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Home My WebLink About62571D - HillCAMA /❑'DREDGE & FILL ✓ NV 62 GENERAL PERMIT Previous permit # i!! XNew ❑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 ❑ RuJle� 'ttached. nt Name�HA�F %�l �-L. U/� �i� �� Project Location: County i l l s '� 2 6 (u 19AV Street Address/ State Road/Loot #(s) � Z r' V&_ State/VL ZIPZ016V Z.1'� 3c�' /, cikSlEJ G✓/`1�% Fax # () Subdivisio ized Agent r GZ't' c. City � �.(� ZIP d ❑ CW `.GJ EW i_'PTA ❑ ES ❑ PTS Phone # (� )� %!" �/� River Basin ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A Adj. Wtr. Body ❑ PWS: ❑ FC: T yes / no PNA s / no Crit.Hab. yes /�d Closest Maj. Wtr. Body A Project/ Activity l L't C .77 �� er �''W /'et t� ock) length x -�Z_ m(s) Y Z S' pier(s) length � umber ad/ Riprap length vg distance offshore _ iax distance offshore :hannel ubic yards j imp - > Bulldozing ne Length 2 45�C3 not sure yes - ,gs: not sure yes no —" >rium: n/a yes yes Attached: yes ?'.n. ling permit may be required by: (Scale: N ❑ See note on back regarding River Basin I- .... i i if r / oplicant: )' ate: Permit #. G/C_ scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement ind 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 tem impacts) FINAL Feet (Anticipated final disturbance. Excludes any restoration and/or 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 ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ .. . . M16780 12490000 rg,l e 4 PERSONAL MONEY ORDER 3001473002 this 3 0 014 7 3 0 0 2 IWO c now" 'NOT VALID:OVER$1,000.00 - ° ?CIIV@ ISSUING BRANCH6C 'I-�_''-ktIILMINC�TON O� C1Eha 68-236/514 % DATE FG T'FmGCG 17, '"Ill $200.00 * ♦' fl CI r +� rn� ' 1 I�Id (Iu+I1 1.'It!f.,'.r Ilul1 I�W I �.1 11 DOLLARS r .... PURCHASER, BY NING YOU AGREE TO THE TERMS ON PURCHASER'S COPY. PURCHASER, SIGNER ADDRESS � —� v--- CITV & STATE — -- 3002,10 i:0 5 L 40 2 3 6 91:000 L0 L 908000 L110 n, i0 /0 !P ,V e7il o, qf ead I ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to / ( ae f P operty Owner) G- i' property located at ra,/f' j 7n K /T ( (Address, Lot, Block, Road, etc.) on G/L� TG��c.l /e�-lr , in , N.C. (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) zL c C -� c 16 C, 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.) I do wish to waive the 15' setback requirement. L--/I do not wish to waive the 15' setback requirement. (Property Owner Information) Z�- ', , - SigiTature / I Print or Type,Name t (A**ent Property OWper Information) Print or Type Name — 7 en .1 11 —I R'_4G-09'2012 e9yp:40 From: T o : 93294481 ADJACENT RIPABIAN EROPERTY O f= ST E I hereby certify that I own property adjacent to 1 (Name of Property Owner) proporty located at Af)/ (Addreez, Lot, k, Road, etc.) on in KC. (Watarb dy) (C41Town andlor County) The applicant has described to me, as shown below, the development proposed at the above location I have no objection to this proposal. I have objections to this proposal. Dl=SCRIPTION AND/OR DRAWING OF PROPOSED DEvELOPMhENT (Individual proposing development rr of t fill in description below or attach a site drawing) WAIVEj� SFCT[gN I understand that a pier, dock, mooring piiings, 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 Hank below.) I do wish to waive the 15' setbacl; requirement. I do not wish to waive the i 5' setback requirement, (Property Owner Information) (Adjacent Property Owner Information) 1-rii tc>, /3 N.C. DIVISION OF COASTAL MANAGEMENT AGENT AUTHORIZATION FORM Date �Z , Name of Property Owner A plying for Permit: , ii Mailing Address: I certify that I have authorized (agent) "/-)14>.� L4--* bZ3 to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity) el, Pl,-- at (my property located at) Z61, This certification is valid thru (date) Pronertv Owner Signature Date