68011D - Howe

NC Division of Coastal Mgt. Habitat Impact Computer Sleet
Applicant: f rAA Permit #:1-
Date: d L/Z.C4/(_7
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet,
(Applied for..
Disturbance
total includes
any anticipated
restoration or
temp impacts
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
OLAJ
Dredge ❑ Fill ❑ Both ❑ -Other
2 Ct
Z
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 ❑
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 ❑

Payment Proccessing Confirmation
Date Received 1/26/2017
Check From (Name) JRW RDW Corporation T/A West Enterprises
Name of Permit Holder Frank Howe
Vendor BB&T
Check Number 1131
Check amount $200.00
Multiple Permits No
Major/Minor
Permit Number/Comments GP 68011D
Receipt or Refund/Reallocated SF 3497D

C,e�ae14
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: -f � 14 ,-, IL t C
Mailing Address:
Phone Number:
-' Email Address:
I certify that I have authorized
?c < f S 77
--
a
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at C.k'_ CF Z /4!�
County.
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:
I
Signature
Print or Type Name
Title

1 ^� n1 04.4-1
Q c e.H, X Sly 4%S
C!- 4a-
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:E—
Address of Property:
(Lot or Street #, Street or Road, City & County) //
3s
Agent's Name #: Mailing Address: �-;�' i
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 drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
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 Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at http://www nccoastalmanagement net/web/cm/staff-listing or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15from my area of riparian access unless waived by me. (If
you wish to waive the setback, you must initial the appropriate blank below.)
l I do wish to waive the 15' setback requirement.
k I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
(Riparian Property Owner Information)
Sigr azure
1
Print ar Type Name `
Mailina Address

.�.� , G' 1111U J.
name and address on the reverse
can return the card to you.
card to the back of the mailpiece,
ront if space permits.
:ssed to:
r
O Agent
x/L--J:b Addressee
C. Date of Delivery
As
D. Is deillvery address different from item 17 ❑ Yes
ff YES, enter delivery address below: ❑ No
B. Re ivHat V /Printati Na 1
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o aervlCe type
Q Adult Signature
❑ Priority Mall Express®
L dult Signature Restricted Delivery
❑Registered MaiIT"'
❑ Registered Mail Restricts
9403 0235 5146 9870 56
Certified Mail®
'ertified
Delivery,
Mail Restricted Delivery
❑ Return Receipt for
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❑ Collect on Delivery Merchandise
❑ Collect on Delivery Restricted Delivery DI Signature Confirmatir
Mail
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❑ Signature Confirmati, i
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Restricted Delivery
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1, AprO 2015 PSN 7WO-02-000-9m
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Domestic Return Receip
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