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Home My WebLink About72541A_Henry T. Cheseldine_20190214SCAMA / � DREDGE & FILL GENERAL PERMIT ,1New ❑Modification El Complete Reissue ❑Partial Reissue No. 72541 A* 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 N' 00 Fwi Rules attached Applicant Name kcn r ci -T,-f,y, r C hes e t rl i i"c Address I (o 061 St QC Nn V_A . State J a ZIP- Phone # (?M) SPQ E-Mail Authorized Agent G, (A Jt , A r Affected ❑ CW N EW K PTA ® ES Cyl PTS AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A ❑ PWS: ORW: yes / 4i0PNA yes / o Project Location: County b CA_ re — Street Address/ State Road/ Lot #(s) --p0.�7 -S FrcebwQArer Subdivision City %r I.SC G Phone # ( ZIP River Basin Adj. Wtr. Body (' J (nat /unkn) Closest Maj. Wtr. Body a rv� t' 'S + NONE EESE■■OM■■■■■■■■■ME ■■■■ MOEN ■■■■�'ic■■ ■■■■ ■■■ ■■■EE■■EE ■■■■■■■■■■ ■■m■■■® Oi�Iri�l�■■■■■■■EN EH■MEMO . ■�■■■■■■■■■ MM■■MM■■■■MMM■■EMOMM■EE■ME■ME■NE■■E Fill I INN ■■EEO■ ■■ ■■■E■ ■O■�■MEE'�lE■E■EME■EM ■ ■■■M■■EEM■■E■EEM■■EMS■�■EEM■E■■ EME EiOE■OM■EE MEMO MEN �ME■■MEME WKE■M■■MMM■MM■MM E■EM■MEMEM�E■M�■Es�■■MERE■■■EEMn■E OEM my R& "llom ■■■�■■■■ •�M■M■■ ■■®■ MOMINAMUMEMEM • E■M■E a®iDE■�■l1=E MEMMM■■MEM IM ... I■.MONEMEM■Ei�i■.._■■...... -�"- M■■■■EE■E■■■MMO■EE■ ■ IN■■■IMIMM ■�■g■■■■■E■MEEE■■MME■ ■En�tt�l!rt�EM EEmommmE■E EE ■EE�■EEE�■■■EEMM ■■M■M■■M■■■ Agent or Applicant Pri ted ame Signature Please read ompliance statement on back of permit V V 4 r �y� Application Fee(s) Check # CkAW�'�t(A Permit _er Pri Name e f Ln Signature q 7 //L-1�l`4 101tq /I9 Issuing Date Expiration Date NC Division of Coastal Mgt. Habitat Impact Computer Sheet Applicant: o en r j _f11 Permit #: Date: *� / J'I / I ct 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 Sq. Ft. (Anticipated final disturbance. Excludes any restoration and/or temp impact amount) TOTAL Feet (Applied for. Disturbance total includes any anticipated restoration or temp impacts) FINAL Feet (Anticipated final disturbance. Excludes any restoration and/or temp impact amount Dredge ❑ Fill ® Both ❑ Other ❑ 6 St } \ �b Nf� Dredge ❑ Fill ❑ Both ID Other ❑ Dredge ❑ Fill ❑ Both ® Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ N.C. DIVISION OF COASTAL MANAGEMENT AGENT AUTHORIZATION FORM Date Name of Property Owner Applying for Permit: Mailing Address: /�./Uo 1 &aC,41 I certify that I have authorized (agent)to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity) 1 4 j*,kh Ca at (my property located at) 50d 53 f Chi This certification is valid thru (date) /44 x Is 0/,9 Property Owner Signature Date ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to property located at 5 02-5 of Property Owner) I (Address, Lot Block, Road, etc.) on QA-nl� CO , in_ keisco N C. N.C. (Waterbody) (CitylTown and/or County) The applicant 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) CQ 6STRVGq 4 New vt'�L ewe (4tJ --r - -r ak- ix i 5 � �' ►q V'00V'P igvlKt�ead( 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.) i do wish to waive the 15' setback requirement. k _ I do not wish to waive the 15' setback requirement. (Property Owner Information) (Adjacent Property Ow r information) /—/- I — — - C14 z &4�j Si naltu•e Signalure H&R, CbV:,4OSue Print or ype q ' , / g) S` 1J Print pra ype9Name Do"- o " , e x ai ng Addre Madt''n Adbre �� n City/ tate2i ate-- City/ to i 'P�� l/A Tele�r�e,Q[Umbef� ��j! ll - Teleg(io ,[ f l Date Date'' (Revised 611812012) 02/14/2019 08:55 FAX 14132636814 Springfield Museums 0001/0001 )b 11 19 0911 a E 1505 252 995 6776 p.1 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to i�� uSZ•c �1PS� ►_=IU s property located at 5 O L =) 5 tK:tUo&i r; 2 UFT (Address, Let,Block, Road, etc.) on QIFvhLr'CD , in 2.iSG0 N L N.C. (Waterbody) (Cityfrown and/or County) The applicant has described to me, as shown below, the development proposed at the above .,/ I have no objection to this proposal- I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing deve►opment must fill in description below or attach a site drawing) �pin��travc7 Q N$w Jr�t_ (�,1K, �h �`z cam- axis?�►g w00-o'- o gvt K4�e�v{ peril �, j RJI K •« �xxas t MJR tf•�P 1 � terse , WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or gran must be set back a minimum distance of 15' from my area of riparian access unless wanted by me. (If you wish to waive the setback, you must Initial the appropriate blank below.) 1 do wish to waive the 15' setback requirement. >K 1 I o not wish to waive the 19 setback requirement. Date (Adjacent Property Owner Information) .1 Stg»Ql (Revised 6✓18/2012) "� , lQk.- �r -�, _ :.� ; �*� ;�\/g. ��;�� /\� »z� � � \ . �� \\ _ �' ±� \//� �� \?�^ ydd« % 2\> « 3� � 2�° ¥ aw � �. /� � � § �� / //� /� ^ � f�/: . � \ /\z� � «:� This map is prepared from data used for the 1' inventory of the real property for tax vva purposes. Primary information sources such as recorded deeds, plats, . wills, and other primary public records should be consulted for verification it { \R`�� of the information contained in this map. r I 3.87 �.- O 45.42 4 31.51 1 .3.87 a 91.s3 r3 + r ova;'•' .. ,L dK a a -��• ' `A 50253 Freebooter CT Owners: Cheseldine, Henry T Tax District: Frisco Frisco NC, 27936 Cheseldine, Sharon M Subdivision: Brigands Bay Parcel: 011774000 Building Value: $130,000 Lot BLK-Sec: Lot: 193 Blk: Sec: Pin: 051607686399 Land Value: $109,000 Property Use: Residential Misc Value: $3,000 Building Type: Traditional p� 6 , bza=T 1d Total Value: $242,000 Year Built: 1985 Go, -),SIC earth 200 U