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Home My WebLink About57405D - de Roche Division of Coastal Mgt. Habitat Impact Computer Sheet . V )licant: [AVVk1'vLQ Permit #: 5 5D e: b -b . 'cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement nd in your Habitat code sheet. Atat 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 Dredge ❑ Fill ❑ Both ❑ Other CQ 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 ❑ ;E CONSTRUCTION OF BRUNSWICK COUNTY INC 6618 BEACH DR SW BS. 910-579-9095 OCEAN ISLE BEACH, NC 28469-4710 8985 66-1121531 ATE ` DOLLARS BRANCH BANKING AND TRUST COMPANY f�1-j8�0Ti--BANK BBT BBT.com p 85n■ i:053 LO L L 2 Li:0005 L999 265 29n'_ ��w;o 'A. \�� •'1' � •r .�.'y. . r,..'�' `�; -...',pit y, �..(.1.�.:, �'f„ - ..- , �.; i:� . ...._. a ...5r � ... �:� .. �' • .. _ _ .. NNCDER North Carolina Department of Environment and Natural Resources Division of Coastal Management everly Eaves Perdue ,fames H. Gregson ,overnor Director Dee Freeman Secretary AGENT AUTHORIZATION FORM Date: )me of Property Owner Applying for Permit: Name of Authorized Agent for this project: 1 CL wner's Mailing Address: d 'hone Number otm Aoc. — J 9c, Agent's Mailing Address: C,c,►8 bay �ti �•� OL 4-3 Phone Number(, ? certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying or and obtaining all CAMA Permits necessary to install or construct the following (activity): ? ` b (my property located) at This certification is valid thru (date) 0 Property Owner Signature Date US MAIL CERTIFIED MAIL — RETURN RECEIPT RE VESTED DIVISION OF COASTAL (MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER STATEMENT Name of Property Owner: Address of Property: (Lot or S(reet #, Street or Road, City `< & o2,�`_unty) Applicant's phone #: �— 5�q'9��tS _ Mailing Address: l�lpky l Q� �� I hereby certify that I own property adjacent to the above referenced property. The individual applying for this pern has described to me as shown on the attached drawing the development they are proposing. A description of drawir, 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. Correspondence should be mailed to 127 Cardinal Drive E: Wilmington, NC 28405-3845. DCM representatives can also be contacted at (910) 796-7215. No response is considered the.same as no obieclion-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 hack a minimum distance 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.) zl/I do wish to waive the 15' set back requirement. I do not wish to waive the 15' set back requirement. (Property Owner Information) IA -SLED — g8P—(N� Signature Print or Type Name Mailing Address ` pavan Property Kt-�- J h-, L.,N Print or Type Name a , k-2 Mailing Address tion) '.�s /, do \ p - 1'i 61 eY►S�, ►y S6—T7— z(zcs'm z�zzc� I ■ 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: ct, o 2-10-7y A. Signature X � A4 ❑ Agent ❑ Addressee B. Receive y ( Printed Name) C. Date of Delivery D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No 3. Service Type Xertified Mail ❑ Express Mail ❑ Registered 5LBeturn Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number (rransferfrom se 7009 1680 0000 2205 9854 PS Form 3811, February 2004 Domestic Return Receipt 1p259"2-M-1540 elivery information visit our website at www.usps.com. Postage $ yl I M 46 (1¢ (i l $3. 111 Certified Fee 12 turn Receipt Fee ement Required) Postmark Here $2.55 $0.011 led Delivery Fee ement Required) -ostage & Fees I $ $6.11 I 05/04/2013 CYIC��hI i n 1a° _ - j��jpppp�� p�Lp(►V (�(�� !-`-Lo .....V ,.-:-"1..Ou `?VR^!-�................... ate, ?i on c-t 1 WL ab "TC/ 900. August 200E (uomesuc man vary; ry .■ For delivery information v Postage ru Certified Fee O Return Receipt Fee O (Endorsement Required) O O Restricted Delivery Fee (Endorsement Required) S-: 11' Here 1 Postmark t2.55 O CID Total Postage & Fees —0 g $ 1i•`?JI�SI�Ui r-q Seri Er C3 -A --------- Street, O or POBc Ct te, Zl��, illl 712 PS Form 3800, August r,. See Reverse for Instructions Is Complete items 1, 2, and 3. Also complete item 4 If Restricted Delivery Is deslred. IS Print your name and address on the reverse so that we can return the card to you. g ■ Attach this card to the back of the mailpiece, or on the front if space permits. Addressee Name) C. Date ofQelivery .n _ /lam. / /,2 address diffeltfrom item 1?