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Home My WebLink About67976D - WillifordSJ'CAMA /❑ DREDGE & FILL YL 1 3 I C- 79 E C A B GENERAL PERMIT Previous permit# New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued wized by the State of North Carolina, Department of Environment and Natural Resources Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC �L+/. ) ()() , / Z00 t ElRules attached. itName o- ; U L. W. 11 1� d State&L(--ZIP Z$3Za 0 ! O) 5C 2_ 3; 3 I E-Mail zed Agent L, c,c� ( Qv-;,p� ❑ CW N(EW X PTA gES ❑ PTS ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: yes / no PNA yes 1 f Project/ Activity Project Location: County Street Address/ State Road/ Lot #(s) Subdivision Cityt�,i ZIP�"i' V Phone # River Basin[ , I j " Adj. Wtr. Body (' u �R (nat A Closest Maj. Wtr. Body r'-LLJW (Scale: )ck) length ■■■■■■■■■■■■■■■■■■■■�■■■■n■■■■n■■1 ■■■■■■■■■■t�:llli5li11liillll�iii■■■■■■■■■■■■I :mber■■■it■■■■■■■■■■■■■■■■■u■AW ■■■■■■■■■�■iallr■■■■■■■■■■n■■■■■■■1 ■■■■i■■■�I�I�Y�I�!''��,lllCY■■■■■■■■■■�■■1 ■Yi*I`:■■ ■Iiilliiwti�IN,�MI�!Y�I�1■■■■Y■■■■ o■■momi NEW ■■1 mummomummi ■M1:��11�■■■■■■■�EI§kLi■■■■■■■■■■■■■■■■■■1 Ei�■.�■■■■■�.�■1��■■■■ ■■■e■■W■■■■■Y'/■■A�■►�■■■■�■■■■■■■■■■■1 ■■■■■■■■■■■■ram■■� �■■■■■■i■■■■e■■■■■■■1 MUNI Ell 1�� _.■■■�■■■■■■■■■ - ■�■i■I�tli■Ifl■�� __ilk\■■�1■■■■/1■i[1lRI�!� N ■■■■■■i��11■��i■►Q!� �1�■■��iY�■■■■YLt.iR1f�?IiMA ■■■■iiiill�f■�1■!'�iii�:.� :.'��::�7■■/i��l�itlt�l� - . ■■_■Y■■■■■.■IET►d- � ■■N■■1 ��rr�e�I�t��.�3'i�!i�l�i!�"!'l:►J71��oAti�rr.�rla.�� Y'.'�w��1 ■■!�■■■■■■WEEMME■■DIY■ir■■■if►�NIIYi•�■��■■A r1w ■■ i1ii�Y Yam■ ■■ 1,1 �■■�� ■■■I11E■■11■� ■■■NO�■■■■■o■■■■�■■■■ ■■■■■■�■■■■■■■■■�■■ 1 Itii■■1■■1 ng permit may be required by: �� TY ❑ See note on back regarding River Basin r Local Planning lurisdiction) NC Division of Coastal Mgt. Habitat Impact Computer Sheet Applicant: t; v2 L , jni� ��; Permit #, Date: (.) r 13o j I -� 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 TOTAL Sq. Ft. (App)ied. for. DISTURB TYPE Disturbance total Choose One includes any anticipated restoration or temp impacts) FINAL Sq. Ft. (Anticipated final disturbance. Excludes any restoration and/or temp impact amount TOTAL Feet (Applied for. Disturbance total includes any anticipated restoration or temp impacts FINAL Feet (Anticipated final disturbance. Excludes any restoration and/oi temp impact amount Dredge ❑ Fillkf Both ❑ Other ❑ %Q 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 ❑ DredgeEl, 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 0 Other 0 )ayment Proccessing Confirmation Date Received 1/31/20171 ;heck From (Name) Lighthouse Marine Construction Inc. Name of Permit Holder Alice L. Williford Vendor Coastal Bank & Trust Check Number 1317 Check amount $400.00 Multiple Permits No Major/Minor Permit Number/Comments GP 67976D Receipt or Refund/Reallocated BS3438D Authorized Agent Form Date: - Z To Whom It May Concern, I certify that I authorize -eT�/,/J,QP�iyU to act on my Name of Agent behalf, for the purpose of applying for and obtaining all CAMA permits necessary for my project located at %01/ 'VA 5 Address Since ely, Property Owner I le-�-fZ-3221 Contact number ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to l cc G lwl�� 2 �, // (Name of Property Owner) property located at � � � T o (Address, Lot, lc Roa , etc.) �✓ on (Waterbody) (City n and/or County) The applicant 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 WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or grd must be set back a minimum distance of 15' from my area of riparian access unless waived t me. (If yo 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 Informatip ) Signature (Adjacent roperty Owner Infor n) Signature 7-�►�11e.,3 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to 4ve-x- L 's A (Name of Property Owner) property located at D %-r� (Address, Lot, Block, ad, etc.) on �T (Waterbody) (City/To n and/or County) The applicant has described to me, as shown below, the development proposed at the abov( locatign. 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 WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groi must be set back a minimum distance of 15' from my area of riparian access unless waived b 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) Signat e 4(114z I Fy 40 (Adjacent Prope Owner Information) Signature