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Home My WebLink About64710D - Jenkins\'e' CAMA DREDGE & FILL � \' 11\ 64 x "ENERAL PERMIT Previous permit # ,New EiModification El Complete Reissue L-1 Partial Reissue Date previous permit issued ized by the State of North Carolina, Department of Environment and Natural Resources oastall Resources Commission in an area of environmental concern pursuant to I SA NCAC ❑ Rules attached Name PnKtA- t - :1e-N V- I r"'s 0 Fax # .d Agent Jc4'Z- (VA A CW �gW -'] PTA 1:1 OEA El HHF El lH El PWS: El FC: (es / "rio , PNA yes Project/ Activity N,length .�fs ❑ PTS 1:1 UBA D N/A 15 Crit.Hab. yes /`nn) Project Location: County Street Address/ State Road/ Lot #(s) I �: A - �h6-c- Subdivision �ACN s-,--tA City zip 7 9-4- Phone # )Rjver Basin Adj. Wtr. Body 71 6-P 5,4- 1 L- 5 1) 0 lJ P,> K-na-t Ir Closest Maj. Wtr. Body T&5 A, I L 5 c.) rZ, L (I (Scale:' It. Z mommommmME MEMEEMM MIEN= ■ mommoom ON momommmmmm ■11110 �:■■ MENIONE ON ommommoommion mommommmmo M iber M■EMOMMENEENOMMEMM C�50 Niprap length di I stance offshore ■�■■■�■■■:l�■�■■� distance offshore_� innel Womb MEMO WRIMUM2 M 0 MINE NEEMEM 1,Zards PUMM Ne■MEN0 mommommommon Boat 'MENNEN MENE M MM111M NoNo INS ■ ■■■us ■ �■rEM214001 MM1 MENNEN■MINSIM11 Er M 1911111111FIR MAM En■E■ommmi Emommommom 7rr4,Mm mmmmorili EM ANNE& M irrrrA 17: Lo F i M M 0 I&M�ll NNEE I IL F J MEN qVIE too 0 NUMUMU 17, IT A ,I No no 6111 mommmom momimm■ONEMMEN -I- No 1111111111110 MENEM No 0■NONE 0 M■MEN MEMO■ Nmmm ME ONE No 0 MEN MEMO ;m■■■�■■■■�■■■■■■ o MEo■■� NE =ME 1111110111111 OEM ME 0 MEMO i ° o _ `�° T. � o < p (b � NC Division of Coastal Management Cashier's Official Receipt 0 3 4 Date:. 2� i Received From: �'- `M1�11� C $ r`- t� Permit No.: Check No.: S r�' , �ilfx �P/4�/N 1 Applicant's Name: County: i Project Address: ,.y Please retain receipt for your records as proof of payment for permit issued. Signature of Aqent or Applicant:,' �1�� -f7`� -+�-% Date 1 NC Division of Coastal Mgt. Habitat impact Computer Sheet r-- f Applicant: 4jl!t /vIS Permit #. Date: 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 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 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/or temp impact amount) 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 0 Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Applying for Permit: `R /�-� AA 4 �A K, AIS Mailing address: Phone Number: 3A -�)-Y certify that I have authorized - AP_ Ai4 Cm , Agent / Contractor to act on my behalf, for the purpose of applying and obtaining all CAMA permits necessary for the proposed development of at my property located at r'oloiLC� in �� County. This certification is valid through Date (Property Owner Information) MaA act— X QLj4.� Signat e _M4kSAA 14lj-Yy/JS Print or Type Name Title CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner: / YhAsl)A Address of Property: %7 /ti�� i ��1 �(A (Lot or Street #, Street dr Road, City &"County) Agent's Name #: fjF 7 E P, %1ki-I)E -j Mailing Agent's phone #: Agent's email: Address: 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 (910) 796-7215. 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.) I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. .s a S'8--r- wa // (Property Owner Information) (Adjacent Property Owner Information) Signature Signature A A . 1 CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Owner: f2 o,&AA L , Address of Property: ,' t0ES�- (Lot or Street #, Agent's Name #: BF-7,Fk y-nuE/)U— Agent's phone #: Agent's email: r Road, City & County) Mailing /\J.� �s 46— Address: 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� 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 (910) 796-7215. 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.) I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. 5 f, 5,t,a-L" I (Property Owner Information) (A nt Property Owner I ormation) Signature