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Home My WebLink About61669D - FoldhamI CAMA / 'D DREDGE & FILL GENERAL PERMIT Previous permit# ONew ❑Modification ❑Complete Reissue ❑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 Rules attached. nt Name CtiY7t1.. Project Location: CountyIJ►tiS1nl► t�L S. t Street Address/ State Road/ Lot #(s) 4I?''1-11 z-7� V ru L-L. L-A (f -.-F prZip Fax # ' 2 Cj Subdivision ized Agen'(� `L �P7� ► �'f V 1. �, City V . ZIP d ❑ CW ❑ EW ❑ PTA El ES ❑ PTS Phone # 1( )y� `�' �� River Basin �Vvl ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body�V 0-� (nat PWS: /' no ❑ FC: PNA no Crit.Hab. / no Closest Maj. Wtr. Body�� yes yes yes A Project/ Activity — ock) length neLength _o (Scale: ling permit may be required by: ❑ See note on back regarding River Basin . f .. A 1 P4, — 1 1./.� I C I DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Individual Applying For Permit: Address of Property: Wvl \C3\, , S� - (Lot or Street #, Street or Road) 0(,4, �J, (City and County) Era',, "0e-L L� hereby certify that I own property adjacent to the above -referenced property. The indivic applying for this permit has described to. me as shown on the attached drawing the.development t are proposing. A description or drawing, with dimensions, should be provided with this letter XI have no objections to this p rop osal. 1� If you have objections to what is being proposed, please write the Division of Coa Management, 127 'Cardinal Drive Extension, Wilmington, NC 23403 or call 910-796-7 within 10 days�of receipt of this notice. No response is considered the same as no.objectic you have been notified by Certified Mail. WAIVER: SECTION TT understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must b bek a minimum distance of 15' from my area of riparian access - unless waived by me. (If wish to «waive the.setback,-you must initial the appropriate blank below.) I do wish to waive the 15' setback. requirement. Al I do not wish to waive the 15' setback requirement. t/, 3 Sign Name Date �e ) a ,&IQ.K?FA M A fo imp DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY 0`VNER NOTIFICATIONAiVAIVER FORM Name of Individual Applying For Permit: l`&Jl Address of Property: / �^ (Lot or Street #, Street or Road) tz.�t c (City and County) hereby certify that I own property adjacent, to the above -re erence property. The in ivi i applying for this permit has described to.me as shown on the attached drawing the development tl are proposing. A tion or drawing. with dimensions, should be provided with this letter. I have no objections to this proposal. If you have objections to what is being proposed, please write the Division of Coas Management, 127 Cardinal Drive Extension, Wilmin;ton,.NC 28405 or call 910-796-7 within 10 days of receipt of this notice. No response is considered the same as no.objectio you have been notified by Certified Mail. WAIVER SECTION I understand that a pier, dock, mooring pilings, breal,��,ater, boat house or boat lift must be bck a minimum distance of 13' from my area of riparian access - unless waived by me. (If wish to ~naive the.setback,'you must initial the appropriate blank below.) I do wish to waive the 1 5' setback requirement. I do not wish to waive the 1 a setback requirement. Sign Name Date V, rint 'Mama *7 1! �_ FA NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management McCrory Braxton C. Davis ✓ernor Director John E. Skvarla, II Secretary AGENT AUTHORIZATION FORM Date: O of Property O finer Applying for Permit: Name of thorized Age t for this project: is Mailing Address:: e Number Agent's Mailing Address: Phone Number fy that I have authorized the agent listed above to act on my behalf, for the purpose of applying id obtaining all CAMA Permits necessary to install or construct the following (activity): ,y property located at ;ertification is valid thru (date) /07 Prope y ner ignature r O-11- Date i --v;7S kZ0 -k �! 7W Tim h �' � 5d1 F417T ((-z )--� . , C Division of Coastal Mgt, Habitat Impact Computer Sheet ,plicant: �a -b �avv�, Permit #: Abib ite: g ascribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement ind in your Habitat code sheet. ibitat 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) JW Dredge El Fill El Both ❑ Other ( 2-10 2 t V 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 ❑ �xID� 50 ate items 1, 2, and 3. Also complete if Restricted Delivery is desired. wr name and address on the reverse we can return the card to you. this card to the back of the mailpiece, ie front if space permits. [ ,,d/ddrressedd to: J K.—� 1 ✓ r ' ie ( I I►� 1 ��-- ►�c— �45�1v1 A. Signature �' El Agent X ❑ Addressee B. Received by ( Printed Name) C. Date of Delivery 1�-/- 3a -11 � D. Is delivery address different from item 19 ❑ Yes If YES, enter delivery address below: ❑ No 3. Service Type >E� Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) r 1 4umber r from service label) 7010 3090 0003 7165, 3232 3811, February 2004 Domestic Return Receipt to items 1, 2, and 3. Also complete Restricted Delivery is desired. ur name and address on the reverse we can return the card to you. :his card to the back of the mailpiece, e front if space permits. Jdressed to cis ^by-e 109GQ5-02-M-1540 A. Signature ❑ Agent ❑ Addressee B.//Received by ( Printed Name) C. Date of Delivery ^/ 117 S Shc L D. Is delivery address differen rl$Agm 1H.N " /ji' If YES, enter delivery ad r0's below: �❑ tl9 � w N Y (J v l /Jpr�t&1 3. Service Type 1/ �Rt $1 Certified Mail ❑ Express tv al ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes lumber 7010 3090 0003 7165 3225 - from service label) 3811, February 2004 Domestic Return Receipt 102595-02-M-1540