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Home My WebLink About68568D - HoffmannCAMA / Ci DREDGE & FILL � N EMRALon Po R Complete M IT T55ue ,>8568 A B Previous permit # ❑Partial Reissue Date previous permit issued_ rized by the State of North Carolina, Department of Environment and Natural Resources / +j jj )) :oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC I L L'y ❑ Rules attached. it Name JA (?�� ;�� (:� f f Project Location: County V �t I I (I j 1 L V R�Viyyt Street Address/ State Road/ Lot #(s) I LI 2 - 0%1 (I f YYV( o 61 lo) State L_ ZIP 1 i l-1 l -034 E-Mail Subdivision O t i lm L Sh we1 :ed Agent Jt i'1AJ S 0()PLJ City I•L 6' L1 ZIP 'l EW I PTA ES ❑ PTS 'hone # () g' C� tifS�' River Basin OEA HHF /❑ IH ❑ USA ❑ N/A Adj. Wtr. Bod L S � i" f P ❑ Pws: y a� k3�� yes / no PNA yes / no Closest Maj. Wtr. Body A I VV w f Project/ Activity ' r` X (Q 1 yet I ill P i , (d I i (t X -I t yrd (mil Length " } _ 6 no no ig permit maybe required by: Ne W, 1-1 a ti c+ F' Y (O-m 1'l hi ❑ See note on back regarding River Basin n -ocal Planning Jurisdiction) AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Applying for Permit: -fg-65!N [je)FFMAti Mailing address: -7412 -7 P05f—=I MA,L Pr (✓III ! VON Phone Number: 9 l o S-I Z — nCI 74 I certify that I have authorized Agent / Contractor to act on my behalf, for the purpose of applying and obtaining all CAMA permits necessary for the proposed development of e jar li NC4=fK at my property located at %4 Z7 POSF-iDcmv, P-r- , in e uJ 14A&) OVE-Z County. This certification is valid through Date (Property Owner Information) Sign re ��sv�✓ �oFF�a>vy Print or Type Name Title lr) 1 10 1 -7,--) i--7 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to pes AnnMV 1 FFM ),t 's (Name of Pro erty Owner) property located at __ '%y 2 -7 P ,S-► Dpti Po/&.) y-- (Address, Lot, Block, Road, etc.) on Pi4F S 425EK in ��iL�I1A1C— fWL- N.C. (Waterbody) (City/Town and/or County) The7ant 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 DRA (Individual proposing development mys Ib 1". I silo 5-T ep 0 6X(V, 6OF PROPOSED DEVELOPMENT in description below or attach a site drawing) rid' WAIVER SECTION I 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.) do wish to waive the 15' setback requirement. Q I a I do not wish to waive the 15' setback requirement. (Pr erty Owner Information) (Adjacent Property Owner Information) Si nature U V j Inature I exr4fp.M0�1 Print or Type Name Ph t or Type Name . A A.:/:-_. A _1_ ._ ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to _ (Name of Proerty _I �� Owner) �JA# )V 's property located at _ _ %y P �� Pj�/ti> 7— (Address, Lot, Block, Road, etc.) on F/A&s <" e2Be►c in - jA11,Lt'1iA/t}�n� N.C. (1Waterbody) (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. "' cowf % SkK mkt -CA OK 1N2-31 I have objections to this proposal 'j ' YL Kc cbje0t ut' DESCRIPTION AND/OR DRAWN OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) C�. 10lt' L,.1 AJP I I V WAIVER SECTION I 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. (Pr erty Owner Information) Si nature Print or Type Name --74 Z-7 P, - Signatu e "(�-t_!� . ► I L)�ci Li ► 4 6l� 1 Print or T e Nam (040 � kurlAkv-la .��I� NC Division of Coastal Mgt. Habitat Impact Coml WVA Applicant: # l Date: tD 1711 R 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 Fit (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 ten temp impacts) impact amount temp impacts) am V) Dredge ❑ Fill ❑ Both ❑ Other 1 4 I v1/ 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 %,V1lSIl UlGUV11 LLIi ay MILA ldCl %acivC11CifA Kenneth Moyer YYCll* rGI V 0411K PNC Bank VY0.7 1494 .pvw.v $200.00 Vr VVJ/Dv GP 68580D Jv 1V1. — I — JD rct. 5073D Mike Williams Coastal Bank & Trusl 501 $200.00 GP 69269D JD rct. 4747D na Jones Jason Hoffmann PNC Bank 2878 $200.00 GP 68568D CS rct. 5107D ction Angela Smith BB&T 11619 $400.00 GP 68564D BS rct. 5332D