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Home My WebLink About62672D - GrazeCAMA / F] DREDGE & FILL 3 3ENERAL PERMIT Previous permit# )New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued rized by the State of North Carolina, Department of Environment and Natural Resources ' A :oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC + •' �.. t Name's 'Q Rules attached. Project Location: County-1��VYiSY`n CiL I Street Address/ State Road/ Lot #(s) State ZIP �Q,� t ` 7" Q Yl ; (� 'y) Fax # O Subdiyision A ed Agent Ci �1 ti ZIP '2' 1 CW '_ EW -J PTA ES n PTS Phone # ( �, River Basin OEA HHF IH _ UBA N/A Adj. Wtr. Body � ✓ nat PWS: FC: yes / no PNA yes .1 no Crit.Hab. yes (no� Closest Maj. Wtr. Body A Project/ Activity " .L�, ` ' r V Z 1�L4 ula ock) length �/ m(s)i^ 0 length umber ad/ Riprap length vg distance offshc iax distance offsh channel ubic yards imp wse/ Boatlift Bulldozi ne Length J not sure yes gs: not sumyes no )ru,m: /a no ne -- .. _.. Attached: yes no ' ling permit may be required by: ---: -- = 11 _ I-)M n 1t ✓ (Scale: VA ❑ See note on back regarding River Basin n H f, 4, , r-7f, 1to A A L.,4, (, i/'4c,iInd-,n.E . Division of Coastal Mgt. Habitat Impact Computer Sheet dicant: ! C ` � Permit #: cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement id in your Habitat code sheet. dtat 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/c temp impact amount) Dredge ❑ Fill ❑ Both ❑ Other ('0l) O 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 0 Dot;estic"'Ma"fl Only; No Insurance Coverage Provided) Ir _a delivery Information visit our website at www.usps.come o MIAMI FL 33172 7 r%- ru Postage $ $0.66 0526 ru Certified Fee $3.10 12 M Return Receipt Fee (Endorsement Required) $2.55 Postmark Here M O Restricted Delivery Fee (Endorsement Required) $0.Q0 rI r,U ru Total Postage & Fees $ $6.31 OB/20/2013 rU Sent 'r%q r � V )l �--�----------- ` O Street, Apt. No.; or PO Box No. QD • ---------------- /�4V / o 2 � ------ acre City, State, ZIP+4 -- �Q �/ PS Form :r0 August 2006 See Reverse for Instructions ■ Complete items 1, 2, and 3. Also complete item 4 If Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. CD U Oho CO O lid C7 N U Z CID 1 °9U 0 O z LU 0 'J a \ r X ant ❑ Addre ❑Addressee B. 4C156ed (Printed Name) C. DEV of DeljArery D. Is delivery address d'rfferent from item 11 ❑ Yes If YES, enter delivery address below: 0 No 0 Y Q L) I l C 1. Article_ Addressed to: /4, AT NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management McCrory Braxton C. Davis remor Director AGENT AUTHORIZATION FORM Date: of Property Owner Applying for Permit: :r's Mailing Address: �LeffOfVta e Number(,,W) 5 /7q: _3r) 9' John E. Skvarla, II Secretary Name of Authorized Agent for this project: Agent's Mailing Address: YLL ar1V6�'S 471 Rd Phone Number 0) 51o? .3 - O V 9 fy that I have authorized the agent listed above to act on my behalf, for the purpose of applying d obtaining all CAMA Permits necessary to install or construct the following (activity): iy property located at /'/ y% C1/1) rOwiC,r L 41v :ertification is valid thru (date) L 47%/d /v� Pr erty Owner Signature Date CERTIFIED MAIL - RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner: 2-e� Address of Property: (Lot or Street #, Street or Road, Cil & County) Applicant phone #: )-7 411q` 7y% Q Mailing Address: Y/) %ALL-��V �� Cot' lx4, S i *At4 -Y CT, Dk S � 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. V 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. Contact information for DCM offices is available at www.nccoastalmangement.net/contact dcm.htm or 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, breakwater, boathouse, or lift 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. Xature Owner Info n) &114.6 6 -�- Print or Type Name 1 17q? C�,4wlck 6 rd Mailing Address _ Property Owneonformation) Je#5 Print or Type Name Lzndf� Aylg A ress CERTIFIED MAIL - RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner: Address of Property: J-191 NAufi' k- lvl '. �T (Lot or Street #, Street or Road, Cify & County) Applicant phone #: IX?-999 -3`i I Mailing Address: L/ /U 1 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. Contact information for DCM offices is available at www.nccoastalmangement.nebcontact dcm.htm or 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, breakwater, boathouse, or lift 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. !j,MA (PropedyGwner Info atio Sign llid+/L-�✓X� - A s2d-AeAleve Print or Type Name ?006 Cenhu) && W7oo Mailing Address (Riparian Property Owner Information) signature Print or Type Name Mailing Address I 4`1 ,JffW�, Ap c G� & A -A 11F, � L3 oil. IAIA I �D 2013 GoogIL GOOSIC