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Home My WebLink About54574D - Burch)LAMA / C DREDGE & FILL 31ENERAL PERMIT Previous permit# lqq w -Modification iComplete Reissue ❑Partial Reissue Date previous permit issued •ized by the State of North Carolina, Department of Environment and Natural Resources /J :oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC l Q d EtiMes attached t Name D'O c U 3/ a-SZ,�,..� h�,�c R�, h V 4.A /,./ State,— ZIP ,Z S— (Vj) S-..3 %%--.TVc-Faxx # ( ) ed Agent E: L- /C., tASl CW EiM E= PTA ❑fS ❑ PTS ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: ❑ FC: yes / no PNA yes / 4o Crit.Hab. yes / no ' Project/ Activity ngth -nber I/ Riprap length : distance offshore x distance offshore cannel sic yards 1p se/ Boatlift ulldozing �1c4- l� ' e Length T 61 not sure yes o s: not sure yes io ium: n/a yes yes no . \ttached: yes L Project Location: County 13K y N S uJ Street Address/ State Road/ Lot #(s) 3s—,n/i Q� 'Subdivision city ,0,R,� Z 2-4 43awc- ZIPZ i 196 Phone # ( ) /yRiverr�Basin Adj. Wtr. Body (�i-et C't'f'- (nat 6_ Closest Maj. Wtr. Body A91 W Id U.440 U`p (Scale: / ng permit may be required by: I'llf 429,. 40' See note on back regarding River Basin rL ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER/MOORING PILINGSBOA TLIFTBOA THOUSE) I hereby certify that I own property adjacent to y; �>_ 1 /-0 k is (Name of Property Owner) property located at S f - , (Lot, Block, Road, etc.) on , in A o PQ n T ,!� / P- E'C# C% , N.C. (Waterbody) (Town and/or County) Applicant's phone #: Mailing Address: 3 b S 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.) C / 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) --------------------------------------------------------------------------------------- --------------------------- (Information for Property Owner Applying (Riparian Property n ormation) for Permit) Mailing Address' — Signature A n ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE) I hereby certify that I own property adjacent to �� '_j ('( is (Name of Property Owner) property located at f l Yl (C L� S t— , (Lot, Block, Road, etc.) on , in��121.1� �, N.C. (Waterbody) (Town and/or County) Applicant's phone #: Mailing Address: S 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.) U-)a 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) ------------------------------------------------------------------------------------------------------------------- (Information for Property Owner Applying (Riparian Property Owner Information) for Permit) Mailing Addres Signature AWIFA NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary Date 0'u Name of Property Owner Applying for Permit: 1 A P. Mailing Address: CI I P_l--n t . _S C_ (� I certify that I have authorized (agent) , ,� p la S S to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity) k-e-Z7/d r_,e- at (my property located at) 3,j U A' n4 This certification is valid thru (date) 2- M -T 1 1,. - _ licant: , O L u 2 C h Permit #: y S- 2 y _,P cribe below the HABITAT disturbances for the application. All values should match the name, and units of measuremem 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 / 9 Z 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 ❑ I WESTE MONEY VN��--_NI (ORDERiaYebleel WeIIs Fero WESTERN UN/ON FpygN ---_�,�9 Bank Gra_;tl function Downtown, N.q, Grantl �� ICIgL SERVICE'S _. . coloraao_ En / /NC ISSUER - - 9 ewood, A 33108 d° 072010 141211565123 L 002130 PAY EXACTLY TWO HUNDRED DOLLARS AND NO CENTS PAY TO THE ORDER OF C ��n — L•r565123ue 14-121156512