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Home My WebLink About69128D - McKeithan11loT.liiiri"Wml4mrolMimi 1111P—VdAJIZ ;j�jaZMWj sl rndm�m Ma- ; oP DOE A FILL NO fi � 1�� a e c CD LAMA Previous permit # }E pF.RMIT pate previous permit issued }►.� `lM ificwon 'G+P�Ce°ss'� JPanal Reiawe ufhorq by th Sate of North Caroline. Department of EnYlrenment and Nawral Rasources ! �,0 the tat q rues Corn mist•an �w an area of emrlronmemal concern pursuant co 15A NCAC Rules oltachsd. '% _ " _ �y � �jl h Project Location: County. �� j'nu, - — - ilicarn Name } _ f r A y !4 Street �ir Strt Address( State Road) Lot #(s) Tress- _ - - State p Subdivlsiota .. }� -- } one # (��Uj ` LOW-) D�iv--m*t _ City M!. t1 �' "� (� V�i"/I� 71P A_V? fJ Ihorixed Agent .�(( fr - l ? / I`-f ! t GW X. Ew '�TA -! ES L PIS F'r ohe"# t t j �� ( � River Baslrt . pLT— mted L cW L HHF LJ lH -j unA fl Pb'A Adl. Wte. Rudy..— C) h'L�-sY c{f) I I taws: Closest MaE. Wtr. Body-- —� (VY: ya ! P1YA Ye v� l u p A r fPa � Project! Activiq _ IN r "Lk�MIC;hV1wcr (c --- —� FrxedPtrSiorm(Si _ - - I - Flvol,nK Platform(S) fir�inlength _ — - / ��i-- Iw lkhead! Riprap 1w ang dii—ce ars max dlswKs d+e►e Bamn.dut+wi +a! GYfi �� cubic Beach B+wtuaxing -- _ � � i _ 1�► [ � i Shor>l6ne �rs;th -_ I _ . n t, r i 1 �•c iu�vf Moruorlum rVa 7K werwrAtucmd: ^° � r � 5eo note on back rcgalydinY Rrver Bali n rules, i A bui Idkn permit maybe required by I O d (Note lflcai Planning �l,risdicti on) �j�- ( I J1•�•+ !/.-�vj 4/26/2017 ji'vdaliacl I 11VlUGl JRW RDW Corp. T/A West Enterprises (Rick Richard West) McKeithan r4umoer I amount I uommen s BB&T 1184 $200.00 GP 69128D NC Division of Coastal Mgt. Habitat Impact Coml Applicant: M Date: Describe bellow 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 FIP (Applied for. (Anticipated final (Applied for. (Ar DISTURB TYPE Disturbance total disturbance. Disturbance disc Habitat Name Choose One includes any Excludes any total includes Ex( anticipated restoration any anticipated res restoration or and/or temp restoration or ten telm impacts) impact amount) temp impacts) am Dredge ❑ Fill ❑ Both ❑ Other Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ rt Owner Requesting Permit: t ` `t �"�'c 1� Mz-- ` t`1 � Name of Property Mailing Address: Phone Number: Email Address: q 5,f `( G i 2 7 I certify that I have authorized Agent 1 Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: . ! '11i�t'T at mypropertylocated at in I' 7H G,,t''7 County. tw zr— i furthermore certify that I 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 on the aforementioned lands in connection with evaluating information related to this permit application. Property Owner Information: Signature Print or Type Name .— Title ADJACENT RIPARIAN PROPEM OWNER STATTEEMENTT I hereby certify that I own property adjacent to 'l� �,e' r'yC� � " "J 's (N e gf Property Owner) property located at �-3 i ` /�, u �` �"" (Address, Lot lock, Rooaad_�tc.) C .� r�l t7 L/0 1I , N.C. on � 7, c E. c.� � � in .¢ (Waterbody) (CitylTown and/or County) The applicant has described to me, as shown below. the development proposed at the above locatio � 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 descrlpdon below or attach a site drawing) ell, 5// > 1 WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin must be set k a minimum distance of 15' from my area of riparian access unless waived by me. (if yo sh 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_O erer Information) lgrrature Pr1nS ,off rype IV e J 4Z MIff 'd /�'ti� (Adjacent Property caner Information) l rin or ;'Pe PB' Miring Add srQ— s ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to �(N me of property Owner) property located at Al (Address , Lot,_ Lo k Ro etc.) N.C. in _� �ii /- // - on _ (Waterbody) (City/Town anti/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. 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) INAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, 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) (A 'acent Property Owner Information) .�iildfriUY2 Sin Print or Type Name Print or Type Name , �% `i " 5'%{ p 3��, ^ �1 r`. - -- �2 ► v7' 15 C No- l7� 7 L ne., a: A.lrJraco r, _ -&4T kf ,all r r<