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Home My WebLink About50307D - BroadhurstCAMA / DREDGE & FILL GENERAL PERMIT Previous permit # LJNew —Modification ❑Complete Reissue El Partial Reissue Date previous permit issued iorized by the State of North Carolina, Department of Environment and Natural Resources Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 0 Rules attached. int Name (4 %i Project Location: County ;s 161 r - r j t' Street Address/ State Road/ Lot #(s) State ZIP # Fax # Subdivision -ized Agent Cityzip 0 Cw EJ EW E PTA El ES 0 PTS Phone # River Basin A lLI OEA L1 HHF Ll 1H Ll UBA E N/A : Adj. Wtr. Body , L_t' t_j tj F�A-IJ [T(nat El PWS: LIM - Closest Maj. Wtr. Body f yes / no PNA yes / no, Crit.Hab. yes no, of Project/ Activity 7• jai (Scale: A7 pier(s) length )umber tad/ Riprap length -vg distance offshore nax distance offshore_,MMMM1EMMEMM1M channel ENMMMMM■EMENIMEMEMMIMIN :ubic yards amp ■■■®■■■■ E N 0111111011100111021ME Boatlift EMEMMEMEMEMMEMEMEMMEWIMMES■MEMO Bulldozing■ ■■M■■■: M■MEMEM ■'1■■■:■■■■■ ine Length not sure yes ('ho-,, rgs: not sure yes■■ arium: n/a yes yes 0 6- Attached: yes rn o, 11 AV 11 10111 M�` ■0 EME ■ OEM■■ EMEMNIMEMMEMEMEMAN EMOMEMMEM ■■■�i■'��'■■■■■■■■■■■�■■i�i=MINE 1 ■■■ 10 —M 0■ ■■■■■■MM 11ME M ding permit may be required by: N r, Go See note on back regarding River Basin NCDET�R North Carolina Department of Environment and Natural Resources Division of Coastal Management ievedy Eaves Perdue James H. Gnegson 3ovemor Director AGENT AUTHORIZATION FORM ate: zo a ime of Property. Owner Applying for Permit: 4,0 tiling Address: one Number: 3 Dee Frey Secn srtify that I have authorized (agent) 1l,*� /--�& q,? Ito act on my hail, for the purpose of applying for and obtaining all CAM Permits necessary to install or istruct (activity) Amy Property located at) is certification is valid thru (date) s �i� ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER/MOORING PILINGSBOATLIFT/BOATHOUSE) I hereby certify that I own property adjacent to�`�` (Name of Property Owner) property located at /y �' NQ �� 'll""r"d (Lot, Block, Road, etc.) on /�,i� c�%'1N/y� , in afrt�u /5� N.C. (Waterbody) (Town and/or County) t a� y Applicant's phone #: g� 3 �� Mailing Address: 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) (Information for Property Owner Applying for Permit) (Riparian Property Owner Information) M AN al�AsatJ ,64 vb, Mailing Address Signature -2 10 04 : 54p Hal Fo=1 eman 910-270-33-Idt r•L (J�,J/ ✓Ci� ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIERIMOORING PILINGSIBOATLIFTIBOATSOUSE) I hereby certify that I own property adjacent to (Name of Property Owner) property located at � i �' ~ 2"' (Lot, Block, Road, etc.) on/ in obi ,��R�/y ,N.C_ (Waterbody) (Town and/or County) Ira 3�-�� - -2.— ��'o�Iz ral� 44 "r Applicant's phone #:� Mailing Address: / He has described to me, as shown below, the development he is proposing at that location, an I have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / e 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) ----------------- (Information for Property Owner Applying (Riparian Property Owner Information) for Permit) Mailing Address Signature 12 10 04:54p Hal Fogleman Lclo( SrOOkAd , t t d I X At. 4eer-4-son C iDivisioil of Coastal V.9t. Habitat impact Computer Sheet plicant: W rl�lo de: 3 /Z3 7—Z-V (D ,scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement and in your Habitat code sheet. TOTAL Sq. Ft. FINAL Sq. Ft. TOTAL Feet FINAL Feet (Applied for. (Anticipated final (Applied for. (Anticipated final DISTURB TYPE Disturbance total disturbance. Excludes any Disturbance total includes disturbance. Excludes any abitat Name Choose One includes any anticipated restoration any anticipated restoration and) restoration or and/or temp restoration or temp impact ,, r�� impact amount) temp impacts amount ❑ Other p Dredge ❑ Fill ❑ Both Dredge ❑ Fill ❑ Both ❑ Othe 2— (3 6 Dredge ❑ Fill ❑ Both ❑ OtherxQ WM, Dredge ❑ Fill ElBoth ❑ Other •{O� Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Dredge ❑ Fill ❑ Fill ❑ Both ❑ Both ❑ Other ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge 0 Fill ❑ Both 0 Other ❑