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Home My WebLink About56561D - Holland uivision of Coasta! ma VI Ws in C- Rr;ss jr- Seaetar -Name dPro p--arty 0—,- ner Apply4m. for Permit 0 z Z, z - 4 ram All, g Address; ft-� p a-110 to met on nay eartj& lhat I have aeth-Oriz, ad, NL 2-77 Y-O In. -r ths- p"arpose of -apply g for arzd, obtaininag, aE A. Fermi: s or conyl!-Act (a& -!vary) AlIz 74, e!!2�0 JOZ7 ,vlo J 7 Son c-eri-Ifezaoii is vshd thum fdate) _Sipa-ture ,1127,C"ardinai Onve Ext, Wftirigibn, Nott. Carolina 28-405-3845 Y10-796-72-151FAX_ 910-395-3W.,killi-Itc-mat: iccoastailmwagemawtile( )er. 2, 20111 4: 01 Phl CHARM TART PROPANE INC, '- "" ' No, 2644 P. 1 AD.lAC1=T'T gIPA, t (v_` PRQ�G ZLQ� ER NbT ,FfCAT10NlWA V_L&fQM The purpose of this form is to provide proper nolic.t to you as in adjarent riparian property a,ucserro the individilal or indevidu4s listed. below_ -Me CAMA General Patmit applicedon proaedwcs regetiret that applicants provide thg division of Coastal management corifitmefon than a *Tiv= sratatnent h»s been obaYi si, "d by the ad3aaeat riparian prey owners indicating thff r-5V have ea objection to the proposed work sly rhxr the adjacent .iparian prepetty owners have bap notified by cerxviied mail Of tho proposed eo o& Often these corm wt submitted to r;e adjacent rka6dn• prop, Q%wnem by uterine conrractnr or ocher radi.vtduals acting as an authoHzcd agenr an behalf of the applicant. This foinon was Scut. to you by the followlmg individtnal or company deaignaced by tLo:��pi�cant as•r�• authorfzed agent: MW�' Authorized Agent's Sign Name of Individual Apptying For Permit Address of Property -- (Lot or Street #, Sftec or Mad) (City and County) [r..by certiFv thZ' 1 awn property adjacent to the abc'�va-c,efereneed pro; erty. The individual eppfring for this permit ,,*scribed to me as shown on the attached drawing tea development t';cy an proposing A description or drawing,. Ll d>nncnsions, should epre ' d wij h ahis letter. haYc no objections to this proposal. rou have abj:Cilolts -o what is being proposed, ple.,s.se wtti-ze the DivLiaa of Coastal kfansgaweu;;<. 27 Ajpol Drive Extension, wi1m4nVOo, NC 2905 of Ball 9M,796.7215 within IO dayu orr eipt of0is notice. c�apttr is considered the same -as to objection if you havo been 0001ed by carolled MaiL WA.iv'F<R SECTION I sA0011111d that a pier, dnCL4 mooring pilings, breakwater, bust- house or boat lift tnusx..be set back i ; .� l :dfstttttcr of 13" froYn my area of riparian acceu • valcIAI(.- pu wish to wrtivs t3te u must ltlitial the approptinte biank below.) I do wish te, waiyc the 15' setback rcgsirerient. I d9-`tg_t wish to �.vai*,�* 15'setbdr.l re;uir}oxen'. o,j uL C ra 1 CERTIFIED MAIL RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ie purpose of this form is to provide proper notice to you as an adjacent riparian property owner to the individual or on of dividuals listed below. The CAMA General Permit application been obtained segned byquire the he adjacent riparian property applicants provide the town rs oastal Vianagement confirmation that a written dicating that they have no objection to the proposed se orms are submitted that the dto the adjacecent nt riparianoepawners by notified marine certified mail of the proposed work. Often 3ntractor or other individuals acting as an authorized anent on behalf of the applicant. 'his form was sent to you by t following individual or company designated by the applicant as an uthorized agent__�� , kuthorized Agent's Date ,lame of Individual Applying For Permit: address of Property: (Lot or Street ``. Street or Road) "n /—' C% 7; (City and County) li Thereby certiry that I own property adjacent to the above -referenced property. The individual applying for this perm s described to me as shown on the attached drawing? the development they are proposing. A description or drawins with dimensions. should be provided with this letter. V-1" I have no objections to this proposal. If you have objections to what is being proposed, please write the Division of Coastal Management, 12 call 910-796-7215 within 10 days of receipt of this notic Cardinal Drive Extension, Wilmington, NC 28405 or :;No response is considered the same as no objection if you have been notified by Certified Mail. WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be set back minitnum distance of 15' from my area of riparian access - unless waived by me. (If you wish to waive tl setback, you must initial the appropriate blank below.) �l I do wish to waive The 15' setback requirement. rx I do not wish to waive the 1 5' setback requirement. � • " a C Division of Coastal NIgt. Habitat Impact Computer Sheet plicant: qt Permit #: 51P51 te: scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement ind in your Habitat code sheet. bitat 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) Dredge ❑ Fill ❑ Both ❑ Other ❑ �3 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 ❑ PILINGS A D MORE JOHN -ASSIDY PH: (910) 327-2009 119 LAKE HAVEN DRIVE 5983 SNEADS FERRY, NC 28460 _ Y�Y-t-0�--�th;') � 66-30/331 rdee Date 457 $ "Tf 14 Dollars First Citizens Bank rstcitiFair zens.com ':0 5 3 100 3001:D0 4 5 7 13 2 70 131I B "°� 05983