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Home My WebLink About62628D - DavisCAMA / -I DREDGE & FILL v/ TIO 62 ENERAL PERMIT Previous permit # New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued orized by the State of North Carolina, Department of Environment and Natural Resources �^ Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC . KJ Rules attached. nt Name is Project Location: County t✓1' UY1 Slni 1 GLL, s r ' ✓" VVCL Street Address/ State Road/ Lot #(s) `� State. ZIP'1 (�✓ y1r ��' !i i # } 4 — q Fax # )_ t SubdivisionN >'�` - G ized Agent t T City -LAW 1-; tt� ZIP t0 d ❑ CW El 1] PTAj ES ElPTS Phone # ��) River Basin 1'Y1 ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ^1 r I 1 ( e ❑ PWS: ❑FC: yes % no PNA yes no Crit.Hab. yes /"no A Project/ Activity 'ock) length r r rl pier(s) length umber :ad/ Riprap length vg distance offshore iax distance offshore channel ubic yards imp )use/ Boatlift Bulldozing i �r ne Length-% not sure yes � gs: not sure yes r no .r mum: ( n/a yes no— _/ -- yes Attached: yes Mio ling permit may be required by: Yp�(rns" i /� (A, `/�• ^ �V(n} — Adj. vvtr. Body 'V 1VCJIi i'nat Closest Maj. Wtr. Body AA LOW (Scale: 1 ❑ See note on back regarding River Basin i o * i /\ A I,. .i a — f i -P, r_. NC Division of Coastal Mgt, Habitat impact Computer Sheet Applicant: ��%� S Permit Date: Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen found in your Habitat code sheet. Habitat Name DISTURB TYPE Choose One Dredge ❑ Fill ❑ Both ❑ Other 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 fn< 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 ❑ Other ❑ . . . ........ ......... ;ON CTION 5431 66-112/531 Date Dollars WY 2 1 S 2 L,13 9 2 ?1100 S L, 3 1 Mmtorh# Cavac Pp.k lltp J - - - 'vovernor I iZ r'nrnlinn n^n,-wfn not rnf Cnwirnnmont �:P' iiptorai Rc¢ntlrrPs Division of Coastai Manwemeni .lamr-s'ri. Greason Uee t•rE 'v'lrcr,irr' vc� AQF=NT 41_ITHQRt7ATlr-jN FORM )AtP- Adl� nt?R,o of nrr,ne:tV Owner Aooly_ ina_ for Permit: Name of Authorizes Agent Tor this proteuL. Owner's Mailing Add- ss. Phone Number 8/0_ )3(e7-03�5 _ ��s,• t�, ,F i r.a,/C :v jthnri7Pd the anent listed above to act on my behalf, for the purpose of applying Ynr and obtaining all LAMA Permits necessarl to install or construct the Totiowing tacuvlcl). t_ \ c'JrV'/r ( 1 r -4-r L This r,prtification is valid thru (date) 9 rnnarrw i nunar Sinnnhira wait_ vu�-r► c �e l �Y� ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE) I hereby certify that I own property adjacent to Sti is (Name Of Property Owner) property located at 35-76,giCL ?D II 11 (Lot, Block, Road, etc.) ' r N.C. (Waterbody) (Town and/or ounty) Applicant's phone #: 7` `JF Ste" Mailing Addressa1,0% e'rD He has described to me, as shown below, the development he is proposing at that location, and, I have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse must be set back a minimum distance of fifteen feet (15D 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 not wish to waive ��do wish to waive that setback requirement. -- -------------------------------------------------------------- ----------------------------------------------- DESCRIPTION Ati-D/OR DRAWING OF PROPOSED DEVELOPMENT: (To be filled in by individual proposing development) oua� (Information for Property Owner Applying for Permit) Mailing Address - 1, qe .au�r City/State/2tip ------------------ ------- (Riparian Property Owner Information) are Print or Tvpe Name i dar L�"JtYc-r- ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (Fall A P,LE e26t00RBVG PILNGS/BOAM&M BOATHOUSE) I hereby certify that I own property adjacent to c>A Sr; s 's (Name Property Owner) property located at ��`'S 6 t L _Pq ixi`U .(Lot, BIock, Road, etc.) on" �CL Z , in t� N.C. (Waterbody) (Town and/or oun[y) ff Applicant's phone # `f Mailing Address9b elrco He has describedto me, as shown below, the development he is proposing at that location, and, I have no objections to his proposal, I understand that a pier/mooriag pilings / boatlift / boathouse roust be set back a minimum distance of fifteen feet (I fl from my area of riparian accessu tens waived by me. (If you wish to waive the setback, you mast initial the appropriate blank below.) I do not wish to waive I do wish to waive that setback requirmnent DFSCRIPTION A DIOR DRA ING OF PROPOSED DEVELOPMENT: (To be fillers in by individual proposing devdvpmertt) (Information for Property Owner Applying (Mpaarlan Property Owner Information) for Permit) Mailing Address Signature Print or Type Name Ql_D --3(� n of CQ�o k l `4V. i. P;Q,�j►�C,AEj� N O IN 0 m' 6