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Home My WebLink About69220D - RussAMA / DREDGE & FILL ZN ERAL PERMIT Previous permit # A B ew - Modification [-]Complete Reissue ❑Partial Reissue Date previous permit issued rized by the State of North Carolina, Department of Environment and Natural Resources `' \ �I O -oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ? J / it A ❑ Rules attached. t Name �t AVA S 1(. Project Location: County a 'Vl �AA?J A V GL Street Address/ State Road/+_Lot #(s) .Sa V� State �ZjP -�" 12- `� (a Aj td�1wA Or-, C (�(f —) 'Ic i E-Mail SC� A �� C-(VM Subdivision ed Agent - Ci(o ZIP ❑ CW N€W APTA - ❑ ES ❑ PTS ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A ❑ PWS: yes / /176) PNA ye) / no Phone # ( ) River Basin Ly Vy Adj. Wtr. Body_ s V °�l I 1 �c r;Vf4- t /i Closest Maj. Wtr. Body Al lil/l�tJ ' Project/ Activity L U yl S1"VtiL--k- 1 :k) length Platform(s) US V ZZ315 igth a 2 1211 ■■■■■■■■■111i■■11M1:.NUGM ■"".19.91 mr ■■■O ■E11l1■■�l�■• ■■w■-MLZF.A ■n ■UNPIN MEMO Riprap length distance offshore nnn�s�lr■■n■MI��aMi's::�■I■�•�►��nl*e�r.!��■zis► �Eljrilwl■r!■rWii�■r�r■■�r.��l■•�■I�iw.RM�i��li■■�ill wool ■� iMl��i■■�■■I■ �■■■It1 m■ ■ ■�! ■0 r,ic yards 11MEMME■■■■1■■■■■■I■1■■■®■■■1■■�:■■■■P!1 1p ■MM■■MEEME■ mom ■'■I■■■ MEMO MEMEMEN ■■■■■■■■■■f ■■■■ ■ IM■■ ■■■■■■■■■■■■ ■■■M1 ■■ME ,■■■P■®■01■� ! ■ - ■■E■r■■■■r�■■ EE■EWEEM■■■■■� "EM■1MMEN M■■N ■■■■■■■■■■IEEEE■■■■■n 6Y1P ILWAHS 31MME ■■ONE ■MEiiil�■■ioil■ice :��;�■■■■1■■■■■ ■EMEMME■■■1■E■■■■■EMM ■0■■1■■■■®■■■■ ■ ■■■■■■■■I■■■■■■■■■■■■■■11EEMo®�■■■ ■■il■EM■■■■■1■■■■■■■■ ■■■■■ Elm Mr0�W1_ Mn�.■■MM■ ■■■■■■■■■■■M■■l1■ELjlili MEME■ -I■■ . ■■A■[INEE■■.■■E■E�11■■■■�ME" RNM■■■■oi■■ ■■MERE■■■■ ■■■■UZZLAM 11 IIl:1■■�■■■®■■■■ EMPI M■ ■■■EMi ■■MEN rZION�■®■■■■E■Mr■ECM■■■■E■ MEMEMEMEM11 ig permit may be required by: I ny-t b 1 SY ' V l —(i AA4&Sz 1 " ❑ See note on back regarding River Basin r4 -ocal Planning jurisdiction) 1 % o • / ,^ NC Division of Coastal Mgt. Habitat Impact Com Applicant: Otis ss 221 Date: 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 FII (Applied for. (Anticipated final (Applied for. (Ai DISTURB TYPE Disturbance total disturbance. Disturbance dis Habitat Name Choose One includes any Excludes any total includes Ex anticipated restoration any anticipated res restoration or and/or temp restoration or ter temp p/ impacts) impact amount temp impacts) arr C V 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 ❑ ■ 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, B. or on the front if space permits. 1. Article Addressed to: Agent by ((P�rinted Name) Cfate f Qelivery D. Is delivery address differlent from item 1 ❑ Ye: If YES, enter delivery address below: 'V0 3. Service Type ❑ Priority Mail Expresso I III' III II I II III I IIII I II I I I I I I I ❑ Adult Signature ❑Registered MaiIT'" ❑ Adult Signature Restricted Delivery ❑ Registered Mail Restricted 9590 9402 2021 6123 2852 75 ❑ Certified Mail(D ❑ Certified Mail Restricted Delivery Delivery ❑ Return Receipt for ❑ Collect on Delivery Merchandise 2. A•- - ^ • • . fr'—s , from sarvira /abe0 ❑ Collect on Delivery Restricted Delivery G Signature Confirmation- 7 016 0600 0000 5522 2086 CI Restricted DeliveSignature ry lion estricted Delivery )0-9053 Doryestic Return Receipt SHALLOTTE 209 SMITH AVE SHALLOTTE NC 28470-4732 3669920459 17 (800)275-8777 9:32 AM Sale Final ion Oty Price ass 1 4StiC) -FORD, CT 06437) jht:0 Lb 0.70 Oz) acted Delivery Day) Jay 05/19/2017) ad 1 1SPS Certified Mail #) 160600000055222086) 1 JSPS Return Receipt #) )0940220216123285275) 0ne1 Domestic .Mail Only For delivery information, visit our website at www.usps. tll !I� ° == ru ru iL Certified Mail Fee t $ 3 . ,a :5 1111 $ ' -7C Extra Services & Fees (check box, add Ln $3.35 ❑ Return Receipt (hardtop» $ ❑ Retum Receipt(electronic) $ �I1. 1lI1 C3 ❑ certified Mail Restricted Delivery $ 0 ❑ Adult Signature Required $ Y �� $2.75 r3 ❑Adult Signature Restricted Delivery $ Postage $0.49 C3 C3 $ Total Postage and F -0 C3 . 6.59 $6.59 .0 a ird Remitd $6.59 ED J Name:MasterCard) r` )unt #:XXXXXXXXXXXX4014) oval #:81734P) 1145� ill Postmark Here 05/16/2017 �t`-n`C----012i9wi5- ----------------- pt. No., -or-PS Box No. ------ SIP 4� a-QSL- .ix.��[__ �lC.__ ,,,z,W ( y3 7 u, N N N N N NNN NN' 0 0 0 0 0 0000 0. P?i N T n co co m'co cu- �a_mQ9mm'm m x = a _.2 a'o a I tp m 8 w m 1-11 8 �i�� N�� WI�� c N N N,N N N 0 0 0 0 0 0 OO O O C 00000001000� 000000iooao= 3 m M v 0 T -UooM Mv -01 xn > Mv o� m w w w xn�m a .rn W N N T N WIIT'T n C m 000W.M. 0 00 m x3 m M_ 0 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to Name of Property owner) property located at l �� 1�i IVr ,�,�� j , ; s L, `//o ,� i' J i (Address, Lot, Block, Road, etc.) onin 16 t'f l�i.'lr�!r�._.•clC N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above loco 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 drawin F WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set b minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to the setback, you must initial the appropriate blank below.) �lf� 1 do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner In rmation) (Adjacent Property Owner Information) Sign r,e Signature GGUU V�!!�G/�rr�/ �%� `- Print or Type W�me Print or Type Name ! �SZu K,,., zt?4 ��' xl ,� �.�IJ is Q— Als