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Home My WebLink About49125D - Davis] CAMA / ❑ DREDGE & FILL 3ENERAL PERMIT Previous permit# ]New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued rized by the State of North Carolina, Department of Environment and Natural Resources -oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ❑ Rules attached. t Name Project Location: County 16wq � Ck V ` �k I Street Address/ State Road/ Lot #(s) V1 State ZIP 11 YMby li Fax # ( ) Subdivision `,, :ed Agent City A V t ZIP_AL ❑ cw C >Enr ' PTA p ES ❑ PTS Phone # ( ) River Basin Lvav, ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body ' nat El PWS: ❑ M yes % no PNA yes /� Crit.Hab. yes / no Closest Maj. Wtr. Body Project/ Activity V x �� i ck) length li (Scale. I I Z IT- 1(s) - - - - , ngth - mber i/ wprap length - -- ;distance offshore ! _ x distance offshore canneli 44 —� 0L )ic yards lP se/ Boatlift Adozing r �►� �0 Length \ 06, 6V.`� 1� 4 `. not sure yesnot sure yes n um: n/a yes , Y no T ktached: yes no ig permit may be required by: in 1 A IAI�Y \ ❑ See note on back regarding River Basin rL 116 Greensboro St, t 06 10 07:04p Michael C Davis, CPR 910-791-5040 NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Beverly Eaves Perdue James H. Gregson Governor Dkeector AGENT AUTHORIZATION FORM r Date:10 Name of Property Owner Applying for Permit: /rIlCNAE G IA ✓Ls -�R Mailing Address: 380 2 �,2lGi/fS ✓1 � �E. �/�� Phone Number: 9( io) 79 t- 3 33 ! Dee Freeman Secretary I certify that I have authorized (agent) Zf1A-el.e c -ZI'-- to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity) -BrcalrWf.a-&,;� �f f'c AcEr_f �✓'� at (my property located at) //Zo 6RZI ✓s-RcAo 1346ACW e✓G This certification is valid thru (date) 10 1� Aa 0 Al Property Owner Signature Date t 27 10 12:21p Dennis D Mickler 704-708-6029 P.I. Oct 06 10 O?:04p Michael C Davis, CPS 910-791-5040 p. 3 A* r,./ - &A+a/t'.I ADJACENT RIPARIAN PROPERTY OWNER STATEIYIENT 1 hereby certify that I own propertyadjacent to �'71UI.oEc �r . ��llS "R L�!f v 's (Name or Property Owner) property located at Go! 31 N ��!• Go�E.is�:o�� ! (Let, Block, Road, etc.) on A-CAWAa; 1 NB fc.Af N112.10 , /tlotbt.✓ (Waterbody) (Town andlor County) Applicant's phone N: Mailing Add He has described to me, as shown below, the development he is proposing at that location, and, I have no objections to his proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: (To be filled in by property owner proposing development) r6 r � tit of Pu , i� S�' -------------------- ---- ------ -------------- +--.- (information for Property Owner Applying for Permit) Mailing Address /L (Riparian Property Owner Information) ✓it: mot►,%,f�J �%G Z87o3 �ur /E/C/!/1i S / <. EGG e✓r City/State2ip Print or Type Name ?/0-991-339! %Of �Y�i cler417 Telephone Number Telephone dumber Signature Date Date t 28 10 09:10a Michael C Davis, CPR 910-791-5040 OCT-27-2010 13:52 FROM: 3366265145 TO:19107915040 Oat 06 10 07104p Mtehael C Davis, CPA 910-791-5040 H&--j - bbo-mw ADJACENT RYPAR A_r1 PROPERTY OWNER STATEh[ENT I hereby certify that I own property. ad)acent to AkCMAL49.. - .��s Sr N�� •t (Name of Property Owner) property located at Lot' (Lot. Block. Road, ate.) of A-4Ca.4c- f AIA Acr4/-11/a&,in 6ia.AtJ ALRca! _ �tv/sv1.0 �'M�l N.C. (Wiattrbody) (TOMtt and/or County) Appliesnt'a phone d- Mailing Address: He has described to me, as shown below. the development he is proposing at that kacntion. and, have no objections to his proposal. DZSCIC"OPI AND/OR DRAWUfG OF PROPOSED DBVELOPMJ:n;�. '.- f To be Jbf[ed In by prop" 0—er p opasf darel0pnii-9 Fo PI� PL - '��G/to�r�oio (information for Property Owner ApWna for Permit) city/Stow7ip _-- Telephone Number G 1014 �� o SZgnature Date iWIAIVI 'A P L ....-._.._......_L./l� (Riparittn Property Owner laformadoe) 7 $1�'nti I IItC Print or Type Name Tetophww Number /0%-7A a of Date P.3 P.1 P.1/1 Division of Coastal Mgt. Habitat Impact Computer Sheet C11 P Oiq I � Is - icah Mtcvvq� C { J Nov tribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement d in your Habitat code sheet. tat 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/c temp impact amount) Dredge ❑ Fill Both El Other El I1 i V f 4 1 i Dredge ❑ Fill'4 Both ❑ Other ❑ lJ 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 ❑ 1028 66-112/531 one Construction p.0, Box 370 DATT_E/4Z-- —0—j 3upply, NC 28462 DOLLARS BRANCH BANKINGANDTRUST COMPANY \ / f/'%`//�l ?,kCjJi. _.-_._...- - I _SO4D.8A,K3B, BBT--OM Ila Lt 2 0 1 11.000 S -.3 a Ila I - OS31 II0OOUU 6