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Home My WebLink AboutKubeck 72322 FLORENCE JOS lv11ZII 0 0 LAMA/ ❑DREDGE & FILL NO 72322 A B C GENERAL PERMIT Previous permit# r�% ldNew ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina,Department of Environmental Quality Q�O j� and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC (/� (J ^�� y LL Rules attached. Applicant Name LD✓) f-- J�G Project Location: County 444,/ Address W brim" Street Address/State Road/Lot#(s) (s) City wv, 9 State AK/ZIP �Q �, Q Phone#(*) 3g 14/ 1 E-Mail - L0,7 Subdivision Authorized Agent "Poly /D City LY /,— ��y`�i ❑CW 1w / Y6A ❑ES ❑PTS Phone# ( )a3/ S 5k �� River Basin " ' Affected ❑OEA ❑HHF ❑IH ❑UBA ❑N/A AEC(s): Adj.Wtr. Body _ (natar /unkn) ❑PWS: W (/ ORW: yes PNA no Closest Maj.Wtr. Body i t , Type of Project/Activity ply. ,. S ✓P Q _' i pr/ f ' / A % _ / C/ it, / ir_ •/ A . Pif t#Z' ,/ ', 1 at'.441, /' ► , " i. : ► 'liii PA ! a S tv dir.a (Scale: I*. • ) Pier(dock)length Fixed Platform(s) `a c 6/ 1 Floating Platform(s)6X ' 2X, II iiINuIIIIIIIHi'! I I II H II Finger pier(s) e acom. 1 :: pIengt h ' 1!ulIolhmo avgdistance offshore max distance offshore Basin,channel uIuIIAhIIIIIuIii cubic yards Boat ramp 2 N Boatho oatli 13�� ' MOMMINN E MIIIllhIIIIIIIIII 111111111111111111111111•11111111111111111111111111111111WEINI1111111111 Beach Bulldozing INMIMIMIMIWMMMNWIIIIIMEI.IIIIHH1HIIiiiIIIHIIHhIII!!I!hiii Other (jr.� 3 x l6 llaill 1111111111111 , RUaoma■L •••■ IlU■UUUUU� ■ ■®uaaauu• Shoreline Length /Qa MOMMEM1111111111111111�� M��•�� SAV: not sure yes ,,rf.11��1111��J�M .1��.��®11.��1nEI�ll11��.��..1� Moratorium: n/a yes moo/ 11111_1HhIIIII Photos: yes no fill Ma ) 1!1! �,. 1 � tp ,.: F.Waiver Attached: 6no O A building permit may required by: . I See note on back regarding River Basin rules. (Note Local Planning Jurisdiction) Notes/Special Conditions ,`? r1 , / C iiiriCi61I7O Agen or Applicant Printed Name Perm' cer's P inted Name / /_!'••7 Signature's **Please read compliance statement on back of permit** Signature / /0///7/g //070/ CII41"6'' Application Fee(s) Check# Issuing Date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: 6N1IV,c /ief(p �ki g 4—cit- / C / D� Mailing Address: it L& (34/r N (Ai t AO N c 2-61 of i Phone Number: Cii (. 0 35-,-,1_ -11/40,5 Email Address: aS - , um "`'�e�'`� � *u. I certify that I have authorized ri i ,-,,`, ice„ I .L.___ ' Agent/Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: a .—) e c--% 4,/l, (4 ,c, c-E/ at my property located at ; i c L ({ 11; f-' I in /C--,,„ w.c,;cr County. I furthermore certify that I 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 information related to this permit application. Property Owner I ormation: lb" 1 / ,i, Signature Print or Type Name Title `1L 1 c 1 zip " 5' Date This certification is valid through 1 - / 1) 1 I Z v i ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent too Lu e c--<< 's (Name of Property Owner) property located at �-^- �' '/ I e ~� r (Address, Lot, Block, Road,etc.) on L-.., � 0 Cc, / , in 11 C 4 7 , N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. a12 I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a minimum distance of 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.) t'k!✓l I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. ( erty O e I orm ion) (Adjacent Pro erty Owner Information) S'v ature Sig a ure or Type Name _ Print or Type Name g' /or i-e7L �o«� .Nf- lel' AddresMailie, Address l��i r� 4 /VC cA8 'I 6t/ t T t J\IC�-3� rti,11<<= l/-a Citytate • City/ t /Zip3 5-0 M33 Telephone Number Telephone Number /0 — / /o Date Date (Revised 6/18/2012) I ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to (Name of Property Owner) property located at (Address, Lot, Block, Road, etc.) in N.C. (Waterbody) (City/Town and/or Cou ty) The app' ant has described to me, as shown below, the development proposed at the above location. I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) ft 1 WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boattiouse, lift, or groin must be set back a minimum distance of 15' from my area of riparian blank raccess unless bunless waived by me. (If you wish to waive the setback, you must initial the appropriate I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property • ne Infor .•tion) (Adjacent Property Owner Information) •ature Sig ature ` p Print or Type Na'}e Print or Type Name = aa-?-aa- h -P51r � pov4 Mailing Address (f r��bc Mailing dress 1,JC• �,g `0‘1 M.N�` O' j �t �`�� Cit Sta e/Zi J City/State/Zi -104 de �-{c0 �`' � �� Telephone Numberp Telephone Numbe I CSI 6 Date Date (Revised 6/18/2012) .7.1" (let 1 41 g 0i.)05 bc.4 I t 4, t, /6 olech- 3 y 14 c.. e- Z-14± 7 I S 21.1 ,1 + I0,„ . ?c-iC AMR Mir