HomeMy WebLinkAbout63170D - Merritt� f
LAMA / CJ DREDGE & FILL � ��� 63.
1 E N E PAL PERMIT �'� Previous permit #
New Modification ❑Complete Reissue El Partial Reissue Date previous permit issued --Q--
zed by the State of North Carolina, Department of Environment and Natural Resources vQ • ! L
)astal Resources Commission in an area of environmental concern pursuant to 15A NCAC F't
❑ ules attached.
Name � J- �q JIA/,7/l �[,%�'� F AID /7r Project Location: County �1^ S c r,J
Street Address/ State Road/ Lot #(s
N i UN Stated ZIP 2
Fax # () Subdivision C AiJZ4, DF �✓l�F Cam(
dAgent ; n4jA VI iN/G' City aL��FF C4 TU, ZIP Z< �
❑ CW ,;�\EW PTA >tES ❑ PTS Phone # (.{�j�0" ` E River Basin idle
❑ OEA ❑ HHF IH ❑ UBA ❑ N/A
Adj. Wtr. Body A NP 15 0,0=�7 S 1%L;rnat J6
❑ PWS: I❑FC:
es / no PNA yes n Crit.Hab. yes no Closest Maj. Wtr. Body
...
Project/ Activity ►-m J
(Scale:
c) lengtth� ( u Q
, 10
�th __�1
fiber 1-M!Na
' Riprap length
listance offshore
distance offshore
.nnel
c yards
e/ Boatlift i- I T 1 V
[dozing 710—
nG=
Length'f �gJ
not sure yes no
not sure yes An
im: n/a yesyes
.tached: / Yes ] no
g permit may be required by: cEA ❑ See note on back regarding River Basin ru
2818
Bank of America.
;alftslp
ANTINORI CONSTRUCTION, INC. ACH Rrr 053000196
252 ENNETT LANE 66-19-530
SNEADS FERRY, NC 28460 14
PAY TO THE
ORDER OF CJ ►D? o $bo'
hundad do ua-vs C) I Ion DOLLARS f
U)
MEMO AUTHORIZED SIGNATURE
olicant: L 1 O4
'e: 2—
Permit#: L2�)
J
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
-id in your Habitat code sheet.
DISTURB TYPE
itat Name 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
Sic 4�
Dredge ❑ FiIX 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 ❑
CAR �`�8/
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9
SEAL.o
iP-680 i
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N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date i Z- I 2
Name of Property Owner Applying for Permit:
my i- MY S mry y ►.
Mailing Address:
I certify that I have authorized (agent) -I 1tjA Vjf to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at) -n � I ) I
This certification is valid thru (date) 6I
-�
a
Date
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Own
Address of Property:
(Lot or Street #, Street or Road, City & County)
RN-�n
Applicant phone #: �i h� U1� Mailing Address: I-C-)
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. Contact information for DCM offices is
available at www.nccoastaimangement.neticontact—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.)
l I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
// Signature
l�I L I �JDA N EP,R 17
Print or Type Name
If tW y6 6 7 G, ,12
AAnilinn Arir'Imcc
(Riparian Property Owner Information)
Siknature
►f
Print or Type Name
W'4i ij-l'
Mailinq Address
/9
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL:MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Own
Address of Property: -7 tl"l1)
,,Lot or Street #, Street or Road, City & County)
ntvJZt �by 1"111
Applicant phone#: Mailing Address:���
�Y�eo�to ?:�a a
I hereby certify that I own property adjacent to the above referenced property. The individl4al
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawmg w�tli dimensions must be'provided with this fetter.
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.nccoestaimangementneticontect dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no object%n if rjouu have.been notified byCertified 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.)
do wish to waive the 15' setback requirement.
` I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Riparian Property Owner Information)
Signature Signature
" .Print or Type Name
Mailing Address �'
3
i
16
...,tea
a
1
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
b rtify that I own property adjacent to
s
I here y ce
rr , Name of Property Owner)
property located at
_ (p� (Address, Lot, Block, ad a c.
on
(l�.1I 0 JC in N.C.
(Waterbody) (City/Town d/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc
l� 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)
�Sre �thicE���
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.)
fD5I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property O n Information)
Sl*gna ure -�T- Signatures
�'o=�� I r ` / Prin or Type m
P� t or Type�N e ��- �? �--
Mailina Address c--
_
■ 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#his card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
A. Sign Ztre -%
/ /f ❑ Agent
X
LC/l. ' ❑ Addressee
B. Received by ( Printed Name) C. Date of Delivery
41 v
Is delivery address differhnt from Rem 1? ❑ Yes
If YES, enter delivery address below: ❑ No
MU, L,6�VA
` 3. Service Type" " : 11 V.
y� ►� TDrp� -y ❑ Certified Mail MExpress Mail
v w J ❑ Registered Q Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7012 2920 0001 3991 3724
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
■ 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.
1. Article Addressed to:
my-4, Mrs f1&yPc'
I L3 OW M/-1 p!l
1e h v/sf- ,
I UIjbs o l Lt Kz 2e4 0
A ' nature
II ❑Agent
/ �! ❑ Addressee
B. Received by (Printed Name) } C. Da e of Dfe1ivery
D. Is delivery address different from Rem 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ CertlW Maii ❑ Express MagO(]
❑ Registered ❑ Return PqqV for Merchandise
❑ Insured NAZI % 13 G?io
4. Restricted Delivery? (Extra Fee) ❑ yes