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Home My WebLink AboutOLIVER GP73781LAMA / AMA/ DRDE FILL 73 EG& 'Z 1Z F No. 781 GENERAL PERMIT Previous permit B C D �',ilNew [...]Modification � ]Complete Reissue UPartial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in any area of environmental concern pursuant to 1i 5A NCAC r I Rules attached. Applicant Name Project Location: County A' . . ...... ... Address (f, 2 <��, X"iStreet Address/ State Road/ Lot #(s) State City_ ZIP . .. .... ....... Phones --Subdivision o A/ J E-Ma , , , " I I - - ''I ....... ...... J Authorized Agent t City ZIP ES �,J PTS River Basin J,f El CW �W ��,(FTA Phone # Affected [I OEA F1 HHF [I 1H LJ UBA Ll N/A )unkn) AEC(s): Adj. Wtr. Body . . .... . ...... ..... 11 Pws; ORW: yes 1,n'" ) PNA yes / no Closest Maj. Wtr. Body. Bulkhead/ Rip avg dista max list Basin, chann6 cubic yaj Boat ramp Boathouse/ & Beach Bulldoz Other Shoreline Leni SAV: n( Moratorium:, Photos:, Waiver Attach S A building pert -nit may be: required' by: (,J � �� # , , , 1 _ ( Note Local Planning jurisdiction) J Notes/ Special Conditions . . ........ _A Agent or Appli/ant Printed Narne 4. Signature **'Please read compliance statement on back of permit ... . . ...... . . . .............. . .. . ........ . ....... . .... . ... . ...... .. . ....... ........... ... . . Application Feels) Check # � I See note on back regarding River Basin rules. Per it Officer's Printed Name ....... .. ... Si Issuing Date Expirition:�� Date 5-11 AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: /i L ---r— 7 — Mailing Address: Phone Number: Email Address: I certify that I have authorized/ Lctig1t... ON ver ljct(�cli Lz/ Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all LAMA permits necessary for the following proposed development at my property located at 'J ta'J in County. / furthermore certify that / am authorized to grant, and do in fact grant permission to Division of Coastal Management staff, the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating infonnation related to this permit application. Property Owner Information: �/gnature ve)/ Print or Type Name Title ox Date This certification is valid through -/-/ Revised Mar. 2016 DIVISION OF COASTAL MANAGEMENT AD,/ACENT'�IPARIAN PROPERTY OWNER NOTIFICATION FORM CERTIFIED MAIL, RETURN RECEIPT REQUESTED or HAND DELIVERED I hereby certify that I own property adjacent to fq el', N"t", I$ WAS (Name of Property Owner) property ;..., Jocaled at 4 a /z- i tu W (Project Site: Addr Lot BlInAMo d etc.) on in oa�2-- N. C. (Waterbody) (CitytTown and/or County) Agent's Name #: Mailing Address: Agent's phone He/She has described to me as shown below the development he/she is proposing at that location, and I have no objections to the proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill in description below or attach a site drawing) if you have objections to what is being proposed, you ,must notify the Division of Coastal Management (DCM)' in writing within 10 days of receipt of this notice. Correspondence should be mailed to 401 S. Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264- 3901. No response is considered the same as no oplection if you have been notified,py Certified Mail. owner Information) (Adjacent Property Owner I Signature Signature* Print or Type Name Print or Type Name ir - Mailing Address Citylstatelzip Telephone Number I Email Address cl�!) � �-Zf -7 ! �5115� Date Walid for one signature* Mailing Address Citylslatelzip Telephone Number I Email Address Date* calendar year after Revised Jan. 2017 DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM CERTIFIED MAIL. - RETURN RECEIPT REQUESTED or HAND DELIVERED I hereby certify that I own property adjacent to , all (4 1 'a (Name of Property Owner) J property located t at (Project Site: Address, Lk;t, Block, Road, etc.) in x/1-ywQ on ZZ( N. C. tj (Waterbody) (City/Town and/or County) Agent's Name #, Mailing Address: Agent's phone He/She has described to me as shown below the development he/she is proposing at that location, and I have no objections to the proposal. --------------------------------------------------------- I ------------------------------------------------------------ DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill in description below or attach a site drawing) Tf you have objections to what is being proposed, you must notify the Division of Coastal Management (ACM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 401 S. Griffin St., Ste 300, Elizabeth City, NC, 27909. ACM representatives can also be contacted at (252) 264-390,1. No response is considered the same as no objection if you have been notified by Certified Mail. (Property caner Inforpaption) , i I t r6l Print or Fype Name Mailing Address ch;1stdielzip e , � -5 2----- 46 Telephone Number/ Email Address Date ,rVaiid for ona calendar year after signature* 2017 (Adjacent Property Owner Information) lei S1 m gnaturoYr Print or Type Name Mailing Address City/State/Zip 2 Telephone Number/ En5ail Address 7— Date* Revised Jan. OD 0 0 d q Ln ,ter PAMUCOWAY OT -V COSLA U.S. 158 5 NC Division of COastai M9t- MabjtOt impact Computer Sheet Applicant: 0 4 / UM Date: j 13-117 Permit M ? -,3 7 S/ 4 Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement 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 S4. Ft. (Anticipated final disturbance. Excludes any restoration and/or temp impact amount _ TOTAL Feet (Applied for. Disturbance total includes any anticipated restoration or term p impacts) FINAL Feet (Anticipated final disturbance. Excludes any restoration and/or temp impact amount Dredge E) Fill Ej Both El Other Dredge E] Fill ❑ Both El Other El Dredge D Fill ❑ Both 0 Other 0 Dredge 0 Fill 1771 Both El Other El Dredge E] Fill [] Both f-1 Other ❑ Dredge 171 Fill El Both El Other El Dredge El Fill El Both El Other f-1 Dredge Ej Fill Ej Both 171 Other ❑ Dredge 171 Fill Cl Both El Other El Dredge [:] Dredge[] Fill 0 Fill [j Both Ej Both El Other El Other El Dredge [I Fill [I Both El Other 171 Dredge El Dredge E] Fill 0 Fill El Both El Both: Ej Other [I Other El Dredge [] -L-.- Fill E] Both n Other El 4 3 as ra,, in.' n-