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Home My WebLink About56655D - MooreCAMA / DREDGE & FILL iENERAL PERMIT Previous permit# New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued ized by tl� S-,Ite of North Carolina, Department of Environment and Natural Resources oastal Re!�ources Commission in an area of environmental concern pursuant to 15A NCAC 24 , .2 mules attached. Name_ _ __ Project Location: County 4 Street Address/ State Road/ Lot #(s) State ZIP Fax # ( ed Agent °' ❑ CW ❑ EW ❑ PTA Figs ❑ PTS ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: ❑ FC: Subdivision ZIP Phone # O River Basin Adj. Wtr. Body �-��(nat /fi Closest Mal. Win Body 4 1 yes / no PNA yes /. no Crit.Hab. yes / no Project/ Activity r ier(s) ngth tuber J/ Riprap length distance offshore uc distance offshore cannel bic yards np ulldozing ie Length not sure yes no ,s: not sure yes no rium: n/a yes no yes no Attached: yes no ing permit may be required by: ap ❑ See note on back regarding River Basin r P 10, ❑ffs, Canal Proposed Boatlif t Yl u ---50' 6 Goldsboro St. ,May. IQ. LQl1111,47AM STIFEL NICOLAUS No.4621 P. 1/2 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR .4 P1EWU00R11VG PW1VG&210ATLMT18OATHOUSF) J hereby certify that I own property Adjacent to 14enr v MQQCp,, 's (Nan a of Property Owner) . property located at 6 Goldsboro � (Lot, Block, Road, etc.) on_Cgrtal .—,in Oceon_ Iste Beach N.C. (Waterbody) (Town and/or County) Applicant's phone ht.,7-9'232" Z7 Kailing Address:_= Mulberry Rd Martinsville VA 24112 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 ai pier/mooring pilings / boadift / boathouse must be set back a minimum distance of fifteen feet (15) from my area of riparian access unless waived by me. (If ou wish to waive the setback, ou most initial the ap ro riate blank below.) . _ I dQ. not wish to waive 1 0 wish to waive that setback requirement. ...................----------._ ..._............--- -- -, MClilli''Z'iON AND/OR DItAWXXG OV PW5POStD DE VILOPMLNT- (7'o be filled in by int ividu41 proposing development) (11110rulatimi for Property Owner Applying (Riparian Property Owner Information) for Yennio oC 1510i Mailing Address �- _.�.. Si nature Citytate/Zip v Print or 7I , c Na ne ` P � -3-� �-a� __ rS� m.� 1 L� o `iiu i v Y`i`l1� � ay._10, 201 i111:11AM S11FEt NICOIAUS No. 4621 F. 1/2 -„ ADJACENT RIPARIAN PROI'LRTY OWNER STATEMENT (FOR A P& MOOMG PrUNG"0ATU BOATffOUSP.J I hereby certify that 1 own property adjtcant to NS'nry MOnr't- 's (Nania of Yraper►y Owner) p1'ope* located at 6 G0(d5b0 i"0 St , (Lot, IHoctc, ]toad, etc.) �n CQnCJ- _ _ `, in accom Ista Beach , N.C. (Waterbody)) ('own and)or Cuuttty) Applicant's phone Mailing Address:_1023 ML4 (§erry Ro' Martlnsvllle '/A 241 He has described to me, os shown below, Qxc development he is proposing at that Incation, and, I have no objections to his proposal I understand that a pier/mooring pillnes/ boadift I boathouse must be setback a ntuiimum disr:nCe or fifteen feet (15) from my area of ripuian access unless waived by tee. (If you wish to waive the setback, you m>}st itutloi ro r the op iote bl u,k ww..rr �..m e .....�< bubw.) 1 d not wish to waive I A2 wish to waive that setback requirement. ------------ ----------•---------------v--------- ------------ -- DES CRIPTMON AND/OR 614kVhNG di` PROPOSED AILVUoj MtN1'. (To be filled in by i afividuai proposing devtlWmcr+t) - --------- ------ . ...... (II1iOXlnetluu for Property Owner Applying (Hiparisn Property Owner Information) " for Perinit) v/' Mailing Address Sigaature �tve�zip� City feint or T* Name w �7� -" Q 7'R9-e� -7o 4 — .5� - e -- 3 � � May.10. 2011 11:48AM STIPEL NICOLAUS No.4627 P. 2/2 jA WD North Carolina Department of Environment and Natural Resources Divlslon of Coastal Managemen! Beverly haves perdue James H. Gregson Dee Freeman Governor Director Secretary AGENT AUTHORIZATION FORM Date: s- /O- // Name of Property Owner Applying for Permit: Mailing Address: Phone Number. (/� '1j?ae2 I certify that I have authorized (agent) �,�Ps� /' to act on my behalf, for the purpose of applying for and obtaining/ all CAMA Permits necessary to install or construct (activity) OQTIt`16/✓ �(lrl�io�t at (my property located at) C'V1Ys40'-y Y�- This certification is valid thru (date) S G a' zz-'� S- iD - /.,' Property Ow,her Signattfre Date flicant: ��✓/��/ /Y%aa 2 e- e: _ Permit #: cribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen id 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 fins disturbance. Excludes any restoration and/ temp impact amount) Dredge ❑ Fill ❑ Both ❑ Other ff 27F 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 ❑ OF Mareene Construction P. O. Box 370 Supply, NC 28462 DATE i h BRANCH BANKING AND TRUST COMQNYP 1 �� 5-51-800-BANK BBT SBT.com Oro •s ;� / 6 ry `�'�J n 0000 1 2 66u' 1:0 5 3 10 l l 2 L1:000 5 104 2 1 3 3 L8u' 1216 66-112/531 $ �ZJD, v v