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Home My WebLink About61573D - Rooks'CAMA / DREDGE & FILL c N? U1 3ENERAL PERMIT MPrevious permit# 19- New ❑Modification E-Complete Reissue ❑Partial Reissue Date previous permit issued —15 >rized 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 O 7iTL/ l ,, / Z OQ ` Oe) Rules attar ed. it Name � /� Project Location: County *�� StreettAddress/ State Road/ Lot #(s) State ZIPS 73/ ... aK5 Fax # ( ) W Agent %/APM 1 ❑ CW 511EW `ETA I ES PTS OEA [=j HHF -- IH -:1 UBA ❑ N/A C PWS: I FC: yes / no PNA yes /® Crit.Hab. yes /® A Project/ Activity lock) lengthy y / •m(s) pier(s) length lumber !ad/ Riprap length_ vg distance offshore nax distance offshore channel ubic yards amp >usVftQtli4 :< / Bulldozing ine Lengtt(AQI not sure I igs: not sure no >rium: n/a yes no yes no Attached: yes /' li>o Subdivision CitySf�et� Phone # ( ) — River Basin (,f Adj. Wtr. Body/G+r/!41 (nat, Closest Maj. Wtr. Body Jing permit may be required by: rjoddy y. bt'6 on back regarding River Basin 3r1�� O I-i L w 1t f ! fr i r i 4' f l Irn�oS�.G. i ' r r I /��c 1�'r Csezc tr l( I ' - NX 13' Jimmy North - CMC FAX NO. : 9102566357 Mar. 01 2013 12:23PM P1 North Carolina Department of Environment and Natural Resources Division of Coastal Management t McCrory Braxton C. Davis ;ovemor Director John E, Skvarla, III Secretary AGENT AUTHORIZATIO dRM Date: " me of Pro erty Owner Applying for Permit: Name of Authorized Agent for this project: 04 vner's Mailing Address: 13`/6 WO s% lone Number Agent's Mailing Address: Phone Number ;ertify that I have authorized the agent listed above to act on my behalf, for the purpose of applying r and obtaining all /LAMA Permits necessary to install or construct the following (activity): ` or my property located at 'his certification is valid thru (date) Property Owner Signature Date ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to TTct {� ��-C S s OName of Property Owner) property located at T (Address, Lo ,Bock, Road, etc.) on in N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above I i n. 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) 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 w' 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) r In Signature A �ur Le� Print or Type Name Print or T pe N me •�_:c__ err____ "i_er.--_ "-'_'-- - ^ T� ADJACENT RIPARIAN PROPERTY^^ OWNER `STATEMENT C I hereby certify that I own property adjacent to �� KS 's (Name of Prooertv Owner) property located at t K'� -s 5 L'� i (A dress ,Lot, on T CW W (Waterbody) k, Rpad, _etc.) own and/or County) N.C. The applicant has described to me, as shown below, the development proposed at the above I o tion. 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) i 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 Owner Information) C.I 6 i c�Yi04 Signature Print or Type Name 1`i "10 AwI)id c ilicant: �� Permit #: (� 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 9W 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 J 5 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 ❑ STAL MARINE PIERS & BULKHEADS LLC 6314 WRIGHTSVILLE AVE 910-256-6357 18787 WILMINGTON, NC 28403 66-21/53010141 [� 2086170206961 DATE � � S (L)C i�1'Z- $Vac) — 1i4 y 60 LGtB�Z�� o� �O o DOLLARS �lIs Fargo Bank N.A. rth Carolina 115fargo.com -1