HomeMy WebLinkAbout57401D - Yarborough!`C MA /-TDREDGE & FILL
GENERAL PERMIT Previous permit#
1New Modification !Complete Reissue Partial Reissue Date previous permit issued
>rized by the State of North Carolina, Department of Environment and Natural Resources �1
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC �17 /jaU
ules attached...
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it Name 7 1,41011/
/ �" Project Location: County 1&k7z
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❑ OEA
❑ PWS:
yes / no
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HHF IH UBA N/A
❑ FC:
PNA yes / no
f Project/ Activity
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Crit.Hab. yes / no
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ng permit may be required by: li%e� �� y/.�'/ 0 ..�+�5,�l�e�►i� See note on back regarding River Basin r
] 1 rt / / / . _. /
Ipplicant: ,"",,I%y �•/�,.�p�o�r Permit #:
late: \1 V
escribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
Fund in your Habitat code sheet.
rbitat 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/orternp
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 ❑
Z
Dredge ❑ Fill Both ❑ Other ❑
C
3 3 f 0
33 yo
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 0
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N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date �
Name of Property Owner Applying for Permit:
�►. M �� ` JC�e_ � � S� fir--'1--�
Mailing Address:
I certify that I have authorized (agent)5 to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at) Vg�5 Gceek 'K A -
This certification is valid thru (date)
-05/Z8 Za [ 3
Date
Signature �� _
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: V m201-6�=
Address of Property:
C_
Koj
(Lot or Street #, Street or Road, City & County)
Agent's Name Mailing Address: r2 R7 Ou - 5�4-
Agent's phone #: 02 �� - 3?�l'-�o Sal _14�
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. l 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. Contact information for DCM offices is
available at www.nccoastaimanagement.neticontact dcm.htm or by calling 1-888-4RCOAST. 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 waive y_ pq (.If o _.
wish to waive the setback, you must initial the appropriate blank below.)t�'EIVLU
DCM WILMINGTON, NC
I do wish to waive the 15' setback requirement. MAY 2 9 2013
I do not wish to waive the 15' setback requirement.
rty rner Information)
I 9 l '
or Tvo� Name
lszs 3reey.-i�oox1�
Mailing Address
(Adjacent Proper"wner nformation)
Signature i]
i
Print or Type Name
Mailing Address
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: QJt M (1c1(k
Address of Property: S
(Lot or Street #, Street or Road, City & County) t\�ek's «a�dov
Applicant phone #: 1 - rJ Mailing Address: \ 62.S �7�-6-V\
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. Contact information for DCM offices is
available at www.nccoastalmangement.neCcontact dcm.htm or by calling 1-888-4RCOAST. 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, or lift must be set back a
minimum distance of 15' from my area of riparian access unless waived by me±l�ygtlp p
waive the setback, you must initial the appropriate blank below.) Ct f� �V/ f�=
DCM WILMINGTON, NC
I do wish to waive the 15' setback requirement. MAY 2 9 2013
A I do not wish to waive the 15' setback requirement.
rty OwnerInformation)
Print or
(Riparian Property Owner Information)
4 A `LV
Signature
C0 #--) e- c'40 H LP
Print or Type Name
I� �S V7 t.4t_In 0-r- .'3 7 B AI-0 (901r5 !-e—
Mailing Address Mailing Address
Rl��T 4bSL f
•
Al li DCRECEIVED
M WILMINGTON, WC
MAY 2 9 2013
low.
Legend
• Points
Lines
Polys
• Addresses