69136D - Schoonmaker

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1A A"4 x
Ii.umucr
i amount
i t,omments
5/4/2017
Allied Marine
Meyressa
First
5465
$200.00
GP 69136D
Contractors LLC
Schoonmaker
Citizens
Bank

NC Division of Coastal Mgt. Habitat Impact Com
Applicant: Me- e- r` . S � N- tah -
Date: Oslo qf' I --;z,
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
FI
(Applied for.
(Anticipated final
(Applied for.
(A
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
di:
Habitat Name
Choose One
includes any
Excludes any
total includes
E)
anticipated
restoration
any anticipated
re
restoration or
and/or temp
restoration or
tei
temp impacts)
impact amount
ternimpacts)
ar
Q�v
Dredge ❑ Fill ❑ Both [IOther
Li8l
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

Name of Property Owner Regt
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
Agent I CmtmcWr
225�`�
to act on my behalf, for the purpose of applying for and obtaining all LAMA permits
necessary for the following proposed development:
at my property located at
�� _y�CCounty.
1 n _� I =-t r' � i J-
I
1 furthermore certify that I am authorized to grant, and do in fact grant permission
Division of Coastal Management staff, the Local Permit Officer and their agents to eni
on the aforementioned lands in connection with evaluating information related to tl
permit application. S"-;eU1
C
Property Owner Information:
Signature
rC.SSGL � �L�00h0-kCC. CY"
Print or Type Name
'
brnar-
ril t 86 �. Zq? 5
0Ci• A e r
Title

e p 1 0. 0 0, P A -, n_ t -
_ -Irn prnn i p
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property:
P �- d6�r, �r �k
5
or Street *, Street or Road, City & County)
Agent's Name #,. /%iar,,to, (�,Ihakj ULNlailing Address: % "<H Clo•*I�
Agent's phone #: -a 5,)* Pa,�j r� jG ra? :av -V .3
hereby certify a own property adjacent o the above referenced property. The indi ua
applying or this permit has described to me as shown on the attached drawing the development
they ar proposing_ A deschotionordrawing, with dimensions.must be arovided with this lef#er.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you mustnotify the Division of Coastal Management
(DCU) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
avaiiableathrtp_;'www.nccoastafmanagement.net1weblcmistaff-listin orbycallingl-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certied Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.
4(Property Owner Information)
Sig ature
�� " yr C-& .S uz �'� J GC,, 0 ('D t t t L a ICr lr
Print or ype Name
.), 0 q 0 R c:, "6 w I� -) V-
(Riparian Property Owner Information)
Signature
S6�
Print or Type Name j�

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
ru of Property Owrwr. !1W a <4rr .SimA
Idress of Property: k.a % We 1C4Y1
(t.ot or Sbvw a, Street or Road, CRY 3
Address:
phone-
terey own property adlacent to The above NWO—rOnCOd property. T-me inaNtaux
plyin9 this permit has described to me as shown on the attached drawing the development
AW
�y ar proposing.
i have no objections to this proposal. I have objections to this prapoW.
Rots have objections to what is bekig proposed you must notity tlta Oivftiorr Of Coasfei iltanapei"N't
CAI) in writing within 10 days of receipt of this notice. Conwo lnformadon for OC1M ofrices is
eilahie at htpv /lwww nccoasraimanagement_net/weWcmistalf listtn4 or by car 1nq 1488-4RCOAST.
re nse is considered the some as no objection if you have been mWfted by CerdW
AM
WAIVER SECTION
nderstand that a pier, dock, mooring pilings, boat ramp, breakwater boathouse, or lift must
set back a minimum distance of 15' from my area of riparian access unless waived by me. (if
j wish to waive the setback. you must initial the appropriate blank below.)
i do wish to waive the t 5' setback requirement.
I do not wish to waive the 15' setback requirement.
operty Owner Information)
azure ( r^
?t or type N eme
(Riparian Property Owner In1*n"d0n)
Signature
Flint br Type Name
o�ro ROYU- (( 3�

4 . _ _ I
A O . A 0 � �
DIVISION OF COASTAL MANAGE
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIYER FORM
Name of Property Owner. 411,46 te S4 Q # .5�ili
�--
Address of Prop: s� �� 91 b2cS
erty
(Lot or Street i#, street or Road, Clty &
G
Agent's Name # �r/%C� �%iar�,Q �4k-Mailing Address:
Agent's phone # /lam �2 �d J �t•� /1% -�-
own props adjacent o e above referencedprops . The individual
hereby the deve ant
applying for this permit has described to me as shown on the attached drawing
they are proposing. o imer '_must be orts.
/ With
!
d l have no objections to this proposal. W1 I have objections to this proposal.
N you have objections to what is being proposed, You must notify the Division of Coastal fj/anagement
(OCAOJ in writing lr �nnce4 ei'Sf ofreceipt
ac em p� nthelt/web ccm/staff $itstin o � ng 1-� 4RCOAST.
available at hr
No response is considered the sarrre as no obJectiort If you have dee�t notified by Cerrifled Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwati:;r, boathouse, or lift must
be set back a minimum distance of 15' from my area of riparian accii;ss 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.
_(Property Owner Information)
Sig ature
"- s
Print or ype N eme
a0go
(Ripari n Property r Information)
Signature
-.rodd �Y LL t --
Plint or Type Name
p 0. �o s
usUlnn Af**T#cc

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