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Home My WebLink About69214D - Parker,LAMA / DREDGE & FILLA B ;ENERAL PERMIT �'� Previous p ermit # �Nevv ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued •ized by the State of North Carolina, Department of Environment and Natural Resources :oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC a > t'� �^ n Rules attar ed. t Name YI Gl V Project Location: County ` Street Address/ State Road/ Lot #(s) V 106 li=�V1� State ZIP_ __ r E-Mail Subdivision —r—�— :ed Agent V�sS�( GyrdlC Vt ZIP ❑ CW f�CEW pQ PTA ❑ ES ❑ PTS Phone # (TWO 0 J Rk r Basin ❑ OEA '❑\HHF ❑`•IH ❑ UBA ❑ N/A Adj. Wtr. Body G(, Vl (nat / ❑ PWS: ! 1 /LAL Closest Maj. Wtr. Body ding permit may be required by: ❑ See note on back regarding River Basin ■ '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. �icleAddressed to: A. Signature B. Received by e IM ., - Er -Agent ❑ Addre C. Dadof Deli D. Is delivery addressldifferent from item 1?10 Yes If YES, enter delivery address below: Ao II I IIIIII IIII III I I I I I I I I III II I II III I II I I III III d. JervlCe Type ❑ Adult Signature ❑ Priority Mail Express® ❑ Registered MaiIT'" 9590 9403 0603 5183 4333 15 ❑ Adult Signature Restricted Delivery ertified Mail@ ❑ Registered Mail Restricted Delivery ❑ Certified Mail Restricted Delivery � Return Receipt for ❑ Collect on Delivery . Merchandise 2. Article Number (Transfer from service label) ❑ Collect on Delivery Restricted Delivery ❑ Signature Confirmation- 7 016 0600 0000 8200 4822 ail Restricted Delivery lion ❑ Restricted DeSignature livery PS Form 3811, April 2015 PSN 7530-02-000-9053 nomestic Return Receipt Postal CERTIFIED o RECEIPT Domestic Mail Only C ARC] r W 27$1- 0 p Certified Mail Fee =3 • v5 � (472 fU $ ED Extra Services & Fees (check box, add fee �op(�/�gate) (_14 0 ❑Return Receipt (hardtop» $lr C ❑ Retum Receipt (electronic) $ SI . �� Postmark � ❑ certfied Mail Restricted Delivery $ $f�._ Here r ❑Adult Signature Required $ �� • r r� ❑ Adult Signature Restricted Delivery $ VC p0 Postage $U • 49 $ 04/25/2017 0 Total Postage and F s $ t6.59 .D Se _ C3 11 Street avi-ted Ap !V or PO Box N ipNS 2__v_ 7_VA 11 Cv t C 1 Domestic Mail Only - .. �• For delivery information, visit our website at www.usps.com `. ll ra US L- :io C roC- o n o c NC Division of Coastal Mgt. Habitat Impact Coml Applicant: I V � �' ��V Date: 0 5 b, "" A, 61- 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 FIB (Applied for. (Anticipated final (Applied for. (An DISTURB TYPE Disturbance total disturbance. Disturbance disc Habitat Name Choose One includes any Excludes any total includes Exc anticipated restoration any anticipated res restoration or and/or temp restoration or tern temp impacts) impact amount) temp impacts am Dredge ❑ Fill ❑ Both ❑ Other l 6 Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ � 4V NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management 3t McCrory Braxton C. Davis 3overnor Director John E. Skvarla, III Secretary AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FORM Date: Sf q / /7 ime of Property Owner Applying for Permit: n--,Ir eof Authorized Agent for this project: 4— � i <� � C _ VNSA vner's Mailing Address: 11,f,es (/: /4 ivy 2 El/ 7 lone Number (,70) 6 19- FSO � Agent's Mailing Address: Phone NumberNi() ) ,57T WY-) ;ertify that I have authorized the agent listed above to act on my behalf, for the purpose of applying r and obtaining all CAMA Permits necessary to install or construct the following (activity): Dr my property located at 91 his certification is valid thru (date) w s f 2 0 7 7 Property Owner Signature Date CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Owner: J�CX - Address of Property: U 1 (Lot or Street #, Str Agent's Name #: 1C\ C� ` -IISA ucvtk� q1 Agent's phone #: \MY V-I�_ �() �S -fin s� or Road, City & ounty)\ Mailing Address: 26W 1 hereby certify that I own property adjacent to the above referenced property. The individual applying for this_nermit has described to me as shown on the attached drawing the development they are proposing. 1 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. Correspotiti'otice should be mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM representetfvos can also be contacted at (910) 796-7215. No response is considered the same as no objection lf`y0a lop been notified by Certified Mail WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a mip^um distance of 15' from my area of riparian access unless waived by me. pf you wish to waive the ac , 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. (PrtyOwner Information) Sjgnalurc> Print or Type Name Mailing Address City/State/Zip Owner Information) ATAz Print or Type Name . jwl 4m,&d Mail' g Addres �C%C �-Rq2 City/State2i CERTIFIED MAIL - RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT �RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Owner. �� `` e\ �O(A� Address of Property. 1 w �, , �n ( (Lot or Street #, Str Agent's Name #: 1C\ Agent's phone #: or Road, City & ounty) c� Mailing Address: �R��' b11Og certify that I own property adjacent to the above referenced property. The individual applying for tlllis omit has described to me as shown ort the attached drawing_the development they are proposing. 6 ' have no objections -to this proposal. I have objections to this proposal. # ):,% have objections to what is being proposed, you must notify the Division of Coastal 1 Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to-127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM representativAerrrt..,a��ls,o be contacted atf910) 796-7215. No response is considered the same as no objection tty 0been 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. you wish to waive the setback, you must initial the appropriate blank below.) RNA/ I do wish to waive the 15' setback requirement. I do not wish to -waive the 15' setback requirement. (Pr perty Owner information) SigC\)k nature Print or Type Name Mailing Address �M& �� 1q( City/State2ip cent Property Owner Information) Signature Nnnt or type ivame v mailinglAddress City/State2ip VV w