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Home My WebLink About69180D TopsailCAMA / ❑ DREDGE & FILL Q '.0-1 A B 1EN ERAL PERMIT Previous permit # New ]Modification ❑Complete Reissue El Partial Reissue 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 15A NCAC L E Rules attached. :Name-! c,05AIL kjA ► s CA V & t 1 N raw (l VC. - T)Pv e ),tF C/ State NC -ZIP �1�A"; 0) 328 E-Mail edAgent }�1)#-JT<'�fL �' ►1�9i' ❑ CW WW PTA G ES ❑ PTS ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: yes / tio! PNA /e7e-S)/ no f Project/ Activity rf; ; r7G%ate CSC- J ,ck) length atform(s) —Ty--e Platform(s) — IT[ mgth amber - id/ Riprap length distance offshore ax"distance offshore ibic mp use/ Boatlift 3ulldozing i ne Length �00 not sure yes — )rium: n/a yes — �: yes T Attached: yes ling permit may be required by: ll Project Location: County r-&-- %`Vc'Q Street Address/ State Road/ Lot #(s) I I I N. N,kA (Li V e )e Subdivision City5i)AF!��P l'1 ZIPS Phone # ( ) River Basin`2 Adj. Wtr. Body '��/i Closest Maj. Wtr. Body (Scale: Arl VI/ e� �/� see n� on back regard' River Basin complete items 1, 2, and 3. Tint your name and address on the reverse ,o that we can return the card to you. attach this card to the back of the mailpiece, )r on the front if space permits. lrticle Addressed t f A. Signature X � r ❑Agent ❑ Addressee B. Received Printed Name) C. Date of Delivery D. Is d4irvery address different from item 17 ❑ Yes If YES, enter delivery address below: ❑ No II I'II I III III I II I II I 'll II I I II I I I3. rvice ype 0 Priority Mall dU at 0 Registered aoASgnreO 9590 9402 1942 6123 3586 55 Signature Restricted Delivery 0 Certified Mall® O Registered Mall Restricted Delivery - 0 Certified Mail Restricted Delivery ❑ Return Receipt for ❑ Collect on Delivery Merchandise article Number (Transfer from service lahen ❑ Collect on Delivery Restricted Delivery ❑ Signature Confirmation - 7 016 1370 0002 2 610 4691 Mail Mail Restricted Delivery ❑ Signature Confirmation Restricted Delivery I l`�vci .DJ\4 Form 3811 , July 2015 PSN 7530-02-000-9053 Domestic Return Receipt NC Division of Coastal Mgt. Applicant: o a I Date: Describe below the HABITAT disturbances for the application. Habitat Impact COMI All values should match the name, and units of measurement found in your Habitat code sheet. TOTAL Sq. Ft. FINAL Sq. Ft. TOTAL Feet FU (Applied for. (Anticipated final (Applied for. (An DISTURB TYPE Disturbance total disturbance. Disturbance disc Habitat Name Choose One includes any Excludes any total includes Exc anticipated restoration any anticipated res restoration or and/or temp restoration or tern 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 0 Fill ❑ Both ❑ Other ❑ AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION .-r-- Name of Property Owner Requesting Permit: /QejA&, Z L&ArA� YAVif— C�U$ Mailing Address: / / / AJ6L?A / Z--,,J ba*yc- !5V94r-- Phone Number: ^le / �d� 3� -,Z (0 2 Email Address: ya-'Y rst-'-rsc. 'b YAC4xrc4u8_ CW01 I certify that I have authorized , Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: %t!T-2 Z baoyg:i- at my property located at /it in P45NO &A- County. 1 furthermore certify that I 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: Signature Print or Type Name Title JSPS.com® - USPS Tracking® Results Page 1 of USPS Tracking® Results FAQs > (http://faq.usps.com/?articleld=220900) Track Another Package + Tracking Number: 70161370000226104691 Product & Tracking Information Postal Product: Features: First -Class Mail® Certified Mail'"" Return Receipt See tracking for related item: 9590940219426123358655 (/go/TrackConfirmAction? tLabels=9590940219426123358655) DATE & TIME STATUS OF ITEM Remove X I Delivered See Available Actions LOCATION May 19, 2017, 3:48 pm Delivered EASTON, MD 21601 Alk Your item was delivered at 3:48 pm on May 19, 2017 in EASTON, MD 21601. JSPS.com® - USPS Tracking® Results Page 2 of DATE & TIME May 15, 2017, 6:31 am Available Actions Text Updates Email Updates STATUS OF ITEM Departed USPS Facility LOCATION EASTON, MD 21601 See More \/ u See Less ^ Can't find what you're looking for? Go to our FAQs section to find answers to your tracking questions. FAQs (http://faq.usps.com/?articleld=220900) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to 0 S SSLiIflYAakr 6t,Uj9 s (Name of Property Owner) property located at / / I Moto �'E c� i�vf't 2Dt2g7i.6fG— / , (Ac �dress, Lot, Block, Road, etc.) on - �: (y0w s ak-KN',,yLL) , in -- St/f-r �N.C. (Waterbody) (City/'Town and/or County) Th licant 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) • MovE fi>m (:,( a FAA. &0) 5 t/plus `l`�s 4-19-"j c-e s' yo 7zrf- /NC k6fralL 9QrPRo'� � rye=L-Y /S 'r-C f tT N-- r-rtc�- r>W-k 0// 7#f sou czr r:P • AOo 01Je o t-i-NG D V-k4 fA-C-A DocK on i7d-t 51ivr,,6 S lib � t)oo K • ADb 30 FooY- X 3 �-,r-XPArv'46 plea A3 F Ls � WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back 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. troperty u ner Information) Si na re vPS f'y- 5S14 4 Y Chu S Pnnt or Type Name 1 / I N090 Ak-*j Print r Type Name 0z AAnilinn Af4,4 en.. Information) v � � Mailing Address +h ►WOM/� I�'V� /KaDV� ¢ ► M It � y A6 04 �CO L)Qr J9n� SAOW VnvdU v .AA 13