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Home My WebLink About57480D - Dorman:-i'CAMA DREDGE & FILL GENERAL PERMIT Previous permit # !fNew : !'Modification :1 1 Complete Reissue Partial Reissue Date previous permit issued )rized b)kthe State of North Carolina, Department of Environment and Natural Resources 'Z CEO Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ❑ les attached. nt Name Project Location: County 5 tlob /JC lc�-Z-- Street Address/ State Road/ Lot #(s) v) State `C- ZIP OE (�ro) 3;�� Fax #1(_) zed Agent Of J /CC. CID4, S � It I J'I Cw F3jEW —&PTA El ES E PTS OEA EJ HHF El 1H OUBA ON/A PWS: — FC: yes / no PNA <*,ps / no Crit.Hab. yes no of Project/ Activity e,` C, A 3 / X 1A", / 11'714 - Subdivision City ZIP Phone# River Basin C�114 Adj. Wtr. Body — Closest Maj. Wtr. Body r e- ., i - /,, i .1 X 22 / A I T-e#- (ScWe: Al 7 r■,,■■■��cios�■■■■■■ii■�■■■ -ngth III MIR R29 owl IN 111W 2T, imber -----MMMMF6 P 111,221111HOOMMANOWN EM I ME if �'EMEMMMMMIMMMER192*11 Miami id/ Riprap length !g distance offshore_ ax distance offshore— :hannel jbic yards rnp i�n�wr�■■■�i■■■�■i■■■■■■■■■I - a-e Wildozing -INEZ" MEMENEEMEMMOMMEN Mmmmmmmmmmmmmmmmmmmm■■EMM=EEMMMEEI • M MMMMEMEMEMININMEMON ■WHIERNMOMMMEMMEMMMI 1 • 11w MEMEMMERM mommoll/lolifo Now ling permit may be required by: See note on back regarding River Basin * L.,4 F6L16 r2 CO25EI� L3AN4 to QAJ Co vE PE� rj t7(k 3q L LJ A OVEP- AAXJ9 /Z/ S AW, a-M, W.-M,� �' fl, _ 1),E J ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE) I hereby certify that I own property adjacent to --� o z: y _ l o 2 rh iis (Na ne of Property Owner) property located at I �,^, l� (Lot, Block, Road, etc.) on � (�( k in 5►��5 , N.C. (Waterbody) (Town and or County) Applicant's phone #: Ql0-i l- 8 15'A Mailing Address: 40bo N C $ 2 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 I do wish to waive that setback requirement. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: ---------------- - --------------------------------- (Information for Property Owner Applying for Permit) 4tto rJ C- 5, -;- Mailing Address 1 (Rips ' ro r ne formation) A I I I �, - Signature ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE) I hereby certify that " o,vn property adjacent to P lAiNa M .— 1) u2man) s 11 (Name of Property Owner) property located at S d (Lot, Block, Road, etc.) on CM' , in S►JItA aS N.C. (Waterbody) (Town an/or County) Applicant's phone #810 Tt 1-J k5!A Mailing Address:14Uici 1JC 5 a ':(:)un1-1 IJ L a 83?�{ 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 I do wish to waive that setback requirement. --------------------- DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: (To be filled in by individual proposing development) T 6 ------------------------- (Information for Property Owner Applying (Riparian Property Owner Information) for Permit) 4mo PJC �2- Mailing Address Signature NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Beverly Eaves Perdue James H. Gregson Governor Director Dee Freemar Secretary AGENT AUTHORIZATION FORM Date: S J(-, vim, ZD� ame of roperty Owner Applying for Permit: me of Authorize Agent for this project: )wner's Mailing Address: 'hone Number NO) Q69 t-- 71 S-q Agent's uMaili g Address: Zq I HnM 5Cpe,--Ek (ei c So -vi le NC- 2-V5q b Phone Number (it 0 33 ba certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying or and obtaining all CAMA Permits necessary to install or construct the following (activity): (my property located) at 4 This certification is valid thru (date) _� 3 jr perty Owner Signature Date kC— plicant: te: Permit #: scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement ind 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 jrnpact amount) TOTAL Feet (Applied for. Disturbance total includes any anticipated restoration or temp impacts) FINAL Feet (Anticipated final disturbance. Excludes any restoration and/c temp impact amount) bow Dredge ❑ Fill ❑ Both ❑ Oth 10 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 ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ i7 t �- r �v X -(G r (Z�� JOEY A. DORMAN 1676 TAINA M. DORMAN 4000 NC 82 (�'� \ 66-30/531 DUNN, NC 28334 l 254 Date Pay to the Order ofVc, . c Dollars First Citizens Bank 1:0531003001:00 25460490 240 01676