68090D - Trask

CCAMA /r DREDGE & FILL 8096 A B
3ENERAL PERMIT Previous permit#
?New JModification ❑Complete Reissue El Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources I.
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:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 01 f� 1 160 r V_(_
❑ Rules attached.
t Name
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NC DiVISIOn Of COa� ital .Mgt. Habitat impact computer Sheet
Applicant: ��� ✓ ��
Date: 2 --
Describe below the HABITAT disturbances for the application.
Ail values should match the name, and units- of measurement found in. your Habitat code sheet.
Ft FJMAL Sq Ft TOTAL Feet FII
Habitat (dame
DISTURB TYPE
Choose One
Dredge ❑
Fill ❑
Both ❑ 01
Dredge ❑
RNABoth
. ❑ 0'
�V
Dredge ❑
Fill ❑
Both ❑ 0
Dredge ❑
Fill ❑
Both ❑ 0
Dredge ❑
Fill ❑
Both ❑ 0
Dredge ❑.
Fill ❑
. Both ❑ 0
Dredge ❑
Fill ❑
Both ❑ 0
TOTAL Sq.
(Applied for.
(Anticipated final
(Applied for.
(At
Disturbance.total
disturbance.
Disturbance
dis
includes ahy
Excludes any
total includes .
Ex
anticipated
restoration
any anticipated
re:
restoration or
and/or temp
restoration or
ter
ternim acts
im act amount
1. temp im acts
art
her ❑ (v U
her ❑ /� -

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: (o• [ms kJ r Tntsfee
Address of Properly: 1 I b Ca+rt�(t u I� UG{� Tv�S�i i etchr N 4q 5 PeA er��
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Agent's phone #:
Mailing Address: _
( 20 Z UAStWot ) d f2d
N, ZFLf b3
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 rrovided with this letter.
rA[iiave no objections to this proposal. I have objections to this proposal,
J p p
If you have objections to what is being proposed, you must notify the Division of Coastal Management (ACM) in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. 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, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waivek f you
wish to waive the setback, you must initial the appropriate blank M C
`
�, ,./ lG1� M
(�"do wish to waive the 15' setback requirement. FEB 2 3 2017
I do not wish to waive the 15' setback requirement.
-- DCM WILM104GTON, NC
(Property Ow er Information)
Signature
Print or Type Name
1102, W-Kvwd 12d
(Adjacfi0k,property Owpdr Informa on)
01
-
Signature
A yNotreLu c �d� T�ustet�
Print or Type Name
Mailing Address
Mailing Address
�A� C A- wiz cos

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONN VIVER FORM
Name of Property Owner: �?- 0�I ToYd &•Tr4Sk 3r T�wsfet
Address of Property: 1(0� D �CcrD(I fIn dtA ptiA �jLGiG�1�NL zsgq, CPU�d-� �04a1
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Agent's phone #:
Mailing Address: 120Z'CaSf /o041 VA'
Uv G I sn i rz +off N6 2kq c J
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 Management (DCM) in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. 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, 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.) C E ! VE
-a4 I do wish to waive the 15' setback requirement.
1 do not wish to waive the 15' setback requirement.
FEB 2 3 2017
►/11 anon.
(Property Owner Information)
Signat e
Print or Type Name
(zoZ C-cq�wd V-d
Mailing Address
/n//7 L C
((Adjacent PropeOwnef Information)
Signatu e � /h
i
Print or Type Name
CD %1 ,e ,d r1 v e�
Mailing Address
W�1rn�ng��wl, N��03

"ECEIVED
EB 2 3 2017
NC
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