69123D - Mobbs

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own

M�b�S NC Division of Coastal Mgt. Habitat Impact Coml
Applicant.,)*
Date: � 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
disl
Habitat Name
Choose One
includes any
Excludes any
total includes
Ex(
anticipated
restoration
any anticipated
res
restoration or
and/or temp
restoration or
ten
ternimpacts)
impact amount)
ternimpacts)
am
Dredge [IFill ElBoth [I� Other
pa D V
� 0
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge 0 Fill ❑ Both ❑ Other ❑

A,�`'��
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson
Governor Director
Dee Freem�
Secreta
AGENT AUTHORIZATION FORM
Date: 4-4-17
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
Betty Mobbs Will Richardson
Owner's Mailing Address: Agent's Mailing Address:
66 Porter Road 3235 Seacrest Ave. SW
Andover MA 01810
Supply NC 28462
Phone Number f 978) 604-1331. Phone Number( 910) 367-0335
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
Modification to existing docking facility. See attached drawing
(my property located) at 3555 Riverview Lane Supply NC 28462
This ce fication is valid thru (date) 6-17
Prope6 Owner Signature
Date

CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COAnAI., IVVA-NAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATErti1ENT
I hereby cer* that I own property adjacent to Betty Mobbs 's
(Name of Property Owner)
property located at 3555 Riverview Lane Supply NC 28462
on _AIWW
(Waterbody)
Applicant's phone #: [phone]
(Lot, Bloc'Road etc.)
, Supply N 284R
(Town and/or County)
Mailing Address: 66 Porter Road
Andover MA 01810
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
N.C.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(Individual proposing development must fill in description below or attach a site drawing)
Modifications to existing docking facility: See attached drawing
If you have objections to what is being proposed, you must notify the Division of Coastal Management (I)CM) in writ
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext Wilmington, N(
DCM representatives can also be contacted at [phone].
No res Douse is considered the same as no ob'ection if ou have been notified by Certified Mail
(Property Owner Information) (Ri arian Property OW7 information)
X, Authorized Agent 01
Signature
Signature
Will Richardson
Print or Type Name
3235 Seacrest Ave SW
Mailing Address
Print or Type Name
Mailing Address
Supply NC 28462
r,+— i Qf..4-e /'7--

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FORA PIERlMOORINGPZLPYGSIBOATLIFTBOATSOUSE)
I hereby certify that I own property adjacent to BettyMobbs ,s
(Name of Property Owner)
property located at 3555 Riverview Lane Supply NC 28462
(Lot, BIock, Road, etc.)
on AIWW , in Supply NC 28462 . N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: [phone]
Mailing Address: 66 Porter Road
Andover MA 01810
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
ial here 1;" i� I do wish to waive that setback requirement
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Modifications to existing docking facility
See attached drawing
(Information for Property Ovmer Applying
for Permit)
Will Richardson
Mailing Address
3235 Seacrest Ave SW
(Riparian Property Owner Information)^
Signature
L

Finger Pier
up 1 1 Oftx 1 bft
floating dock
iinum'Ramp
Existing Structure
Alk*N