HomeMy WebLinkAbout59136D - White- -CAMA / DREDGE & FILL
E N E RAL PERMIT Previous permit #
New -Modification - Complete Reissue El Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources II
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC q N
t Name � \% I � �/11 h I �-C El Rules attached.
Project Location: County YUY1�W1 G�
sloibi
j 1, Rq(L Street Address/ State Road/ Lot #(s)
I 1(i 1 A. n State_A ZIP S i1_1Gt f w
# ) =43A Fax # ( ) Subdivision � f j ► A:�c
�ized Agent Md ni j m e �&I* �"rS City loo 1 V ZIP 28gC,
d ❑ Cw FEW XPTA ❑ ES - ! PTS Phone # (T I0 ) $ O 24 River Basin L,j M
ElOEA ElHHF ❑ IH UBA N/A
❑ Pws: ❑ Fc: Adj. Wtr. Body A l W W G
Closest Ma . Wtr. Bod I W
„pc f� aNe .,o� ice'\ r..:« u�ti .,e� i.t�'1 1 Y
"r-1 .6'.
*s)
amp
3use/ Boatlift D M
ine Length I , i ;MRPM
-
ling permit may be required by:
❑ See note on back regarding River Basin
,-I, 1, n,.A I 'Zi—L
US MAIL
CERTIFIED MML - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATENIEN7
Name of Property Owner: ---
Address of Property:-
(L.ot or Street #, Street or Road, it jy & County)
Applicant's phone #: y— 7 �G�_ �3�� �� Mailing Address: 6 l d2
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 of drawing.
with dimensions must be provided wit(} 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. Correspondence should be mailed to 127 Cardinal Drive Ext.
Wilmington, NC 28405-3845. DCM representatives can also be contacted at (910) 796-7215. No response is
considered the.same as no obiedlon if you bave been notified by Certified Mail
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or li _: _ ust be set back a minimum distance of
I 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.)
I do wish to waive the IS' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Information)
Si
Print or Type Name /
6/0d, To x� & �e,-t '
Mailing Address
iI1lo, oIomdn Va ill
City / State / Zip , /, % %/
(Riparian Property Owner Information)
5�
Sign
James U
Print or Type Name
CO
Mailing Address
C- k0,6 2�22-7
City / State / Zip
)v"5-1 -?N I)1dd-05
/11-5-lia Sdjoys?jvjjd QR
�no��8d r
y7hb'f -? (u';add-05
45 v 5 Lie
--tillm Pip -Do
9G
crr
ZI
�N�.l
Via^ v flay ���
A157 4s
-in 4�VaM
�t�Abo
� of
HCDWR
North Carolina Department of EnViro6rnent and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue Jaynes hl. Grew
Govemor rector
AGENT AUTHORIZATION FORM
Date: 3 / 2—
Name of Property Owner Applying for Permit:
P06 � . ; f-e
Owner's Nailing Address:
,K'/Oa %:�; u
(17id/o fAtah V
a3 112
Phone Number ( 1
Dee Freeman
Secretary
Name of Authorized Agent for this project:
Agent's Marling Address:
lq,�-7 S/on rLl�S7� Wa'/
ev,n �{
a 9lel6 q
.phone NumbS-
t certify that I have authorized the agent listed above to act on my behalf, for the purpose of apply
for and obtaining all CAMA Permits necessary to install or construct the following (activily):
slew v01(t C4e '1-24,-L /JT r /`
(my property located) at
This certification is valid thru (date)
s
' 3/f
roperty Owner Signature Date
2 V 1-l6 2
127 Cv*W DdW EXL, MdnOmo NC MM Di tWaroi' n a
Phone: 9104%7215 %FAX 910395.M btbm&- wviw.n�atnMQ90MenlW iY�
ilicant:
Permit #: Ll � �3L L
-vibe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
tat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
im—t mmnnntl
tamn imnacts)
amount)
L�) I Dredge ❑ Fill ❑ Both ❑ Other I ` I
■ 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:
rbour T wn ZZe'
3 00
W ilkn1vto IDn
A.
❑ Agent
❑ Addressee
( Printed Name) C. Dade of Delivery
D. Is delivery address different from item 1? I(J Ye+
If YES, enter delivery address below: ❑ No
3.
al-e rtifled Mail ❑ Express Mail
❑ Registered ❑ Retum Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number 7009 1680 0002 3799 4308
(rransfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-024A-1540
Dredge ❑
Dredge ❑
Dredge ❑
Dredge E
■ 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:
Alln A Ar/ � �n Z- �
A. Signature
❑ Agent
R ved by Print N e) C. D to o Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No