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Home My WebLink About68565D - Kowtoniuk•CANIA / DREDGE & FILL WNERAL PERMIT V ew '--Modification❑Complete Reissue I`, ��6'JfJ5 ❑Partial Reissue 1 A B Previous permit # Date previous permit issued_ ized by the State of North Carolina, Department of Environment and Natural ResourcesCi f, oastal Resources Commission in an area of environmental concern pursuant to I SA NCACy� f •' o Name —(l�c— _! Wyi O C Q< VWki State PA ZIP 16105 (bl-i) Z 3- 709 E-Mail ' !d Agent & V1 C DY1 �66 V VI ❑ CW XIEW PTA El ES ❑ PTS ❑ OEA — HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: ❑ Rules atta T. Project Location: County 47 MV (A) j Street Address/ State Road/ Lot #(s) 11 W I in Subdivision �J f Ctity SVVI (5�U('Q ZIP 7-9 1 , hoe (''(U)5 dI5 v� River Basin Adj. Wtr. Body nat fes / no� PNA yes / no Closest Maj. Wtr. Body AL Length I (i -7 not sure yes im: n/a yes yes no ttached: yes ,n g permit may be required by: O ,•M d SLM Y t a ( ❑ See note on back regarding River Basin ru .ocal Planning lurisdiction) .. , NCDE�IR North Carolina Department of Environment and Natural Resources Division of Coastal Management Pat McCrory Braxton C. Davis Governor Director AGENT AUTHORIZATION FORM Date: ame of Property Owner Applying for Permit: WA14r Kot.A)fon)(&lc- wner's Mailing Address: oZ 0 hone Number (g' a y 09 John E. Skvarla, III Secretary me of Authorized -Age t for this project: C�cuan Agent's Mailing Mailing Address: l� I � mac) \�--C:i 2VA Phone Number ) �S ,ertify that I have authorized the agent listed above to act on my behalf, for the purpose of applying obtaining all Dr my property located at install -or construct the following (activity): n({'( its certifca 'on is lid thru (date) v Vy\zyn Property ner Signature Date -- CERTIFIED MAIL, - RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIP RIAN tP�RfO, PE,kTY OWNER NOTIFICATIONNVAIVER FORM Name of Property Owner: l ACC' Address of Property----IftLl �n (Lot or Street #, Street or Road, City & County) Agent's Name #: Gr ICE' (k Ry) LLJiJ() Agent's phone #: Mailing Address:6 I � Dc` &crx,:T.4sIQ �ix� N( 2-6%G I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit has described to me as shown on the attached drawin t_ctc he development they are proposing. ev I have no objections to this proposal. I have objections to this proposal if you have objections to what is being proposed, you must notify the Divig' n of Coastal Management (DCM) in writing within 10 days of receipt of this notice. Corres a should b4i mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM represent can also be contacted at (910) 796-7215. No response is considered the same as no objection l%}beer— notified by Certified Mail. - — -- -- — 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 roust initial the appropriate blankb-e-Tow.) ----- -- Ckl WN I do wish to waive the 15' setback requirement. 1 do not wish to waive the 15' setback requirement. - (Property Owner � Information) �m 1 rip LCt9 A ignature — 1�.� � h; Print or Type Name 54-- Mailing Address ' tA�Y- n P 1 sq City/State/Zip ` 1W\-2�,c;,1)? Z (Adjacent Propeq.9-caner Information) S' naKire Print or Type Name 5J X1� 9(,� j9 N -- Mailing Address City/State,Zp 9 /ls c—:7-q L a 4 2 CERTIFIED MAIL - RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIP RIAN PROPERTYOWNER NOTIFICATION/WAIVER FORM Name of Property Owner: l G LIJ3 11 U — Address of Property (Lot or Street #, Street or Road, City & County) � t, Agent's Name #: C f ICE �hS�!`ta(,�1��1 Mailing Address:6BACK �N D(`" Agent's phone I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit has described to me as shown on the attached drawin th development they are proposing. I have no objections to this proposal. — I have objections to this proposal. If you have objections to what is being proposed, you must notify the Divi ' n of Coastal Management (DCM) in writing within 10 days of receipt of this notice. Corres : s should b4 mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM represent eon also be contacted at (910) 796-7215. No response is considered the same as no objection 00*0 eel - notified by Certified Mail. -- 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. (Property Owner Information) (Adjacent Property Owner Information) CLgerA ignature - -V Signature Print or Type Name Print or Type Name 2b\ &qc n"s S T/,: a 4-A tloo �L001 r `� Mailing Address Mailing Address phi- n� � SAGS °no re N C City/State/Zip City/State/Zio I h ol by � �S lea ■ Complete items 1, 2, and 3. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: �rri�j C�►1 � �� Ct a Iilll III IIIIIIIII II I I I IIII 9590 9402 2219 6193 1026 73 2. Article Number (Transfer from service label) _ 7017 0660 0000 7486 PS Form 3811, July 2015 PSN 7530-02-000-9053 Dostal Service'" TIFIFD MAIL° RECEIF Agent by (Printed Name) 4T'C. Date of Delivery D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No 3. Service Type ❑ Priority Mail Express® ❑ Adult Signature ❑ Registered MailTM El A ult Signature Restricted Delivery ❑ Registered Mail Restricted ertified Mail® ivery certified Mail Restricted Delivery Return Receipt for ❑ Collect on Delivery Merchandise ❑ Collect on Delivery Restricted Delivery ❑ Signature ConfirmationT I ^ ❑ Signature Confirmation 5111 Restricted Delivery Restricted Delivery estic Mail Only -■ elivery information, visit our website at www.usps.como- J Mail Fee $3. 3 5 ro 5 (13 � Brvices & Fees (check bo), add lee VpnWte) irn Receipt (hardoopy) $ vn Receipt (electronic) $ ! )..I_I Postmark E3 ifed Mail Restricted Delivery $ 7l • I �i� Here E3 it Signature Required $ $0 CID It ED It Signature Restricted Delivery $ 121 $0.49 ii9/17/'?017 1ostege and Bepps D 0 C3 o C\, 1f C/ EARL iPQ rq oxNo. W�-k r-� f� ■ Complete items 1, 2, and 3. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on tbeftnt if space permits. Domestic Return Receipt Postal , CERTIFIED Domestic Mail Only For delivery information, visit our SUNSET BEACHC"?F4b#•,' ,N Certified Mail Fee $3.35 7 l i472 $ 03 Extra Services & Fees (check box, add lee �ggrjete) ❑Return Receipt (hardcopy) $ Vla ❑ Return Receipt (electronic) $ �.( (f l l Postmark ❑ Certified Mail Restricted Delivery $jj.,rl ty Here ❑ Adult Signature Required $ $0.90 — ❑ Adult Signature Restricted Delivery $ Postage $! 1 � 49 $ 09/1 a/2017 Total Postage and FeQa rb. _t4 $ Sent o '` - �\ ` ( Si r N i i�O Boz h10 �_-- RSQ� � - - - ---- - ------h-------------- C' fate, ZIP+ a Z6 g r •, p Signat > =�4gent ❑ Addressee ece�d by tinted Name) C. Date of Delivery 1. Article Addressed to: D. Is delivery address different from item 1? ❑ Yes