The URL can be used to link to this page

Home My WebLink About69065D - QuartonLCAMA / ❑ DREDGE & FILL PtA y `►� �ENERAL'PERMIT ew []Modification ❑Complete Reissue ❑Partial Reissue A Previous permit # 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 I SA NCAC 10 G r ❑RI hd t Name I n aS i b U e j frA 0,LA- 11,tDN VUCtS('1-V`1A I ra C1 I evu MID 1A State NL ZIP 2,� qo3 u es attac e . Project Location: County f �l Q ty ��/" � A Y10 V er Street Address/ State Road/ Lot #(s) U%L Pl r�-( ("OV t I- CIImo) 'V 171 U 3?u E-Mail T r�1 �n10-1 (,LV I - 1 W14 Subdivision ad Agent i-oy 01w I V1 Cir V Y� I �M•) lyl��-]'��"j ZIP ❑ CW EW PTA )US VPTS N Phone # (cl T 1 2 Q3 q River Basin 61t P ❑OEA ❑HHF ❑IH ❑UBA [I N/A j;Z,rA zif. I ❑ P�W-S:: des / l / PNA / no Project/ Activity L'y SiYu L j r va o o w aliyl wM :k) length ys1 X L tform(s) ! X Natform(s) er(s) igth nber I/ Riprap length ,distance offshore_ e�distance offshore is ip ie/ Boatlift Length Adj. vvtr. Body L (- 1C-Clnap it Closest Maj. Wtr. Body A! 1/W b 'PiPr and 1,7-x&11 ■l�l�iiiiisi�i�iiiwir (Scale: I A nrni Pinnnino I iiricriirtinnl ❑ See note on back regarding River Basin n Comments 3/29/2017 Wells Pippin Marine Thomas & Fargo Construction LLC Roberta Quarton Bank 4218 $200.00 GP 69065D NC Division of COastsl Mgt,, Habitat Impact Computer Sh"t Applicant: ",too Permit #: 0 (e $1 Date: Describe. below the HABITAT disturbances for the application. All values should match the name, and units of measurement foundin vour Habitat code sheet. et Habitat Dame TOTAL Sq, Ft. ANAL. Sq. Ft. final TOTAL Feet (Applied for. FINAL Fe (Anticipated final DISTURB TYPE ie (Applied for. Disturbance total {AntidRa ted diiurbance. Disturbance total includes disturbance. Excludes any Choose One includes any anticipated 6xdudes any restbraffon _ any anticipated rernp imionand/or temp pad restoration or tem ' ii ap'acts) andlortemp impact arnount) restoration or tern impacts — n amount f) Other v Dredge ❑ RI[ ❑ Both ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Other ( Dredge ❑ Fill ❑ Both . Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ 'Both ❑ Other ❑ Dredge ❑ Fill ❑ Both [I Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fm [Q Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Bath ❑ Other ❑ Dredge [IFill ❑ Both ❑Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ r)n--Arle F-1 Fill ❑ Both ❑ Other ❑ N.C. DIVISION OF COASTAL MANAGEMENT AGENT AUTHORIZATION FORM Date Name of Property Owner Applying for Permit: 111.�► �s � ��er�� C��-RTC 4J Mailing Address: i I r i �Ij I certify that I have authorized (agent) R { I pQl to act on my behalf, for the purpose of applying for and obtaining A taining all CAMPermits necessary to install or construct (activity) A b2 d at (my property located at) a 6 Y, !Q CT - r� t� -W At �-Nt � This certification is valid thru (date) 17, 31 I to Property Owner Si ature ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to -0019 IF►9a/ aUy1�9iJ�/� _ s f� n+, � n me of Prop�Owner) property located at Y �6� i' i� /" Im- (Address, Lot, Bload, etc. on �� , in c, o A) , N.C. aterbody) (CityrTow and/or County) The applicant has described to me, as shown below, the development proposed at the above location. L,,CI have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must rill in description below or attach a site drawing) WAIVER 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. L t— I do not wish to waive the 15' setback requirement (3Prarty OJw� r Inf rmation) (Adjacent Property Owner Information) 0m% �✓ Sigur� tl Sl * Print Val r l Print or Typ Name �l y i o L i i� r, ai 'rZg� Add (= ADJACENT RIPARIAN PROPERTYOWNERSTATEMENT certify that I own property adjacent to�=o D d C �� ,s ftl I hereby c fy � 'ertY ! L n property located at �aK � M t i � N of Property Owner) (Address, Lot, to , Road etc. on_ )*41 in N.C. aterbody) (City wn and/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) WAIVER 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.) 4*_ 1 do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Pro= 7ature tyM Print rn S Nan0C1M -/'/,,,,e GT— Mailing Property OwnerT-,O'Z,J'a4d-71L II o ation)) Sig1 to* 'I I e reo P 'nt or Typ e Mail' Address O Mail' Address ki-I„1G *10 / O---/ S'y A, -.4 T- T