL 1 /z'_�;" �41()4jljx' Permit #.- l �SIZU ate: 5 I escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement )und in your Habitat code sheet. abitat 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) JLAIJ 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 ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Applying for Permit: �4 a t— Mailing address: rc.r b/ C' - J-7�� Phone Number: / / 9 - 7 % — ?R�Z !�Z I certify that I have authorized d2rlL Al A er , Agent / Contractor to act on my behalf, for the purpose of applying and obtaining all CAMA permits necessary for the proposed development of d'C- at my property located at 3L l \ L1 \hj L 5+ o h inCounty. This certification is valid through /5 % Date (Property Owner Information) dc,- rgnature r Print orb a Name Title J�- /4- f' **j n I /_ ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to (A�'&l 14 14, Sid U2zc4L 's (Name of Property Owner) property located at 3 �� 5�' b of o k ; fN ��(Address, Lo lock, Road, etc.) on �i.X l S �`�-��— in �gAL. I s\ tad N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. 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) WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to waiv( the setback, you must initial the appropriate blank below.) / I do wish to waive the 15' setback requirement. y I do not wish to waive the 15' setback requirement. (Property Owner Information) (Adjacent Property Owner Information) 4 - a-4 1.4 )1 Si nature Slg/ l Gy//� / v lei 1nl c,(Lr✓ Print or Tye Ahme Pr' t or Type Name 01 -aEsow-4r-- I hereby certify that I own property adjacent to property located at (Name of Property Owner) 's - (Address, Lo I#lock, Road, etc.) n_e� on �aJJ�S l.�c 4— in o•� I Sl A r\ cL N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location 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) WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to waiv( the setback, you must initial the appropriate blank below.) / I do wish to waive the 15' setback requirement. v I do not wish to waive the 15' setback requirement. (Property Owner Information) (Adjacent P operty Owner Inform0 m) nature Signature wr Print or T e N me ypp Print or Type Name / LW