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Home My WebLink About56522D - Otter NC Division of Coastal Mgt. Habitat impact Computer Sheet Applicant: &"WTt-Cnee` Z4gW,� Permit #:,.g5ZZ, Date: IU Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen found in your Habitat code sheet. Habitat 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 fin; disturbance. Excludes any restoration ands temp impact amount ��✓ Dredge ❑ Fill ❑ Both ❑ Other)o 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 171 �� WDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Beverly Eaves Perdue James H. Gregson Dee Freeman Governor Director Secretary AGENT AUTHORIZATION FORM Date: 1 fl 7 i O Name of Property Owner Applying for Permit: Name of Authorized Agent for this project: Owner's Mailing Address: &-)f4 JL P o. 3os 13ss Cam. i ,•., ~�..�rL .. ,u� Phone Number(91U) //Agent's Mailing Address: 340; eaP� +� wfA Ci�, /, A._- , Phone Number (76t/ ) p-o! I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct the following (activity): 'Fl+•�1-dl(=Ci�cl•� (my property located) at oc/— VL -4*-- b This certification is valid thru (date) Property Owner Signature Date C GJ�t-r "LA' U C e— C' 127 Cardinal Drive Ezt., Wilmington, NC 28405 One Phone: 910JW72151 FAX: 910-395a%4 Internet: www.noc=laImanagemwt.net NorthiCarolina 4F�' GE & FILL N? i� PERMIT Previous permit#_Modification t 1Complete Reissue CMartial Reissue Date previous permit issued_ As authorized by the State of North Carolina, Department of Environment and Natural Resources _1 �k 1 , -,, and the Coastal Resources Commission in an area of environmental concern pursuant to 1 SA NCAC ��- iAik ul attache Applicant N�toe_ _ \ect �ocat on: County }VV Address Street Address/ S�tate�Road/ Lot s Ciry 1✓�_ State XIP�- j Phone#( I) a u< Fax#:� )_ Sttbdivsion. - AuthorfzedAgerlt_ . b� 9Y—� Y-L— — City ...----- -- ZIP Affected I ; CW ; l PTs Phone # (. ( ` River Basin AEC(s}: PWS:_OfA ; l HHF `lIH UFC, TUBA L! WA Adj. Wtr. Body 1AVUL ��Closest Maj. Wtr. Body--L v y ORW: yes /� PNA yes / P C/ CAt.Hab. yes / no Type of Project/ Activity _ (Scale: Pier (dock) length Platform(s) Fhtger pier(s)__._ --�"- i Groin length...:... '. - ;. number Bulkhead/ Romp length - avg distance oRshor ... _ _ _. S - I i .. ( i ( ` : I ` ! � max distance olUMre � 1"`^"'• ` Basin. channel cubic yards Boat ramp 1 Beach Bulldozing i Other --- .. h��i ' Shoreline Length._... SAV. na[ sure yes Sandbags of sure yes .0 Morato rum- - n1a yes Photos - tR, yes - ,/� L"�' Waiver Attache&, .yet no ,_ _ _- _ ` A building permit may be required by. l I See rQwt�e on back regarding Ri er (n� t� �r Notes/ Special Conditions A" l• aYy 1 : A. law) as Vv"C,.•1 p.\ all �l Agent or Ap(gcant Pii ted NaFn6 - -P t leer s Sign uric - _ 3 a/1 o - Signatura 'a Plaueread compliance statementon back of permrt•" �. ung UAW& 1�� 315 Apptiration Pee(s) Check# Plamiogiunstkction, Rover i ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE) I hereby certify that I own property adjacent to (Name of Property Owner) property located at 7-OCl t7g t vc- (Lot, Block, Road, etc.) on 1C:W(l /.-"lLyu. t7y(nC�- � ti.L.:tin C,S,LCL/N/� 3��Ck+�r�T�c�S� ,+ck)4CrN.1 (Waterbody) i3li ., (Town and/orC County) lie has described to me. as shown below, the development he is proposing at that location, and, I have no objections to his proposal. l understand that a pier/mooring pilings / boatlift / boathouse must be sc back a minimum distance of fifteen Iect (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 rlevelopnr(,ul) rr ci 5�� I -- - ----- -------------------- t---------------- (Information for Property Owner/Applican Applying for permio Mailing Address City/State/Zip Telephone Number C— '--' " 0-) :-- -- Signature Date (Riparian Property Owner Information) Signalur Print or Type Nam Telephone Numbc Dat ■ Complete items 1, 2, and 3. Also Complete A Signature Rem 4 if Restricted Delivery is desired. X t " ■ Print your name and address on the reverse -- 11 addressee a. Rec try ( C. of every so that we can return the card to you. ■ Attach this card to the back of the mailpiece, ? - or on the front if space permits. P-' C. Is deliveryaddress different from Item 1? ❑ Yes 1. Article Addressed tc: If YES, enter delivery address below: ❑ No 3. Service Type 19-e."ed Maii ❑ Express Man ❑Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. ResMcted Delivery? (F�fra Fee) Cl Yes 2. Article Number 7009 3410 0001 5767 7357 (7r.nsfier from s-A- tabep PS Form 3811, February 2004 Domestic Return Receipt 10259502-WIS40 ■Complete items 1, 2, and 3. Also complete A Slgrhatu Rem 4 If Restricted Delivery is desired. went X IIIPrint your name and address on the reverse JCi ' N�-t'�"' ❑Addressee so that we car return the card to you. ■ Attach this card to the back of the mallpiece, B. Received by (pfrned Nerve) I C. Qata of wtvery or on the front if space permits. /_'"�)7 ICC," 1. Articla Addressed to: D. Is delivery address different from Rem 17, 123 Yes If YES, enter delivery address below: ❑ No Q�h�yr..+M�2�_•^�iv�G�XLtq��', �a�tt'a r�,? �'":^�t, �iC ?,;2fi �--./7 `t `� ^'rr_.-�% U t G to r c- • 3. SSrvice Type +JGdlRa t�, o t� a' era l eg Receipt for Merctendtse ❑ Insured Mali ❑ C.O.D. j 4. Restricted Delivery? Ptra Fee) ❑ Yes 2. AnUe Number 7009 3410 0001 5767 7463 from service law) `(fmrrsfar PS Form 3811, February 2004 Domestic Return Receipt 1025e5-02MA540 1 ■ Complete items 1, 2, and 3. Also complete A Signature item 4 it Restricted Delivery Is desired. X ■ Print your name and address on the reverse ❑ Adc so that we can return the card to you. R Received by (W-d Name) C. Date of C ■ Attach this card to the back of the mailpiece,m ,b or on the froIf space permits. D. Is delivery address different tram item l? ❑ Yes 1. Article Addressed to: If YES, enter delivery address below: ❑ No sit 1-4 n+tVU ;Its "irvl Type C ALCarfifled Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise o Insured Mall o C.D.D. 4. Restricted Dale er,r? (Extra Faa) o yea 2. Article Number 7009 3410 0001 5638 7981 (7hrmler from service lebeQ PS Form 3811, February 2004 Domestic ReNrn Receipt lmsasmz-r. IW