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HomeMy WebLinkAbout71255A_Graham Wagner_201811291CAMA / ❑ DREDGE & FILL 9ENERAL PERMIT New -]Modification El Complete Reissue ❑Partial Reissue No 71255 B C D Previous permit # Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 14, of OU EVRules attached. Applicant Name G (g ka Vic 4 rn l v' Address 3,3 1 :u City Hovcir State PA ZIP 19 D '� 3 Phone # (6io) U u 6- 3-3 0 E-Mail Authorized Agent Affected ❑ CW )EW PTA ❑ ES ❑ PTS AEC(s): ❑ OEA ❑ HHF �1114 ❑ UBA ❑ N/A ❑ PWS: ORW: yes /& PNA yes Project Location: County C I I, r . A,-,, (C Street Address/ State Road/ Lot #(s) qOS s t, y1 , 4 a Q. Or, Subdivision City 01\c ZIP Phone # ( ) River Basin 1'• S �� k Adj. Wtr. Body Carr A -K 4A2-,,r1 Aaaman /unkn) Closest Maj. Wtr. Body ■■■■■■■■■■■■■G■■■■■■■■■■�ii■■�1■■■■■■!■3!Y ■■■■■■r�r�■■w■■ww■��w�wv i�■■■lwrww■■■�w� ■w■■■■■■■wow■w■■■■�■■■■�►:■■■w■■m■www■w■■w Age q or Applicant Printed Name Signatu a "Please read compliance statem t on back of permit" .$1).0010o k,Lw' Application Fee(s) Check # PermitO fic — --- S nn re 1 )",I )dy I l� %Ay'do 15 Issuing Date Expiration Date MAj Nod Carolina Departrne d of Ervlt wont and Natural Resources Dtvtaion of Coastal Managwwt 9emt Ew" Pei . Gomm JI MPI H. Gtegaon, DUscw Cee Frewdn. ROMA Y Name of Projp/ M Owuer App�Jy/�/ /for PPerasitl %tailing Address' 1 rt (r't of✓i1 � / Al t certify titai I bate aulhotizsd (*ger+t) / N r z Pt i tr"rr► f l / If —to wl on my behalf, for the purpose of applYint for And Glad CANA Permits Ottesetrr to Wagm or construct (atrtivity) tAnv at (my property located at) �d a va'�t lfc2 �rc c Jt P7fe7 "It cord b d rn W&W 1/ 400 Canft*oo Avems, Mcxefue<d CR f, North Cotdi 2 28-157 Phooe: 252806.M%FAX: 252-247-33301Immnet avaw.ncaoastahnanagomer+i,ne! 1 fir. CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner Address of Property Agent's Name Agent's phone f1 e r Mailing Address: t )ie_s CUM-6a - I hereby certify that I own property adjacent to the above referenced property. The individual a -plying for this permit has described to me as shown on the attached drawing the development this letter. they are roposing. A desm lion or drawing. with dime i ns must be provided wits by cY I have 1b'bbecdons to Proposal• i have objections to this proposal. If you have objections to what is being proposed, you must notify the Division of coastal Management (DCAI) In writing within 10 days of receipt of this notice. Convspondenee should be mailed to 1367 US 17 South, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-3901. No res onse Is considered the same as no objection K have been notified b Cerdfred Mail. WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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 notwish to waive the 15' setback requirement. (Property Owner Information) Signature `5r' �'1Q.m Qar7er �r Printt or Type Name J 1 �jbr� L n Mailing Address Tel�e)phone ttfurrrber C4 1 Date Owner information) Print of Type Name ,5 y reiephorra Num Vate �QS - i�{q/l1 ✓I 5�� �J CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM Name of Property Owner. Address of Property: % ' (Lot or Street #, Street or , City & County) Agent's Name - Agents phone Shy rc� CU- m - i 4-- Mailing Address: V, it 1 1-4~%i r t� 'fin `� 49 I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit has described to me as shown on the attached drawing the development they are proposing. A desk on or drawin with ns must be vided with this letter_ _ I have no tyb�ections to this proposal. I have objections to this proposal. Ifyou 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. Cor►espo ndence should be nralled to 1367 US 17 South, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-Ml. No response is considered the same as no objection if you have been notffled by Certified Mail WAIVER SECTION 1 understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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_initiali the appropriate blank below.) I do wish to waive the 15' setback requirement. _ I do notwish to waive the 15' setback requirement. (Property Owner Information) Signature Print or Type Nam nw"0'"1 77n P AA VB3 cvstate/Zip Telephone Number Date ( nn Owner int mumon) 97 J! 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