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Home My WebLink About62596D - Inman�M! C:AMA DREDGE &FILL 3ENERAL PERMIT Previous permit # INew Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued ,ized by the State of North Carolina, Department of Environment and Natural Resources :oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC Rules attached. t Name I 1 Yi1(A+1'\, Project Location: County UtkSW l ct � 1�.i Street Address/ State Road/ Lot #(s) , I State ZIP _#� . ' �, V u1 �-t �-� j_) 1 L Fax # ( )_ Subdivision ` ed Agent /V' 1 Y u S4-. Git�- ; IQ �" �ZIP�� ❑ CW ❑ EW ❑ PTA � ES PTS Phone # 10 )�-i N3- 'ver Basin LO ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body (nat i PWS: ❑ FQ yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body w LJ A Project/ Activity , , t , ,. ,._, , � „ V I n lock) length pier(s) length umber iad/ Riprap length LP vg distance offshore iax distance offshore channel ubic yards imp ,use/ Boatlift Bulldozing M 2.d ne Length _ not sure yes no _ gs: not sure yes ,no i t Oum: n/a yes no S yes /no + Attached: yes / no - — ling permit may be required by (Scale: If^OW O 4 ff i V ldt iA 1 X a (L. El See noteon back regarding River Basin ff,, 1\I1 AIIL II It, vIy!/ .-'J r.j C-1-1a A , . A I-P/I i_ I t/n. kpplicant: U �V� �' w� 1/1 VIA 61, Permit #: Z )ate: q escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement )und in your Habitat code sheet. abitat 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 ❑ � Dredge ❑ FillyBoth ❑ Other ❑ C} r Dredge ❑ Fill ❑ Both ❑ Other j 2-L,0 1 ZL 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 0 Fill ❑ Both ❑ Other ❑ TRUCTION INC 1245 142-5707 2 66-112/531 9' - �/� Date ) r - A Al ,/l EN North Carolina Department of Environment and Natural Resources Division of Coastal Management Beverly Eaves Perdue James H. Gregson Dee F Director S' Govemor AGENT AUTHORIZATION FORM Date: 3 Name of Property Owner Applying for Permit: Name/of Authorized Agent for this project: AV Owner's Mailing Address: MA' 3 7 �R , / Phone Number ('qIQ) 9 5 Ell `� Agent's Mailing Address: 1 je ' 15 Phone Number CY 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): �, it i' f-, ♦ _ ., / � //,l -.-- V7 (my property located) at This certification is vali ru (date) �G Property Ow ne nature Date ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (1 OR A PIF"f0oR1tyG PILJAGS1ft0,4TLIF7-IBOATim UVE) I hereby certify that I own property adjacent to / (Name of Property Owner) ilroper.y located at f L/ �C ,rL 4 �1c . �^ (Lot, Block, Road, etc.) , can r,rT -, in — - -- — / � C L --P -r4 C (. Nj (Waterbody) (Townand/or County) Applicant's phone #1:��' �l�(�'f�r' �3 Mailing Address:�� , ( < ,�'� I-Ie has described to me, as shown below, the development he is proposing- at that location and have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathous must be set hack a miniamin distance of fifteen feet 05') from ►ny area of riparian access unles! waived by me. (if you wish to waive the setback, you must initial the appropriate blank below.) I do not wish to waive I do wish to waive that setback reyulrelllellt. ------------------ --------------------------------------------------------------------------- _------------------ DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: (To be filled in by individual proposing 11evelopment) (Information for Property Owner Applying (Riparian. Property Owner Information) for Perm it) Mailing Address Signatul /� 1 p ADJACENT RIPARIAN OISTATEMENT (FOR A rIERIAfn�Nc rxllvcs�o IFBo T�oU,/ CA, 1-C T/ �1 �r sU 'S I hereby certify that I own property adjacent to _ (Name of Property Owner) property located at f " " (Lot, Block, Road, etc.) f! (J , in Cv -e4 C; N.G. on - -- — - - -- - and/or County) (Waterbody) (Town ty} p 910. 3 g9 b Mailing Address:�Z Applicant's hone #: I; Z He has described to me, as shown below, the development he is proposing at that location, and, t have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse must be set back a minimum dos�an� a the setback, you e of fifteen feet (I )must initial the appropriate blankfirorn my area of riparian access es5 waived by me. (If you wish below.) I do not wish to waive I wish to waive that setback requirement. --- - - - ------ -C _--------- -- -------------------------------------------------------------- DESCRIPTION AND/OR DRAWING OF PROPOSED DI;VEI;OYMENT: (To befilled in by individual proposing developmen) �vtl ------------- Perty Owner Applying (Riparian Property O%Ilcr Information) (Information for rop for Permit) iviailing Address �; Ak :4z 66 " & I ), ��(a yadol�wcdcl. gee, /Jof�p�3ea�i�