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Home My WebLink About62650D - Dobzyniak62 C,A,lVlA,,; DREDGE & FILL ✓N9 ENERAL PERMIT Previous permit , # ,,New Modification --Complete Reissue EPartial Reissue Date previous permit issued 1� I 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 I t Name E] Rules attached. Project Location: County Street Address/ State Road/ Lot #(s) State/VC- ZIP7-1 t k' Fax # ( Subdivision 0 t"" zed Agent '4m City'EAeos 1"1 41 P CW EW D PTA F❑-1 ES -nPTS Phone # -River Basin IAJ L, EJ OEA HHF - 1H = UBA 2 N/A Adj. Wtr. Body16.." a-- ane PWS E FC: yes /. no PNA L'yes-',� no Crit.Hab. I — yes A0 Closest Maj. Wtr. Bocly--5�(-'..#� Project/ Activity t;V5 t 6L t - A --I r-by pier(s) ISO length 111=10M iumber �acl/ Riprap length vg distance offsh:e -■nax ONES distance offsl re SEEN channel Ems ubic yards MEN F amp MMMMEMMIMMWI M, 0 MIEW )use/ Boatlift mmoll- E®®■i � Vni low ■W Bulldozing 0111111 IN ine Length f 75 not sure yes Who kgs: not sure yes )rium: n/a yes yes no Attached: yes ling permit may be required by:: IdnJ r Or, V (Scale: III - E See note on back regarding River Basin )licant: / f e `/ r k7 � �� /� �� Permit #: ( , -!/ �_..5 O cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement id in your Habitat code sheet. itat 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 El Both El Other t! `' C 761 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 ❑ JJ1441267 M.O.#331441267 9M::a4'CODOLSO0OiCTS AND 00/100 DOLLARS -:1 rtiti i eb yll' NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Beverly Eaves Perdue James H. Gregson Governor Director Dee Freemai Secretar AGENT AUTHORIZATION FORM Date: lold0l, Name of Property Owner Applying for Permit: Name of Authorized Agent for this project: Owner's Mailing Address: /yC a $ q 0 Phone Number ( %/,�) d t/— rr¢ 6k o Agent's Mailing Address: Ay x;I9A-r ly�C r ,t /VC 766YIL) Phone Number($02 I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct the following (activity): ,06 a U. /-71/ J- ! 7'— (my property located) at This certification is v�hru (date) �� / ,9 $z // Y�J jG � /b 3 cy 7� f/L CERTIFIED MAIL - RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Owner: Address of Property: (Lot or Street #, Street or Road, City & County) Applicant phone#: Y�G— 5,fl Mailing Address: �i}�►iir� 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. C I have no objections to this proposal. '�l 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.) I do wish to waive the 15' setback requirement. T(" I do not wish to waive the 15' setback requirement. (Property Owner Information) A - Signature Print or Type Name (Riparian P pejJ:y!Owner Information) Signature j Print or Type Name CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Owner: ��12 AA Z y y//5? Address of Property: (Lot or Street #, Street or Road, City & County) Applicant phone#: �� 6b6u' Mailing Address: 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. CI have no objections to this proposal. ave 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.) I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) Signature Print or Type Name C yJ Al yr IZIAV AA.ili— Arlrlrnoo (Riparian Property Owner Information) Signature v P/� cl Prihe or Type Na e 11);J .1 IM11 t,-•01� Ati ailinrr ArNrirphs