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Home My WebLink About69280D - RaifordEl NC Division of Coastal Mgt. Habitat Impact Comi Applicant: op'j� { gL{ Date: Describe below the HABITAT T 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 FII (Applied for. (Anticipated final (Applied for. (Ar DISTURB TYPE Disturbance total disturbance. Disturbance dis Habitat Name Choose One includes any Excludes any total includes Exi anticipated restoration any anticipated res restoration or and/or temp restoration or ten temp 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 0 Other ❑ AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: _JoN Mailing Address: 5-i` s PVC HaN A S Phone Number: "t 1 q - aa723 Email Address: (fA AV r_01 {'Orri cPq ('6) gmm* I . com I certify that I have authorized .r Wale (( r Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: �Oa4 J 4 at my property located at 4O5 �i�I in NC1�)_County. i furthermore certify that / 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: Signat /ImP(�A �f . A Print or Type Name QLUnPr Title 5 i O 2017 12:24PM HP Fax page 1 ADJACENT RIPARIAN PflOPERTY OWNER STATEM (E tNT I hereby certify that I own property adjacent to _.. dAl `� Agip (ift ft . '�( !�J. .9 (Name of Property Owner} property located at o } . / ( dress, Lo1�,81oc etc.} on _��_ , in , N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below; the development proposed at the above location, V / I have no objection to this proposal. I have objections to this proposal, DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Irtdiv/dual proposing development must fill In deacription below or attach a site drawing) See ct*allied draiwin j WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breaicaater, 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 Inttial the appropriate blank below.) I do wish to waive the 15' setback requirement. t1� I do not wish to waive the 15' setback requirement; (Pr party Owner Information) .Si rature / EIiA H d Pr' I orType lyarno ' I C S . -1 r- H i (Adjacent fro owner Information) A7 Ix- F 2017 12:24PM HP Fax page 2 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to AJQll 4 A ftl� e. to • Ka j�rd 's (Name of Property Owner) property located at i I nQ jP fn t1 ��f __ f (Address, Lod Block, Road etc.) on _ Yt! in' NO. (Waterbody) (CitylTown a d/or County) The applicant has described to me, as shown below, the development proposed at the above location. _V I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED D=UELOPMENT (Individual praposJng development trust fill in description below or attach a S100 "k) ��e ditached dracJi13 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 wis7 to waive the setback, you must Initial the appropriate blank below.) F 1 do wish to waive the 16` setback requirement. —5-4/ l not to waive the 15' setback requirement. ,(Pro,pe,rty Owner ! formation) Si ature PleA r Prim or IY06 Name MAt"fing Address /� 1SPOIPn 0Ai-;A V' Alf 1P `%' Name Owner Inform9alon) 2017 12:24PM HP Fax page 3 L/ 0 6t- ADJACENT RIPARIAN QROPERTY OWNER. STATEMENT I hereby certify that I own property adjacent to OQA '+ p G.Q. H. 912 Ar"l 's property located at i (Name of Property Owner) _ ZC , J (Address, Lod Bloc1 Road etc.) on y�J , In _� 4e 12,1,q N C. (Waterbody) (City/Town a d/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 DRAINING OF PROPOSED DEVELOPMENT IndlvidLatt osin dd b ro _> ... :. ,_ ( F A g ern9lopment r»test fill in d�scclpUon,eloiiaZ�rs>l�ii��`.�a�te at�wat�ll�lj Selo a1 fac led draIJ 113 Ppc't /VFW J' D tJN 12 ?017 T oN' )Vf� 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. I not � to waive the 15' setback requirement Property Owner Inform Ion) Print or IType Name e, 3 F 3' A4 7' g�4dQ e ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to J Arne(Ih H . f r(Z � s r (Name of Property Owner) property located at " (Alidress, Lot Block Road etc.) on T[ VU in % ,ne- f t"iorr V N.C. (Waterbody) (City/Town nd/or County) The applicant has described to me, as shown below. the development proposed at the above location - y/_ 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) See a+f aCCled Clr4ujlin q RECE " JUN 12 2017 DCM WILMINGTON, NC 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. I do not wish to waive the 15' setback requirement. (Pr perty Owner Information) Si rnrturr meiii;iH ; Print or Type Name �Jv I (( S (Adjacent �r�srlOwner Information) Si print Name �T ya i� �05 J,;g lead Fori-I 0 r 1 �T 0 JUN 12 2017 DCM WILMiNG N, �Ntw; 65 t� -F ADJACENT RIPARIAN PRpPERTY OWNER STATEMENT I hereby certify that I own property adjacent to u Q r„� Arna I;a �� ,s property located at I game of Property Owner) t on (Address, Lo Block Road etc,) in (Waterbody) (City/Town a dior County) N.C. 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) fee d1lached dra l03 NC JUL 12 2011 I SEC understand that a pier, dock, mooring pii ngs boatTaO p, 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. Owner I Aformation) la t Property Owner Info ation) or type Name Name t�'IPc /V,- J.?.1PY �05 �21 !e �,oj� S4- ou I DECEIVED DCM WILMINGTON, NC JUL 12, 2017 0 R ! V laxP pio�:ej f t afi �'j d' 6