HomeMy WebLinkAbout65044D - MauneyAMA / ❑ DREDGE & FILL
ENERAL PERMIT Previous permit#
New CModification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources , y
-oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC N
91 Rules attached.
,t Name I � 1 OiiiJ t VI A VU LA Al !a U ff
COL 6k State` ,. ZIP 2 --�-J5 1
ii Fax # (_) :ed Agent 1; t C� F,1 t . , ('� b1 I h AdCk A
❑ CW n EW K PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWWS: ❑ FC:
yes 1.4o PNA yes / no Crit.Hab. yes /. n, o
f Project/ Activity
Project Location: County �U t a4� (A L
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ng permit may be required by: _,JAM MWE
1�
kl,-J� 64 -CL E]See note on back regarding River Basin r
,mplete items 1, 2, and 3. Also complete
-n 4 if Restricted Delivery is desired.
nt your name and address on the reverse
that we can return the card to you.
ach this card to the back of the mailpiece,
on the front if space permits.
cle Addressed to:
tiro' hi# • 6-74;e,} <-
north 7"
A. 3ature
X ❑ Agent
❑ Addressee
B. Received by (Printed ) C. Dat of (.livery
D. Is delivery add fferent from item 1'1Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Certified MaHO ❑ Priority Mail Express'"
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ Collect on Delivery
4. Restricted Delivery? (Extra Fee) ❑ Yes
de Number
nsfer from service label) 7 011 0 110 0000 8662 8403
rm 3811, July 2013 Domestic Return Receipt
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C* Division of Coastal Mgt.
)plicant: �CQ
ate:
i z l21 �
Habitat Impact Computer Sheet
`^ ��;h j(� AaUht�- Permit #:
Uv
�Sj `1 bit
:scribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen
and in your Habitat code sheet.
abitat 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 fins
disturbance.
Excludes any
restoration and/
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 ❑
NoMCal QmsDqmvnWaIQ 'i o i mnimdNatural Pwmu=s
okbim d coasm v - I
4 F- Eaday, Gomm :his IL
Au"forIARM Agw&COnsant Aipm a
9-%—
VAftI 6 FIN
is he" mAhadzed to ad onn
Wto fift, .83iy CAM^ PWWOW McfL*W for#* pVpaft %%d below. The aLfAIR Ift6a - isbV
is adivWk--z; demo*" in 00 EM whad skstdL
kTM OF PROJECT:
x4EKfycmvNmmAnjms ARDRE S:
t
PHONEN it�-()
d
cez ��CJ-s
lgrz-wm of plapuly 00W.
02/07/2004 19:20
9103429806
GREa LLi�EtJ
PAGE 01
a3 9 . • ••e v. _
Name Of Individual Applying For Permit_
Address'Of Property:
or StrCRt lz
street oz Road, C
I hereby certify that I
referenced prapertY• The o� Property adjacent to the
described to os as indlviaual applying for this above -
they are shown on the attached dravf :� Permit has
should Proposing. A description or draws g the development
Provided with this utter. drawing, With dimensions,
I have no objections to this proposal.
r
I understand that a i
house. Per, dock, uooriri
four . lift _ rust be 9 slings, distance
boat
Y area of riparian sat a ninimue distance of 15'
to waive tback, y U access
unless waived by me. (If you wish
the se
below.) Sust initial the appropriate blank
��-�—►--- X,.do wish to waive the 15 f setback requirement _ �
SIR - not wish to waive the 15 • setback requirement.n F
D
Sic
/ 41
Signature
Date
Print Nape
A.14'V rej
ADJACENT RIPARIAN PROPERTY OWNER STATEIMNT
I hereby certify that I own property adjacent to �, t e• /U04-u--n (fn cjn �'4
(Name of Props )
property located at ioZ 7 atr h'n Q r1t ybe.-'
(Address, L�j MoCk, Road, e! .
on , M A4 ` rn A ole Gt,� a.� , in , N.C.
(Waterbody) (Cityfrown and/or County)
The applicant has described to me, as shown below, the development proposed at the above la
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(ln4vidual proposing development must fill in description below or attach a site draw►
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish tc
the setback, you must initial the appropriate blank below.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
144 1"110 1/ V, ILL) ;J�
Signature Si azure
Print or Type Name Print or Tye Name
ids r ' l�r .
Mailing Address Madina Addwz-t
` -o " 10-0 V/1 VI)OW