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Home My WebLink About57436D - MizeCAMA / DRED03E & FILL 'ENERAL PERMIT New ❑Modification ❑Complete Reissue El Partial Reissue I � i i Previous permit # Date previous permit issued --- >rized by the State of North Carolina, Department of Environment and Natural Resources Coastal Resc -irces Commission in an area of environmental concern pursuant to 15A NCAC 1 , 00 —} ( Z ❑ Rules attached. it Name t✓ > State d ZIP d X Y L S `. —S15 Fax#(—) :ed Agent r' OtM Cw ,EW JQ TA jjES ❑ PTS ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: ❑ FC: yes PNA yes Crit.Hab. yes / no Project/ Activity %G c..c, b inck)1pnoth T x Project Location: County e36_,S1_;t2(A Street Address/ State Road/ Lot #(s) y 07R Subdivision City ZIP Phone # ( ) River Basin Adj. Wtr. Bod1YC_ N fYL 04 A / w aJ (nat Closest Mal. Win Body S �✓ ?,V1 p I t�t/.t -4e^ "J pt'd Y L <:aC (Scale. / t ■■■■■ ■■■■■ ■■■■ ■■MEN ■■ ■■■■ ■■■■■■■■■■■ ■■■■■■■■ ■■■■■■■ 0 MEN ONE momom■■■■■m■ ■■■■■■■■■■■O■■■■■■■■ MEN ■■■■■■■■■■■ ■■■■■ MEMO ■■■■■■■■■■■NEE ■■■■■■■■■■■■ ■■M■M■■/I■M■■■ME■■■■O■E■■■■ME■■■EM■■■ ■■■■■ ■■■■■I�Eti■■i■■■■■■■I■■■■■■■■■■ME■ ■MEN ■■■■■■■■N■�■qpr� ■III M■■0 somomm!!■■■■■■MO■■/_mini FOR Mr. ��■■ iAlf■EEO■■M■■ECM■■■■■■E fr■d►raw:�irai��■Oi■ME�■■ ■■■■■■E■1■■■■i�i■■■■MEN ■:r�ii�c��y i� O1f ■E�E�E■iil ■■NEE mmmi ME ■■■MMWM■1■MOM ��Zi..:aL�i t�l ■■■� EEI�/!I1�, M■■E■OMOL71t!! ■■■S'WON M. = -20— +IWlfiIifts ■■MO■ ■■■■�■�■N ■■■■■M■O■■O■■I EN ON Allizz N■I ■■■En■■■■m E0M■■■■■■111111111FO■■M■■■■■O■■I ;. ■■■■GE ■ ■■■■■■i ■■■■R ■■E■■E■E■■■■MOM■■I ■ui■■■■■■■■■■■i ■■■■� COMME■�■■s,�■M■■■I ■■■■■■■■■■■■i ■■■■■■■■■ ■E,m E1■M■■■■■■■■M■I E■EE■■■M■■■■■■ ■■ElmM■MEMEE■■E■I vNMM■�■■■■�■■■■■■■ EME■MOM■ _ EN■■M■■■MM■■■■■f■■I ling permit may be required by: rg'L,S�Q U/ (.lJ / U�/ ❑ see note on back regarding River Basin / Qnnr•iol Cnnditinnc 'ATL. NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary Date9-2 / Name of Property Owner Applying for Permit: Mailing Addrsm: I certify that I have authorized (agent) �Cl'1/`)p_ to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity) /-� G �' at (my property located at) [ % K This certification is valid thru (date) 2 // ~ / J ADJACENT RIPARYA 4 PROPERTY OWNER STATEIV ENT (FOR A PIEfOOMG PLLLVGSIBOATL'FTTIBOA7WoUSE) R I hereby certhat I own Property A scent to tify Is (Nome of roperty Owner C— D-i� 4 4 property loeatea at , • v — - - -- .�� (Lot, Bl k, Road, etc.) c� -e�� C �q� , in S �i, C,,-" g a -✓ —, N.C. on (Waterbody) (Town and/or County) He has described to me, as shown below, the development he is proposing at that location, sad, I have no objections to his proposal. I understand that a pier/mooring pilings / boadift / boathouse must be set back a minimum distance of fifteen feet (151 from my area of riparian access unless waived by me. (If you wish to waive the setback, you mast 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) It you have objections to what Is being proposed, you must notify the Division of Coastal Mensgement (DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington, NC DCM representative can also be contacted at (910) 796-721!k No response is considered the snme a100 obiecffon if Xgu have been notitied_tiCertified MAA (information for Property Owner/Applicant Applying far permit) C 5 I - Mailing Address 5Qc CL3( 'tk City/State/Zip Gi ( ci �(Z2 co30 Telephone Nuntz Civnnmre (Riparian Property Owner Information) Signature ,jamt or Typo Name 33� 9a s' 9d 2 - Telephone Number Date ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIEA&100MG pLELvGS/BOATLI17TIBOATHOUSE) I hereby certify that I own Property adjacent to C,., c1 "Th Name of - Property S Ow r) L property located at C) -7 h {Lot, Block .r, Road, etc.) on � S�,�a-J''� N.C. (Waterbody) (Town and/or County) He has described to me, as shown below, the development he is proposing at that location, Bad, I have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse must be set back a minimum distance of fifieen feet (1 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.) do not wish to waive AI do wish to waive that setback requirement. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: (Ya be filled In by individual proposing developnunr) 12 If you have objections to what Is being proposed, you not notir, a Division or coastal Management (LICK) in writing within 10 days of receipt of this notice. Correspondence should be auiled to 127 Cardinal Drive Ext, Wilmingtoo, NC DCM representatives can also be contacted at (910) 796-7215& No response is considered the snme as 4eo objection iLygtt have been notified Dr Certified Mall (information for Property Owner/Applicant Applying far permit) Mailing Address 14 City/State/Zip Telepho umber Sianeture Date (Riparian Property Owaar Information) ;gtleture Print or Typo Name Telephone Number 2 —4" Date (L �J J�•cv� �. � .�S �,C,X- aA Pq,z i"je 2 :)licant: I) + V M l Permit #: S7'7 .7 _ :e: >cribe 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/o. temp impact amount) �V Dredge ❑ Fill Both ❑ Other f6— Dredge ❑ Fill ❑ Both ❑ Other ❑ 77 Dredge ❑ Fill ❑ Both ❑ Other ❑ 31 d 3�0 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 ❑ W"D N ARTIFICIAL WATERMARK PRINTED ON THE BACK. THE FRONT OF THE DOCUMENT HAS A MICRD_PRINT BORDER AND UV FIBERS. ABSENCE OF THESE FEATURES 100/pkg Rev 02) 04 I4 X ; I , + ,- + * =f ►7` 29087195 5„O9 Date Ord ,er OfN n�, � 08/1'7/2011 , e Value Valid YOne Year From Issue, Three Years in CA - Money Order Subject to Return and Service Charge Thereafter) IGNT HUNDRED DOLLARS AND 00 CENTS _R Purchaser, Signer For Drawer QAddress ✓ d /i !mot>>-C�PS'131� C�►��) f _ For x �•�-� iPC fir' ff0 V 1 A PURCHASER, BY SIGNI YOU AGREE TO THE SERVICE CHARGE AND OTHER TERMS ON THE REVERSE SIDE ,RGO COMPANY" AGENT FOR MONEY'GRAM DNEYGRAM PAYMENT SYSTEMS, INC. DRAWEE: THE BANK OF NEW YORK MELLON Not Good For More Than $1,000.00 0. BOX 9476, MINNEAPOLIS, MN 55480 EVERETT, MA • 11■2908719Sill i:0110070921:01,7071,L99L,3831"