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Home My WebLink About56616D - Campbell ALT7 NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Beverly Eaves Purdue, Governor James H. Gregson, Director Dee Freeman, Secretary AGENT AUTHORIZATION FORM Date o2 7 467-Zd Name of Property Owner Applying for Permit: Mailing Address: a. /0//-/tiG' � � "(. I certify that I have authorized (agent) %w C4kjw to act on my behalf, for the purpose of applying for and obtaining all CA Permits necessary to install or construct (activity) f -7�10/ZZ 1A at (my property located at) (QqS K;\)� Rv' 2e. 2C , This certification is valid thru (date) =�; 0 -DC'i, zO 1 ,;L70c+2.090 DIVISION OF COASTAL IvfANAGEYfENT ADJACENT RIPARIAN PROPERTY QWi ER NOTIFICATIONIAWAIVER FORM The purpose of this form is to provide proper notice to you as an adjacent riparian property owner to the individual or individuals listed below. The CAMA General Permit application procedures require that applicants provide the Division Coastal Manaeement confirmation that a written statement has been obtained signed by the adjacent riparian property ow indicating that they have no objection to the proposed work or that the adjacent riparian property owners have been notifi by certified mail of the proposed work. Often these forms are submitted to the adjacent riparian property owners by a mat contractor or other individuals acting as an authorized agent on behalf of the applicant. This farm was sent to you by the following individual or company designated by the applicant as an authorized aaen-: Authorized,�f.,I�ii`s Signature Date Name of Individual Applying For Permit: _ Aelwp N C�%iso6alG Address of Property: / Jr 10,k A (Lot or Street =. Street or Road) r oJr f� A/C d � yklo (City and Counn-,) I lereb certify that I own property adjacent to the above -referenced properrv. The individual applying for this per described to me as shown on the attached drawing the development they are proposing. A description or drawl dimensions. should be orovided with this letter. I have no objections to this proposal. lf you have objections to what is being proposed, please write the Division of Coastal Management. I cardinal Drive Extension. Wilmington, NC 28405 or cal: 910-796-'215 within l.0 days of receipt of this noti o response is considered the same as no objection if -ou have been notified by Certified _-Mail. WAIVER SECTION 1 :£. derstand that a pier. dock, mooring pilings. breakwater. boat house or boat lift must be set back minir tit distance of la' from my area of riparian access - unless waived by rate. (If you wish to waive t sell, you must initial the appropriate blank below.) I do wish to waive the 1 ""setback requirement. I do not wish to waive be 1' setback requirement.. L(_.Q//.J // /. 0 7 . _ /1i111 L ----- - ADJACENT RIPARIAN P,,:0P£RTY 0W-NERNQTtjCATITj0 UWAT-VIER FFOURKMM T he purpose ofthis ion t� ifi to proviEle prUper notice to you as an adjacent riparian prtsperty_o�- tc the itidi� is l aj 4r�dividi s Listed below. The C:? V:k General, � n is apgiioa�ofl arcceeures require that apgiie provide the D� r� soy* t� C3ast? iaFiagenient con irrriation that a wriren statement has been obtained signed by the adjacenr rtoarm proper-Y o „ - : ird;c , t that the have no objection ir5 the v=oposeo fork or tahar the adjacent r ipariati proper y owner have been u s Fe{i by cerciiteri i iaii of rr'�e proposed work. t}ften these orms are s'u?t?n?iire.� to theadjacent riparian p-'- ti> W-izers. ; cosi�ctor or other individuals acritig as an authonaeci agent on behalf t31 the applica . T"'ix fog was sent to you by the following individuai o_s coFnnaiz dpsigi3ar b the ag s i n`s as autho ¢d agen=: 1'r Glutiro 19Z-0 ' a�ne of day iLuat npg vi'Ig Fa: Per-I?i : Address OfgropeM,': y�/�yNy # d�t�s". Or Stre2", _s. Sti'per O?' !`.all: ^VC (Ciiry and COLT11 - ) ereDy certi td?at i o�vt? propet;v adjace it to he above- fef?r±cec rogei:y. The, tndt«igav2i description Pc�riotionic dia nth iescrfberi t ;tee 5t`,c`vn or, :}te artached dra« erg th.= �Lt e.op�e., -t;ev ; propose, ' + :.rrovid-d with this !elter. c?tgensions, sitou bw t Nave no oQiectiors to this groposat. vt ' a have oblec-aoi s to what is being proposed; please Yrite the Division of Coastal 'vlaDagee}3Y, ve Extension- 0- litr i toi <C` -8409 of calz 5�I�--�96-7215 within 14 days of rece pt�i3 his i�o€� se is considered the sa"Me as ne ob. ection if yu aye beer-, zQd ed by Cezti ed a . '� A—I'V E R 5r CTsON t ti # t d that a plat, dock moo,i�g pilings, breakwater, beat house or l�at l as must � ,et bac9 :a Bats' 'aiit7c rir from, iF Y area 3+ _`E�'� 3dIi aCCESs - *in, — waived �}Y i11@. i��d c31? TriS�t'fi(s' iLrv?' d st it-tial the appropriate biank beiow T do Wish to }?{.tl� e the t J' Se.baC`t :eS�11F�Fii�r11, ` r - - ~_ Y ltra i? s2;ilaCK re uire� ant. � dsx nett wish tc aiV6 rt Date L I I IIIIIII IIIIIIIII70 le 4�21W e/ 6 > 02V 77ill : Division of Coastal N19t. Habitat Impact Computer Sleet licant: c/ ► GiC\ ��(,(, Permit #: 5� cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement nd in your Habitat code sheet. i,itat Name DISTURB TYPE Choose One TOTAL Sq. Ft. (Applied for. Disturbance total includes any anticipated restoration or temp 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) Dredge ❑ Fill Both ❑ Other ❑ �impacts) V V Dredge ❑ Fill Both ❑ Other ❑ 1--, Dredge ❑ Fill ❑ Both ❑ Other Li 1�0 I I SO Dredge ❑ Fill ❑ Both ❑ Other '74L4O —P40 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 ❑ PILINGS AND MORE JOHN CASSIDY 6015 PH: (910) 327-2009 169 LAKE HAVEN DRIVE /v �� 66 30/531 SNE�A/DS FERRY, NC 29460 i d 457 P 1 [0 [Ile hate 39 Iv - Dollars I o ® First Citizens(f 5(o(allo D fB t�citiiiens.com -.1 rJ COMP I �` or Lr�r�it �'�rx.�. ; -il a 1:0531003001:00[,57132701 n' 601E `