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Home My WebLink About38957D - BrockCAMA / C1 DREDGE & FILL GENERAL PERMIT Previous permit # New — Modification ---i Complete Reissue uPartial Reissue Date previous permit issued_,�i zed by the State of North Carolina, Department of Environment and Natural Resources c)astal Resources Commission in an area of environmental concern pursuant to 15A NCAC r ♦ j 00 �7�fX� i Name 1R619Tq iG CX�(C Project Location: County �`'les attached. 1 C 6 TA O GA Street Address/ State Road/ Lot #(s) Stated ZIP (� T Fax # O Subdivision :d Agenttr� P, NT► WGRJ City GkAa-F C41 _ ZIP Z�' 2-_ ❑ CW >j EW APTA /IQES ❑ PTS Phone # (9 10�3i--4 — 1S River Basin ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A Adj. Wtr. Body �-HN�CI. /�r 0�'� lM/InJ (nat ❑ PWS: ❑ FC: ,es � PNA yes no Crit. Hab. Closest Maj. Wtr. Body TDI� IL- S"flyi� ,'y/e-s - �/ Project/ Activity INN-CQ1//( 11� foi i'-knack WA -AA wa,J &C t z.� LA)Ctj 1 111 I t AA Af n (Scale: ► c Length not sure yes o 'ti not sure yes um: n/a yes yes ttached: yes ` . n9-- ig permit may be required by: - -- -IJ i / J- / .).. It //_- Lq!ii A ❑ See note on back regarding River Basin r JVAA a _ � A a roQ 4m S!X� N a -do Z 1 y} J, y�d'3"mil _tso 'o-f'. M, �. sj A •�� } E 77ZO Z ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIERMOORING PILINGSBOATLIFTBOATHOUSE) I hereby certify that I own property adjacent to &SiA zy-ouz is (Name 4Property Owner) property located at �; OCICO ZACI 5+ / S-LkA '" (Lot, Block, Road, etc.) on —�� in cJ 1 w , N.C. (Waterbody) (Town and/or ounty) ((�� t -iYtaaZi �nSf Applicant's phone ASV 3�� 341CCMailing Address: �� V i' ! n1U-- Lil He has described to me, as shown below; the development he is proposing at that location, and, I have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse must be set back a minimum distance of fifteen feet (1 S) from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the appropriate blank below.) 0#—/ I do not wish to waive I do wish to waive that setback requirement. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: (To be filled in by individual proposing development) (Information for Property Owner Applying for Permit) Mailing Address (Riparian Property Owner Information) City/State/Zip Print or Type Name ADJACENT -RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIERIMOORING PHEVGS/BOATLIFTIBOATIYOUSE) I hereby certify that I own property adjacent to pi y zwo' is (Name of Property Owner) property located at 1 , (Lot, Block, Road, etc.) on CAAIr C Q.� inCal (Waterbody) (Town and/or Applicant's phone#:10 Sol 13415Mailing Address: P tt-,Asi- N.C. He has described to me, as shown below, the development he is proposing at that location, and, I have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse must be set back a minimum distance of fifteen feet (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 not wish to waive Xy_ I do wish to waive that setback requirement. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: (To be filled in by individual proposing development) t� ' (Information for Property Owner Applying (Riparian Property caner Info on for Permit) bk Mailing Address ignature It q- %I [A MA City/State/Zit) Print or Tvne Name NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management ichael F. Eas'ey, Governor Charles S. Jones, Director Authorized Agent Consent Agreement William G. Ross Jr., Secretar A" NUA U NS;TU, Mf is hereby authorized to act on my behalf (Printed Name of Agent) order to obtain any CAMA permit(s) required for the property listed below. The authorization is limited to the !cific activities described in the attached sketch. CATION OF PROJECT: OPERTY OWNER MAILING ADDRESS: --- - PHONE NO. 91?— C3 �— THORIZED AGENT MAILING ADDRESS: �y 1iCKA1 J, Sri t�rj'4t PHONE NO.". 2 r_i t~[ nature of Property Owner: x .' 51 i rat 5-fKtly-fVre.- )plicant: tte: fv Permit #: 3 �-q S 7 scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement and in your Habitat code sheet. bitat 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/oi temp impact amount) Dredge 00 F>tM Both ❑ Other ❑ /5 ( ` -g Dredge ❑ Fill Both ❑ Other ❑ 1a y / yo y D 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 ❑ ■ Complete items 1, 2, and 3. Also complete A. Signatu �y �� •-, �. ! item 4 if Restricted Delivery is desired. — - ■ Print your name and,address on the reverse ❑Agent so that we can returri the card to you. ❑ Addressee ■ Attach this rard to the back of the mailpiece, B. Rec ved Aiamn.�_--__ D of Delivery or on the front if space permits. 1. Article Addressed to: C mOxhu.m I o v �dcr �ti D. Is deliv address different from item 1? ❑Yes If YE enter delivery address below: ❑ No a. bervice Type ❑ Certified Mail ❑ Express Mail ❑ Registered Cl Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 2a. Hestricted Delivery? (Extra Fee) ❑ Yes Article Number . --- (Transfer from service label) 7 011 3500 0 0 0 1 3 9 5 5 7 919 PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 ■ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: LaYq 1,6,K,v,s Pu Bux IOBga ��'�• lLhC. a� 4 o�i A. Slgna X U �0 Agent ❑ Addressee B. Rec ed Py (P '' tednN e) C. Date of Delivery �t\ UCIY ��_� D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No 3. Service Type ❑ Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number (Transfer from service label) 7 011 3500 0001 3955 7933 PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540