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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/ �SS�Q�����i9,��I 9 SEAL.o iP-680 i F�aSsoso�a • �v a0 I 00 e t r�/ �4 f 'Q • f l n 1 D f Q 3 . 1 — _., • / 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