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!
Qc' ;L
7✓
D _ J\t /►t4/f ryA 4,�
Print Type Name
0
_& 20 6
k�A Ilk,
2S7_--722 2s39
T7,,('-'7
ber
t
Date
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