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Home My WebLink About69074D - PinerCAMA / F:: DREDGE & FILL � W n." -�--A A B 31ENERAL PERMIT Previous permit # i New -Modification LIComplete Reissue L-1 Partial Reissue Date previous permit issued rized 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 tName F-ff f,1 Statet/C, ZIP 2,4`11-K6 7 F--Mail ed Agent _70 I (/Sf( El CW )9W �QFTA )NMS El PTS El OEA EJ HHF El 1H El UIRA El N/A 0 PWS: yes no PNA yes Project/ Activity -k) Rules attach Project Location: County C/Ptd 6�0 Street Address/ State Road/ Lot #(s) Subdivision City zip ZG Phone River Basin Adj. Wtr. Body A)4o) KZ( tlex-- na r Closest Maj. Wtr. Body (Scale: ■ EONLis MR "I'm W-Mom - I!! a WOMEN "WEEM., WE I ON No■MIMMMM1 MEE= moons distance offshore ■ 0 - Illiffillkiz. .1 1 i; WN In i 0 FT2 071171.9 M MR 0 ON M anon No MEE IN 10111 K distance offshore A!0■MEE■OEM ME I NINE annel MEN EMEMENE EMEL 16 sib 0. n I i'i wigII■M■■�■■�■�■E:�IN■ME P "N..in■MEME MOM N In E momommm■0 MENkgrJ. '-.V 1941W, p■FAMME -*1 B IME No■NONE■IN ON MEN M ME MENNEN No MEN M Iq-l; M, ■ No■10111111M 01110 No ON No Am Elm Wul 110010111111 Aldozing ME MEMO In EMENE EMEMEN■ME" ONE 0 ONEEMOMEEM MENEM Nmr,j ME MEMO 11MMMIMO0MW Emommu� ■ MMM0H11IIMIH1OM M 10110101110111 In■0■111100111111111 0 E■MEMO 0■MMMMMMOMMM MEMMEMN MENNIN MOMMOMMEMENES Length not sure yes MEMEMEN MEMOMMOMMEEMS 101 ME■mom■NONE■MENNEN NONE M ME MIME■MEMO MENEM IIIIIIIIIIIIIIIIIINKS im: n/a ye s efflnM ■NONE■IN IN■■M■MIN■�■■�■MIN■MIN■■■■■ ttached: yes IMMENEME■M1OMM0MM1MEM■MENNEENEEMENEEN g permit may be required by: 1J (-A ❑ See note on back regarding River Basin r .ocal Planning jurisdiction) NC Dil "S" 101i1 Q�',�Y��14� 98casal.,...� aasa Rno.,-.•— Applicant: 2. Date: r r r Describe below the HABITAT disturbances for the application. the name,.ancl units" of measurement found in. your Habitat code sheet. . All values should match TOTAL Sq: _Ft. FINAL Sq, Ft. TOTAL Feet FIN. (Applied for. (Anticipated final (Applied for. Disturbance (Ant disti DISTURB TYPE Dlsturbance.total disturbance. Excludesany' Excludes any total inaliades , Exc Habitat Name Choose One anticipated restoration any anticipated rest tam restoration or tamp im"acts) andlor%mp Impact amount restoration or tem irtr acts ! amc ❑l� f Dredge ❑ Fil Both ❑ Other Dredge ❑ Fill ❑ Both. ❑ Other Dredge ❑ Fill ❑ : Both .❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ElFill ❑. Both ❑ Other ❑ Dredge. ❑. Fill ❑ : Both ❑ Other ❑ Dredge El [IBoth ❑' Other El AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Mailing Address: oSl Phone Number: (0 N — 23 �1 Q Email Address: I certify that I have authorized __/j%&—'Z1 Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development:C- r o >J S qoa.e u N E-D L� at my property located at 4 in _.NU) County. 1 furthermore certify that l 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: Print or Type Name K( 0 L2) AJ Title ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to property located at� (Address, on OEL,2 , in, (Waterbody) rty k, Road, etc.) own and/or County) 's , N.C. The applicant has described to me, as shown below, the development proposed at the above locati I have no objection to this proposal. I have objections to this proposal. U""IPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill in description below or attach a site drawing, ,�q n1p IFtelf WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set bac minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to wa 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. irrvperty uwELA'7T"' Signatur�nr'L�vt� Print or Type Name jacent Property caner Information) ignature Print or Type Name I hereby certify that I own property adjacent to �r �� h ,, �; K AI is property located at ame of Property Owner) �, �ff (Address, Lot, Bloc , R ,etc.) on JtV � �.� � , in .C. (Waterbody) (City/Town a d/or Coun ) The applicant has described to me, as shown below, the development proposed at the above locati _,�,/ I have no objection to this proposal. I have objections to this proposal. utbcKIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing; A 09rieWd 12, to n6lo WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set bac minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to wa 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 Inf tion) �_-�-- Signatt�i Print or Type Name (Adjacent Property Owner Information) Si nature (2. w y) Print or Type Na e ii.Z a fi e n R,1-_-EX4 -C A AF,4- P. el),Pe snlv� rp,,eeq N4��,� cv6t�-( fob �.QReP pplpat$Ae /,0. �Ry