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Home My WebLink About69121D - GibsonKCAMA / ! _7 DREDGE & FILL ,L �A A B 3ENERAL PERMIT Previous permit# flew -]Modification JComplete Reissue El Partial Reissue Date previous permit issued_ rized 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 ❑ Rules attached. it Name v V I bsir In Project Location: County/YI ��7 K Street Address/ State Road/ Lott#(s) r ppi''G�� State 7 ZIP 31� ��t/�'1 A VO (0ST , ) 3 �S- V3 E-Mail Subdivision ""-- :ed Agent lM 1N 4 a� Wl k City I i� I �T u C f' 1 ZIP f P V� (1 j 0) � � — 11'� � River Basin L f ❑ CW A ❑ ES ❑ PTS one ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body (!L 0(nat El PWS. /i yes / poj PNA yes / A Closest Maj. Wtr. Body ,A1 M41 r Project/ Activity UnINUEF12", �i 1 ngth tuber d/ Riprap h distance i a distance cannel sic 1p i r se/ Boatlift 13 ,kl Aldozing h� 61 a Length 5,17 not sure yes cum: n/a yes _. yes kttached: �s no ig permit may be required by: QT I-Wenc!q ❑ See note on back regarding River Basin n -ocal Planning lurisdiction) _ NC Division of Coastal Mgt. Habitat Impact Comi Applicant: D(/1/ e �; I� S ✓i Date: 04"1 /ak6S . d t 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. (Ar DISTURB TYPE Disturbance total disturbance. Disturbance dis Habitat Name Choose One includes any Excludes any total includes Ex, anticipated restoration any anticipated res restoration or and/or temp restoration or ter ternimpacts) impact amount) ternimpacts) arc Dredge ❑ Fill ❑ Both ❑ Other L J 47� Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ tael F. -'asiey, (3o'ierror AG"A NCDENA -orth Carolina Department of Environment and Nlaturai Resourcas Division of Coastal Management Charles S. Jones, Director Authorized Agent Consent Agreement ,•:iiliam G.:.3css jr. �ecr eta; . M is hereby authorized to act on my behaif Pdrtec ,Vame of Agent) !er o tabtain any LAMA permits) required for the property listed below. The authorization, is !imited to the Fc activities described in the attached sketch. k-','?QN OF PROJECT: 'ER T Y OWNER ,'U1.4,11 .INO ADDRESS: ALL 3L75-a-7 rRIZED AGENT IMAt+ IAIG ,ADDRESS: PHONE NO. �40N= NO. 151t(C -Lw -- % - _ :re of Prcperzy owner. �.1. '— --v �� - -- ;re of Authorized Agent: rage 1 01 1210te-rr„ A Offek j,b5,00ta09 j7Ibi5IL�' (iF tJ. t�� tii, �•1:,�1hCrEV�\' r17= Name of Irdividuai Appi ,Ind ior F:rrz i;: ! o, ` f deress of Pry perty- is _ j. i Pi-,; t'1. lLot or Stree 0.-Stre^_:'ortRwid1— s t ,� � f• (City anc Coan;•) I hereby :W.iPe that I own Ncoper__ ac PUx.^,t to the a':o e-raferrnc:ed pru?enyT.e individual applying :ur :his ptirnit has describer: to me as shoc«t on tlu a!*a chcd s s,L: iag :lie dCVC,.URme:it they are p.-cpciing. da:c-i^tiun oz cta2t►rng, with ciznrr irA , s culd.}rc pmi idau x�:itit 'hip :ester V I have no nh'vuctions to "_::. p:-7ca$al. If you have objections tct w1rat is being propwed, please write the Division of Coastal i4lanngemeat 127 Cardinal Drive Extension. NVAIrnin;ton. NC 28405 or call 910-395-3900 within 10dstys of receipt of this uotiec. No response i:t consideredncr saine is no objechou if you haves heeu nutted by Certified Mail. ' ,kl'V'ER SECTION I understand that a pier, dark, mooring ptlings, :breakwater, hunt house or bosh lift inse5i be 46t bck a minimum disiance of 15' from my area of rfparisut acccss - unless waived by Inc. arvnn wish to waive the-Mbackr you uteri initial the appropriate clank below.) . I do ►vish To t{2?'. t'ei _ F setb'ica rcqu!re01GtT. 1 cc no: %x-LE!,. to waive the 15' scthwk nyuirerrten . r�4'-�� A� :step*,ene \umber S:`C^m.� s!:tis�r:rsrtaAprope:ri;•.frr r_`"'w. A., ,�.,, ,. - ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to ! p r� (;-t 628 s property located at on '0V/-Y10 yn t-- �1 (Name of Property Owner) (Address, Lqt, BJpck, Road, etc.) on , in �- �S , N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above locatic 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 bac minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to wa the setba�c�k,, you must initial the appropriate blank below.) ✓1k,1 do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) (Ad'. cent Property caner Information) Signature Sature j Print or Type Name Print or Type Name 6ff fi5 �"�u��G GPI T L <-- --- 0) �W l a � � 0