60777D - Nelson

CAMA / ,'pREDGE & FILL No. 607
�
iENERAL PERMIT V Previous permit#
New ❑Modification 'Complete Reissue -Partial Reissue Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources H ? , 2 S 00
�astal Resources Commission in an area of environmental concern pursuant to 15A NCAC 1 lees attached.
Name
t �?•C✓✓J Project Location: County_Q µ/
I �,�g� �j f Z,... {� , Street Address/ State Road/ Lot #(s)
hC (i Stater L Y-IP ;ZX"t= J GGt�Gt.t T2X
f toWF — # () Subdivision
:d Agent �Iya Oy� City �1i� .��_ ��f ZIP
i
❑ CWEWTA ,43ES ❑ PTS Phone # ( - ) aver Basin
OEA ❑ HHF ❑ IH ❑ UBA Ll N/A Adj. Wtr. Body b3 C
❑ PWS: ❑ FC:
Closest Maj. Wtr. Body
yes /(�io PNA yes f n Crit.Hab. yes �io
(Scale:
ie Length
not sure yes on
gs: not sure yes - )
rium: n/a yes,.nnTi
yes r�
ling permit may be required by: i �W ❑ See note on back regarding River Basin
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stl!j 26 6 x �b
Ong - #7
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CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: 1 ?,7 b i� Y f- 4. N4 Iso /
Address of Property: 4 3 ca11 CV D% s �Ci!/' 7 1p
u (Lot or Street #, Street or Road, City & County)
Applicant phone #: / ��' 3g , Mailing Address: �� Ce )4 Ct
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.net/contact 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. (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)
Signature
Sv�rt-v-' r-lC4,u
Print or Type Name
P.o. 1)-y')�Cj I --z'
Mailing Address
(Riparian Pr perty pwner Informatio
Signa ure
Ro bar ;
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:(%
Address of Property: 1C' l Dj- 'PG16/S F '4 �v&
(Lot or Street #, Street or Road, City & County)
n
Applicant phone #: ` 10 e9&Z,2Z236 Mailing Address:/V3 6;thQ t pv—
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.nccoastalmangement.net/contact_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. (If you wish to
waive the setback, you must initial the appropriate blank below.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(PrAperty OWnLy Information)
/-- J b/ w l` 6 (4 Q r
Print or Type Name n n
I\fve�Si�P 1✓ `
Mailing Address
(Riparian Property Owner Information)
Signature
ki2b0�
Print or Type Name
Mailing Address ^

I
��
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Micnaei F. Easley, Governor James H. Gregson, Director VV:iiiam G. Ross ,,r_ Secretary
Date /l -/7- /
Applicant Name ob-e r1
:Mailing Address--
S•� e �sr
I certifg/ that 1 have authorized (agent) ✓y ��-� to act on my
behalf, for the purpose of applying for and obtaining all LAMA Permits necessary to
install or construct (activity) 5e
?
at (location) %J C�G1 l or
This certification is valid thru (date) _
Signature �jQ —_--

plicant:5�-
-� Permit #: � O
te:
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 qVqrts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impa ount)
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)
20 Dredge ❑ Fill ❑ Both ❑ Other
CA) Dredge ❑ Fill Both ❑ Other ❑
nr�
Dredge ❑ Fil Both ❑ Other u107
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 ❑