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Home My WebLink About67978D - Smith� CAMA / ❑ DREDGE & FILL f �, 3 ,9 i 8 3ENERAL PERMIT Previous pe7,97 r t#`' A B New �] Modification ❑ Complete Reissue ❑ Partial Reissue Date previous permit issued prized by the State of North Carolina, Department of Environment and Natural Resources Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC Q ? Tf . ' Z w ❑ Rules attached. it Name G• C'^c`eRvrTSrr, 4, Project Location: County Nw k a n oy-f< State /JL Zip E-Mail :ed Agent _-7—r: o \ ❑ CW XEW PTA ❑ ES ❑ PTS ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: yes no PNA yes l no, 1 f Project/ Activity C Once ,ck) length atform(s) Platform(s) X' iier(s) 0 :ngth tuber d/ Riprap length g distance offshore uc distance offshore cannel i bic yards np ise/ Boatlift ulidozing Street Address/ State Road/ Lot #(s) Subdivision City ZIP Phone # ( ) River Basin Adj. Wtr. Body "Nx '%& Y1 M � (nat / Closest Maj. Wtr. Body UNFOrN&L311 V. Nair, tjVIA Mi. own MEN Local Planning lurisdiction) (Scale: t� - 1 ❑ See note on back regarding River Basin ri NC Division of Coastal Mgt. Habitat Impact Computer Sheet Applicant: G-1 Permit #: Date: OZ�13�1�- Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement found in your Habitat code sheet. Habitat Name DISTURB TYPE Choose One TOTAL Sq. Ft. (Applied for. Disturbance total includes any anticipated restoration or temp impacts) FINAL Sq. Ft. (Anticipated final disturbance. Excludes any restoration andfortemp impact amount) TOTAL Feet (Applied for. Disturbance total includes any anticipated restoration or temp impacts FINAL feet (Anticipated final disturbance. Excludes any restoration and/or temp impact amount (J Dredge ❑ Fill ❑ Both ❑ Other l9 ✓ Cp �� 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 ❑ 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 ❑ Payment Proccessing Confirmation Date Received 1/31/2017 Check From (Name) Pippin Marine Construction, LLC Name of Permit Holder George Gregory Smith Vendor Wells Fargo Bank Check Number Check amount Multiple Permits Major/Minor $200.00 No 4145 Permit Number/Comments GP 67978D {BS3 Receipt or Refund/Reallocated 442D N.C. DIVISION OF COASTAL MANAGEMENT AGENT AUTHORIZATION FORM Date &z/_/ hk Name of Property Owner Applying for Permit: ,ell _ _ . Mailing Address: I certify that I have authorized (agent) r JA to act on r behalf, for the purpose of applying for and obtaining' all CAMA Permits necessary to install or construct (activity) at (my property located at) 77 `lam%` S This certification is valid thru (date) _Z99,1112 /;- /f i 116 Property Owner Sighiatuni Date CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner: Address of Property: /c //y�J (Lot or Street #, Street or Road, City & ell ` r Agent's Name #:1 f • MailingAddress: � 3 lGl l� Agent's phone #: q-17021 -r-Z0 I hereby certify that I own property adjacent to the above referenced property_ The individual applying for this permit has described to me as shown on the attached drawing the development they are pro ing. A description or drawing with dimensions Foust be provided withthis letter. I have no objections to this proposal. I have objections to this proposal. If you have objections to what is being proposed, you must notify the Division of Coastal Managemen (DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is available at http lfwwwi nccoastalmanagement netlweblcm/staff-listing orby calling 1-888-4RCOAST No response is considered the same as no objection if you have been noted by Certifited 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. (11 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. (P o e Owner Information Signature (i o G ri�G O r—y i'4'! rr ,Print or Type Name %EDPI CI-:- VY Mailing Address G P-.EENs P0><0 N 0 77 q-10 (Ri arian Property ner I io }/ Si ature r VJ 7� z Print or Type Name 7 Mailing Address CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Owner: Address of Property: �� l�i/.oh� /��/!� �l//�L✓JIVIGI/1Z� (Lot or Street #, Street or Road, City & County) Agent's Name #: ' / - r Mailing Address:��L,��OX Agent's phone #: 9l0 — �%/ —�� lG� y'1'�/� l' Yd t^ /U I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit has described to me as shown on the attached drawing_the development they are proposing. A description or drawing with dimensions must be provided with this letter. I have no objections to this proposal. _ I have objections to this proposal. if you have objections to what is being proposed, you must notify the Division of Coastal Managemen (DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is available at http://www nccoastalmana_qement netlweb/cm/staff-listinor by calling 1-888-4RCOAST No response is considered the same as no objection if you have been notified by Certified 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. (li you wish to waive the setback, you must initial the appropriate blank below.) I do wish to waive the 15' setback requirement. L� I do not wish to waive the 15' setback requirement. (P o e Owner Inform ion Signature 7, , C ri�r;0 n-y ice! 1T 1� Print or Type Name % Mailing Address AC 77�00 Citv/State2iD % - _ — t (Riparian Property Owner Information) Signature r �,• i�� z P i�a. v is Ky Print or Type Name �g Qt'tQP Mailing Address City/State/Zip Al 101