68040D - Huntley

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Comments
3/13/2017
First Permit 3 of 5
Allied Marine Citizens GP 68040D
Contractors LLC Justin Huntley Bank 5385 $1,600.00 @$200 BS r

� // �IIl[ 11 NC Division of Coastal Mgt. Habitat Impact Com
Applicant: Jv S41V 46jN ``�`e
Date: Q 312 q (i(
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
FI
(Applied for.
(Anticipated final
(Applied for.
(A
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
di;
Habitat Name
Choose One
includes any
Excludes any
total includes
E)
anticipated
restoration
any anticipated
re
restoration or
and/or temp
restoration or
tei
temp impacts)
im act amount
temp impacts
ar
❑ ❑ Dredge Fill Both ❑ Other (
b
3" Z
(
3 2 to
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 Requesting Permit:
Mailing Address. -
Phone Number:
Email Address:
I certify that I have authorized
�tis>Lr< �lu�lo�
(ors
!moo ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: scJL
at my property located at �r7 1;) /
in County.
furthermore certify that 1 am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
)n the aforementioned lands in connection with evaluating information related to this
)ermit application.
)roperty Owner Information:
Title

CERTIFIED MAIL RET RN RECEIPT REt�UESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOT FICATION1WAIVER FORM
Name of Property o er:
7
Address of Property: e o i _
(Lot or Street #, Street or Road, City 8 county)
h}!`
Agent's Name #: 7`1% yyJg • t !"A failing Address
Agent's phone #-r��_ryi
r?..
ere Y C41,3 t a own prope y a iacen o t e a ova re ranee prope y. e m Zvi ua
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawino with dimencEnns mutt be provided dm
letter_
_� I have no objections to this proposal. I have objections to this proposal.
if you have objections to what's 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 ofYices is
available at bttp:Ilwww.nccoastatmanauement ner/web/cm/stafi ttstma orby calling i 888 4RCOASi
No re-30*nse is considered the samp ac n ,
WAIVER SECTION
1 understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of t 5' 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.
(Property Ow Information)
„i
.Signa
Print or Type Name
Sly n i
Mailing Address
c;tyisrare/zip ,
Telephone Numberl Email Address
Date
(Riparian Property ne ,1 rmation)
.Sisnature
Print or Type Name
70 8 �q✓.t., ��
Mailing Address
/w
CitylStatel2lp
y11-60,1- 717f j r�yXa»C TItJ ��.Nv•J,%n i
Telephone Number/Email Add ss
-�-lS-I)
Vwe
(Revised Aug. 2074)

1, 2, and 3. Also complete
rd Delivery is desired.
and address on the reverse
iturn the card to you.t
;o the back of the mailpiece,
space permits.
D:
og9�Si
�737�
A. Signature
x C
B. Received
C.
D. Is delivery address different from item 1
If YES, enter delivery address below:
3. Service Type
O"Certified Mail
❑ Reglsterred
❑ Insured Mail
0 Agent
❑ Addressee
Of
❑ *
❑ No
❑ Priority Mail Express,'"
❑ Retum Recelj$ for Merchandise
❑ Collect on Delivery
4. Restricted Delivery? (Extra Fee) _-❑ Yes
7016 2140 0000 0834 7351
y 2013 Domestic Return Receipt

107,

PERMIT
Previous permit#
WENEKAL
New _.-Modification '..]Complete Reissue ..-Partial Reissue Date previous permit issued
As authorized by the State of North Carolina. Department of Environment and Natural Resources 7�
and the Coastal ResoytaetC"mm'sibn in an area of environmental concern pursuant to I SA NCAC � -) l: /
MPlkant Name 1 _
Project location: County 1 j[t+X _ --
Address NLV J I
Street Address/ State Rgadl Lot #(s) (1 _
City Staq6ZIPPPp
/��,
Phone - __ -- _
)
..
SubdNalott
Authorized Agent _
City- - ZIP_
a cw � fA on ❑ Rs
Phone # (__j- �' River Basin
Affected
AEC(s): ❑ OEA G HHP ❑ 1H O USA WA
Adj. Wtr. B
►ws:
Closest Maj. Wtr. Body.
ORW: yes no PNA / no'
Type of Project) ActMty
Pler 1—J Fixed ock)
Fixed lenjdt Ptadorm(s)
Floating Pluform(s)
Finger p,ar(s)
Groin lengthJ.fft
numberBulkhead/
%pavg
distmar
disB.
channecubic
yards
Boat ramp
t
-.
Boathou BoedMt _Y I-_.
.
—I
I
Beach 9ulldoit"
OcherShorellm
—
h'
&W not eta. yes no
Moratorium: n!a yes
Phocos: yes no
ii1n�
tv
Waiver Attached: yes no
ti•
�^
A building permit may be required by:,
( Note Local Planning Jurisdiction)
Notes/ Special Conditions.
y tw -
A Lu-i4eva ►�
Irt
V
_ i I
Ll� Ate. ❑ See note on back regarding River Basin rules.
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