Loading...
HomeMy WebLinkAbout61516D - Cainr.,4MA / DREDGE & FILL EN ERAL PERMIT ;'�� % Previous permit # New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued_ rized by the State of North Carolina, Department of Environment and Natural Resources oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 1 [3Rules attached. t Name--�'. Project Location: County , . „," c -- ` 1 Street Address/ State Road/ Lot #(s) State ZIP ( ) Fax # ( ) Subdivision N zed Agent i �, ,?! .�,ti ,(.tip Y:� �` - -- City �� OtI�tG Lk ZIP CW EW PTA —ES ❑PTS Phone # (`��� )Z3Z-Z5�C River Basin L�•Yin OEA HHF I UBA ❑N/A Adj. Wtr. Body Q A, 4 ! --( (nat Pws Fc. A�wW yes / no PNA yes / no Crit.Hab. yes / no, Closest Maj. Wtr. Body Project/ Activity i P� + (Scale: f lock) length m(s) pier(s) length umber !ad/ Riprap length vg distance offshore iax distance offshore channel ubic yards imp i )use/ Boatlift ' Jx Bulldozing ne Length not sure yes no igs: not sure yes no )rium: n/a yes no yes no Attached: yes no Jing permit may be requirec CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Owner: l'a141 Address of Property: (Lot or Street #, Street or Road, City & County) Agent's Name #: 4az / &nt- �AAdpis Mailing Address: Agent's phone #: JD- c�3o)- 26 �(' All 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. 1 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.nccoastalmanagement.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, 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.) P� I do wish to waive the 15' setback requirement. 5)V I�d�l� av I do not wish to waive the 15' setback requirement. I, , r (Property Owner Information) 3rgnarure Pu��l cct Print or Type Name (Adjacent Property Owner Information) Signature Print or Type Name 30.2-3 Bl�&olee eo�sslw6 Mailing Address Mailina Address N.C. DIVISION OF COASTAL MANAGEMENT AGENT AUTHORIZATION FORM Date Name of Property Owner Applying for Permit: Mailing Address: I YO I 60frK I certify that I have authorized (agent) dW I dr, 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) This certification is valid thru (date) A _ N PropertyOwner Signature ] Date C- /(;, 7 3plicant: ate: WV Permit #: 4 I S l� D scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement ind in your Habitat code sheet. bitat 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) 1 \ \ Dredge ❑ Fill ❑ Both ❑ Other l l l 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 ❑ ALLIED MARINE CONTRACTORS, LLC 08-03 910-367-2159 92 HAROLD CT. HAMPSTEAD, NC 28443 Bank of America ACH R/T 053000196 PAY TO THE U ORDER OF_/�/ � �lJ I $ v dO / MEMO 560, 66-19/52 DOLL ig �-b [ZED SIGNAI LIRE ■ 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: IK- Q A. Suture ��1/ ❑ Agent f Addressee B.L44ec 've by (Printed Name) C. Date of Delivery eladdress different from Rem 1? ❑ Yes If Y e ter delivery address below: ❑ No iJ Certified Mail ❑ �jt� Type y 1 i � Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number (rmnsfer from service label) 7 010 3090 0003 7 210 8281 Ps Form 3811, February 2004 Domestic Return Receipt 702595-02-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: ti�evl It Zt, 9 13tq A. L C McCeive(l bVyPtinted Name) C. D fe of Pelive J)4 Ceso iy Z A 13 D. Is delivery address different from itemm 1 ❑ Yes If YES, enter delivery address below: ❑ No 3. S ice Type I3Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number (Transfer from service /abed rU'ju guy❑ 0003 7210 8298 PS Form 3811, February 2004 r)n-tin Rot.. G--- :...