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HomeMy WebLinkAbout57448D - TeacheyCAMA / --'DREDGE & FILL A 1ENERAL PERMIT Previous permit # ;.New ,__'Modification L]Complete Reissue El Partial Reissue Date previous permit issued Ized by the State of North Carolina, Department of Environment and Natural Resources 1100 , r 17-0c :oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC Rules attached. tN e State ZIP 16) & Fax # ed Agent E CW ,�'W 'f§1,PTA /QES El PTS 0 OEA [I HHF El 1H 0 USA El N/A 0 PWS: EIFQ Ifn'ol PNA yes/ a_67> Crit.Hab. yes /' mod Project Location: County �StM4,r— Street Address/ State Road/ Lot #(s) Subdivision City 511V-74-1 Phone# River Basin6Fe Adj. Wtr. Body Co -;-CA nat i I Closest Maj. Wtr. Body 44 P Sy Ure5 NEI ■■■�■N■W0MONV1,1v019 ElmsM=111I iENNNi NW YINNIN EW■N■■■■W■■N�■�WN■iom OMMEN el-ength A^ not sure yes ,s: not sure yes '01� riurn: n/a yes yes 3� ", / 7 "1 T ing permit may be required by: See note on back regarding River Basin r r 2013-Jan-31 02 38 PM bank of america 9103281491 1/1 ADJACENT RIPARIAN PROPERTY OWNER STATEAAENT 1 hereby certify that I own property adja nt to �j�T.' `� �Le i a �. (Name of Property Owner property located at ( �iY 'i� on 1A �. e, 1n (AddresLot Slo o d, a .) N.C. (Waterbody) (CltylT wn an r 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 H" In description below or attach a site drawing) WAIVER ION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be get 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. n,. me InMrmatian) (Adjacent Property owner Information) I (Revised 8/182012) 11 13 02:30p Byrd Surveying 9199899300 p.l Owner Information) Print r-T i e N Maili g Address City tat D Tefophoge Nurpber An.IACENT RIPARIAN PROPERTY OWNER SYATEMENT I hereby certify that I own property adjacent to a of Property pwnep' () !� property located at (Address, Lot, Block, Road, etc.) terbody) , in on (C',tyfT I antUor C unty) (Wa The applicant has described to me, as shown below, the development proposed at the above location. 1 have no objection to this proposal. I have objections to this proposal. DESCRIPTION ANIYOR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing developmefrt must fill in description below of attach a site drawing) 10 } K6f 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.) ! do wish to waive the 15' setback requiremeni- I do not wish to waive the 15, setback requirement. (Adjacent Property Owner Information) Signature �, y /rV L J 4�OZD Print or Type Name sit, add 0�5 , 27.5 Z4 City/5fateiZip %�d� ���, Teiep oneh Number N.C. DIVISION OF COASTAL MANAGEMENT AGENT AUTHORIZATION FORM Date P I Name of Property Owner Applying for Permit: Mailing Address: I certify that I have authorized (agent)^�"� (�� /`-!'� to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity) w16'c( 4 �i -0 at (my property located at) � (date) This certification is valid ( ) /v— Propefty Owner Signature Date rlicant: VlrJwa e: _ 13 r'-e� 0 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 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 ❑ Fil> Both ❑ Other ❑ /11 Dredge ❑ Fill ❑ Both ❑ Other O 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 ❑ lqiR® GLOBAL EXPRESS® PAYABLE THROUG North H 75-1555 American Banking Company, MN 912 MONEY ORDER 328252538 %OOAL EXPRESS EIONEV OROERS. INC. OIV. OF -EX FINANCIAL SERVICES. INC. EaP O. BOX Ba00 SPRIHG:MAnYLANG30W C—CHECK #1 61432 02/0 i/13 .--- — ��'�C]C3DOL�r�E�I�T; TWO HUNDRED AND 00/100 DOLLARS-3 NOT VALID OVERPIVE HUNDRED DOLLARS 1$W0.001 PAY TO THE ORDEROF -- --- ------ -------------— ---- — -- — _ _ LAST TIER -READ REVERSE SIDE BEFORE CASHING MONEY Ono" PURCHPASER. RCHASBR"S A MESS e,-�r� GIFT CERT RECEPIENT - GLOBAL MXPRESS MONEY ORDER North AmericanBankingCompany, MN 328252539