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Home My WebLink About62699D - LewisLAMA / ❑ DREDGE & FILL 3ENERAL PERMIT Previous permit# ?New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued irized by the State of North Carolina, Department of Environment and Natural Resources Zoastal Resources Commission in an area of environmental concern pursuant to 15A NCAC . to ules attachefl. it Name oX ro State Zip t w) XJ- 44% IFax # ( ) and Agent " t 1 . ftsl Y V� t� ❑ CW ❑ EW PTA �WES F� PTS ❑ OEA HHF ❑ IH C UBA ❑ N/A ❑ PWS: f Project/ Activity ❑ FQ Project Location: Countynswu14 Street Address/ State Road/ Lot #(s) q - . _1 C I__ . . Subdivision City I f, I fill ZIP-A4, We # fftL) - River Basin Adj. Wtr. Body AA al. (nat Closest Maj. Wtr. Body j�j IV V\) (Scale: , )ck) length :ngth ember id/ Riprap length 'IT ,glistance offshore ax distance offshore hannel ibic yards mp use/ Boatlift 3ulldozing AM bfl� AQd e�xZolf_ r ie Length notsure yes no gs: not sine yes no num: n/a \y no yes Attached: yes no ling permit may be required by: L;)2�i, L V Uak�k 15Q 1 a (t\, ❑ See note on back regarding River Basin _ �.1_I1 11V^ AfnA nII lli) ,. 1. 1 I-'- r...A _L.Ae I I-/t. NC Division of Coastal Mgt, Habitat Impact Computer Sheet Applicant: -�-4 Lewis Permit #: Date: Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen found in your Habitat code sheet. Habitat 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 fins disturbance. Excludes any restoration and/ temp impact amount IS" Dredge ❑ Fillx Both ❑ Other ❑ 2pp Dredge ❑ Fill X Both ❑ Other ❑ S Dredge ❑ Fill ❑ Both ❑ Other l CCj 10 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 ❑ ......... ...... 9319 RICE CONS :. TRU - CTION OF BRUNSWICK 121531 COUNTY INC - 910-579-905 661813EACH DR SW BS 28469-47190 DATE \\2-(o OCEAN ISLE BEACH, NC s (OM BRANCH13ANKING AND TRUST COMPANY 1-800 BANK 1313T BST.COM 1-11 AO[ .5 2 9 Its 0 s 3 lo L 12 11.000 5 1 ci ci 2 6 3 q 3 Nrn�r�Q Nnrth r.nmlinn nanortmant of Frniirnnmant and Nnfiiml Pacniirrac Division of Coastal Management iYici;rory Braxton C. Davis uirector John E. Skvarla, Secretary AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FUKM Date: /D - 3 / - l 3 NZ Properly Owner Applying for Permit: ier's Mailing Address: 1.70 k�s TO V f�' D A ',O A/ 0. a7s73 ne Number f336 ) SF9-"57/0 N.pme of Authorized Agent for this project: N C�� Agent's Mailing Address: 1 ugh 3W Phone Number 10 �`Iq - qU qS tify that I have authorized the agent listed above to act on my behalf, for the purpose of applying ind obtaining all CAMA Permits necessary to install or construct the following (activity): 1\�4e(ICI my property located at �9 C'OA/CRd.P,O .-sl F Re-A'h certification is valid thru (date) Property Owner Signature Date CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM Name of Property Owner:`` Address of Property: ��A (Lot or Street #, Street or Ro d, City & County) Agent's Name#:C��C �h��1C)� Mailing Address: Q�u1 O\ ` f ��D D('S` Agent's phone#:��- rj�q-QAOck,[-:) Cst►��- t� �V\ 1Y�Z�j��ip� 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. ✓'_ 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 Ext., Wilmington, NC, 28405-3845. DCM representatives can also be contacted at (910) 796-7215. 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, 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. I do not wish to waive the 15' setback requirement. ,(Property Own rInformation) 7 nature 1EA Print or ype Name Mailing Address City/State/Zip (Adjacent Property Owner Information) Signature �� v�' d � • �3- d c�.y.� cn Print or Type Name ela .Sy/V. Mailing Address fr, ri iy.v T-,qi 3 o 3 -Q 7 City/State/Zip 1�1 cOV W CA III 24�31� $`1 Cohw�l SI-. Oc:�ao.lsl� i'aeurA.. P,-w*mswiik. I I /&Oft& /•o"1 nplete items 1, 2, and 3. Also complete 14 if Restricted Delivery is desired. t your name and address on the reverse A Signature -/ X eL ^� ❑ Agent ❑Addressee B. Received by ( Printed Name) C. Date of Delivery ,iat we can return the card to you. ch this card to the back of the mailpiece, n the front if space permits. D. Is delivery �efe om item 1? If YES, e ivery a elow: _ 71 ❑ Yes ❑ No e Addressed to: lA W WV 2Sf3 a 0 �( 3. Service e �Certified--- Express Mail ❑ Registered Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number 7009 1680 (Transfer from service label) 0000 2206 0003 PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 r g424- Postage Certified Fee $ �� V tJ" ReturnReceipt Fee (Endorsement Required) Restricted Delivery Fee (Endorsement Required) R ark n •�iT�Tler. V $ r Total Postage & Fees Sent Street, Apt. N! ` or PO Box No.. V - ........................................ ------------- ------ ---------------------- ate, Zl V-\ h ( C -2-p 6' 30U, August 211UE U.S. Postal ServiceT11 CERTIFIED MAILT,., RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) - For delivery information visit our website at www.usps.comL - r - PS Form 3800. August 2006 See Reverse for Instr