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Home My WebLink About60795D - GachesXAMA / ❑ DREDGE & FILL / NO • 60 3ENERAL PERMIT V Previous permit # f New [-]Modification ❑Complete Reissue 7Partial Reissue Date previous permit issued i" sized by the State of North Carolina, Department of Environment and Natural Resources L J -oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC W � � ! I � � ❑Rules attached it Name 50L' Ghee- pX . �1✓1✓A e01,/ S Staten ZIPZ `16 to ) 5 `V -S13rr' Fax # ( ) ed Agent 1*�. '$� A lwl� O CW ;?!k'fW -fTA ❑ ES ❑ PTS OEA ❑ HHF -J IH ❑ UBA ❑ N/A PWS: ❑ FC: yes / ,fio ; PNA (J!t>/ no Crit.Hab. yes /.'fi' Project Location: County L-4N/7t V- Street Address/ State Road/ Lot #(s) 360 9A 11,4 5T `'! . 1} Subdivision S40"O/ AO/N7T /-*2MAN717//), City/h � ZIP Z *-Yy Phone # / ' Y yB`. River Basin Clol�-' Adj. Wtr. Body//Q6fN� C/1lL, at Closest Maj. Wtr. Body 1-4x& N1it C695& 01Z� _. Project/ Activity j `I ! I / r: ,/ f ck)length 1(s) ier(s)_ ,"— ngth mber I - d/ Riprap length distance offshore x distance offshore I cannel )ic yards_ 1p se/ Boatlift_ w� Aldozing , Length 0 not sure yes ) >: not sure yes n ium: n/a yes no yes o r lttached: s no .� ig permit may be required by: C--i r -.Airinne ��r (Scale: All ❑ See note on back regarding River Basin n may V " N.C. DIVISION OF COASTAL MANAGEMENT AGENT AUTHORIZATION FORM Date 4E 20/ Name of Property Owner Appplly�ing for Permit: Mailing Address: 3() (,) Y)2 r V,�-c — z /V / U 1 !� ji✓! r) o? / 'i I certify that I have authorized (agent) 6'6,'�kL61ry , AI ( IJ��j,�, to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity) �L-- IyeO,f/Ff l�, 6 at (my property located at) _ dO —R, i--LLAf f �o , oe;> This certification is valid thru (date) - , /fiyc� o7C1 I �- Property Owner SignatuW Date ADJACENT RIPARIAN PROPERTY OWNER MTEMENT I hereby certify that I own property adjacent to 1-/' 1 �f 1 61 VIN - (C ,6- I /? (111; _—S (Name of P operty Qwn A property located at ME (Waterbody) (Address, Lot, Block, oad, etc.) in C- S, ZI (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. ------ I,— I have no objection to this proposal. — I have objections to this proposal. Ut:bCRI"ON 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 wish to waive the setback, You must initial the appropriate blank below.) I do wish to waive the 15' setback requirement. 1 do not wish to waive the 15' setback requirement. S4(Property Owner Information) (Adjace ,p;I Props #y Owner InformaAlon) Signat—re Sign tub MI"t4-V Print or Type Name Print or Type No Y00 RAo,4,t) 7, Mailing Address Mailing /"Ad"ss D'Z-1'(0/ I'v K /9V, / citylstate/zip - fll&.X,.--",- POG-09-2012 09:40 From: To:93294481 ADJACENT BlEARIPN PROPj�RTY OWNER STATFMENT t / I hereby certify that I own property adjacent to ) 0 A.,L cfi l� 's r? . / ` ti , t (Name of property Owner) pre on 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. (Individual DR DRAWING OF PROPOSED DEVELOPMENT ent must fill in description below or attach a site drawing) WAIVg fL SECTION 0 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 To het ack, 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) (Adja.�ent Propert wner Information) Srgnaiure S gnalur , WILL-, AAJ U.gc HEM . 5 ' ry Ivy K Pnnt gr Type b4agie _ _ print or Type Name r //�� plicant: 1 / f /r/f G Wt tT4 C4 c°S O S Permit #: te: 12— Zv -/� Scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement nd 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) n JW Dredge ❑ Fill ❑ Both ❑ Oth /V'V D�g Dredge ElFill ElBoth [IOther ❑ 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 ❑