HomeMy WebLinkAbout71452A_Donna Elms_20180503CACAMA / EXD9EDDE A FILL ND 71452 ® B C D
GENERAL PERMIT Prelions Permit#
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NC Division of Coastal Mgt. Habitat Impact Computer Shoot
Arylbanu ponM Elni° Penalty: 9 WSLq
Data: 5/51iE
DeecriCe belavme HARITATdimmm ae for the appumvm. An values mould mash rM name, am units or measurement
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AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: 2)An4 I—L/YNS
Mailing address: '+Ow (� r
_ rYYJ�J-ni-efl i1 �' ��95y
Telephone Number: Z 52/l3
I certify that l have authorized Jail At.,, &.,/ C"aent/comractorl
to act on my behalf, for the purpose of applyingandobtaining all CAAMA permits
necessary for the proposed development of /X(o w`h t"f 6 c—-
5 tall r�ooPc"�' oo ivm he�/
at my property located at (I% BLor %w �,�Y, 1%"IAN (Yo YC
This certification is valid through
(Prope
rtrt
/y Owner Information)
Signature
��99 aa--
r�/iJ�'Ja,W. C l6h.0
Print or Type Name
Title, co of ner or tsfee hrpmperty
Y- 3- 020/8
Dale
0:2-cos-ees�
Telep4hone Number �
Emailtltlreddly59Cfo
Email As
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONAVAIVER FORM
Name of Property Owner: `ion cat , LJ F".6n�
Address of Property', 1\^ 4G^' aL m04k I„ C N&'L �g
(Lot or Street 9,$Vast or Road. City 6 Couni
Agent's Name")/hft RtatV_Cti.rAw. Mailing Adtlress: a
Agent's phone N:.i Ln31243 I%OZ hC 2�q 5Y
I hereby poppy that I own property opposed to the above referenced property. The individual
applying for this permit has desonbed to me as shown on the attached drawing the development
Iheya propasing.A diverinfon or draveno with dimensions, must be Provided withthislefler.
rlreve m objxlimrs tothia propmbl. .!have objectives to this proposal:
tlyau Mve06)ectlons to what is being proposed, you mustnotify the Division of CoastalManagemenl
dl In welling within 10 days of receipt or this notice. Contact Information for OCM offices Is
available of hH ./www.nccoas(almana em or by calling 14884RCOAST.
No response Is considered the same as no objection If you have been notified by database Mall.
WAIVER SECTION
I undersell that apier, dock, m0oring pilings, boat ramp, breakwater, boathouse, or lift must
be set be u�islance oflb'frommyareaof riparian access unlesswaivetl byma Qf
you
hco 'n)heselvfecesyyr®tOL1fl11�tlie appropriate blank below)
y do wish to waive the 16'setback requirement
V .I do not wish to waive the 15' setback reformulate
(Property Owner Information)
Pont or Type Name
Meienp Address
Cgresfaffl2ip
Telephone Number/ EmarlACdress
(Riparian Property 0 nor led rr often)
�l5
r6Ypllnl Oe:
perAr �� �S
motor TArb Neme:,t
38
V7A
336 &��/ 35vg
.Tfllaphona Nrrmba., Email Addr�'��
(oreack Aug. 2014)
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property.
(Lotor Slreel R, Streator Road, CittBCounry)
Agent's
Agent's
Melling Address:
I hereby certify, that I awn property adjacent to the above referenced property. The individual
applying fortbts permit has described to mess shown an the attached drawing the development
they are proposingA descr[ption or drawing with Im n n with this letter.
1 have no objections to this proposal. I have objections to this proposal.
Avow have objections to what is beingpeopoeed, you mustnotW the ONblon of Coukleranagement
(OCM) In writing within 10 days of rooelpt of this notice. Contact In(orvnaWn for OCM offices Is
evallableathlO.I ..namastalmanaoemenfneN eWCmistaH-lialinoombyotlling1d884RCOAST.
No response Is considered the same as no selection If you have been notified by CemO/Ied Mall.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or Ilk 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.)
I do wish to waive the 15'setback requirement.
I do not wish to waive the IT setback requirement.
(Riparian Property Owner Information)
Pont or Type News
MaIIIrq Address
City/Stale2ip
Telephone Number/EmallAddress
Pot,
(Revised Aug 2014)
CERTIFIED MAILRETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONANAIVER FORM
Name of Property Owner: n Ate. . W P(9n
Address of Property: 111 'BA,et.r Yno..0 Y1C ci�15ti I�un<Cear.7,.
(Lot or Sreet N. Strasser Road CbySCty)
Agent's Name Nyi nw��/t1(A[MalngAddres 10 I,eu
Agents phonellaF) q 3 );Nt5 04G�'C
a
`d1o) 5y
I hereby certity, that I awn property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on she attached drawinglhe development
they are proposing. A description or drew no with dimensions must be Provided with this letler.
"l have no objections to this proposal. Elowhave objections to this proposal.
M you have objections to what Is being proposal, you mus f noddy Na DAv alon of Coastal Management
fOCM) In writing Mann fa days of recelpl of this notice. Correct Information for OCM offices Is
avallableaf htfo:/Anvw.nmoaslalmaruoemenl.nebWeWcm/afafl-liafina orbycellingliMS417COAST.
No response Is cons/tiered the same as no objection If you have been nonfietl by Certified Mall.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift muss
besetback a minimum distanceof l5'fromm area of riparian access untesswaived by me. (It
fick, you wish to waive e setbayotthe appropriate blank below )
NOWN11do wish to waive the 15' setback requirement.
do not wish to waive she 15' setback requirement.
(Property Owner Information) (Riparian Property Owner Information)
4
Signature
surnmilie
IPrinforrwe Name
Paul or Type Name
( Mailing Address 1
Melling Address
Cl ftaaalt
Ciirs3slal
yTwwhone NumberrEncwlAddtQS=
Telephone Number/Email Address
(RevuedAug. 2014)
Yrop%edg� tall
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"Irexua
- Stlp(LE I?I.tgR .Es D I tg%N A� ALMS
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Owner:
Address of Property:
(Lot or Street I. Sliest or Road, ON 8 Ccunry)
Agent's
Agent's
I hereby readily that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown an the attached drawing the development
they are proposing. A description or dramorm. with dimensions,provided with this
I have no objections to this proposal. I have objections to this proposal.
Myou have objections to whalle beingpropoaeo', you mualnotiy ie DIdshon ofCoeatalManagemeal
d0i In writing wWln 10 days of receipt of MIS not/re. Contact Information for DCM offices It
evella0leafhtto://xvw.nccwsfalmanaoementneNvedam/ataMliatinu orbycalling l-8884RCOAST.
No response Is considered the same as no objection if you have been notified by Certified Mall,
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or I ft must
beset 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.)
I do wish to waive the 15' setback requirement
I do not wish to waive the 15' setback requirement.
rty
(pro
IC%e/YYHd/owner
IW,//
Signature
diDnn2 V) ��ms
Pool or Type Name
TO Sou 20-✓°
Mellln AEdreaa
2MV
Gry/Slale2ip
12 r2 _
Telephone NumberlfwaiAddress
Oore
(Riparian Property Owner Information)
pool or Type Name
Malllm Addreaa
Telephone Number/Email Atltl/eas
(RawsodAug. 2014)
ROM a.11rotta.rr
128 Holly Ridge Rd.
Manleo, NC 2795d
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RETURN TO
SENDER
_. 9356030Jii9249±8
UNCVNne EU TOED
FORWARD
ONC BC: 27950936R2B
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a�iSdP§2�gR ..� .I".�I! 1.� ilplllll.11ll.11li�rrrl'nr
"8980-96+89-06-43
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128 Holy Ridge Rd.
Manteo, NC 2798
Rimoillk
128 Holy Ridge Rd.
Manteo, NC 279"
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April 13, 2018, 1:06 pm
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April 9, 2016, 11:02 am
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