HomeMy WebLinkAboutFutral, Sherrell (2)-I CAMA / 0 DREDGE & FILL No. 74477 A B C D
GENERAL PERMIT ` t Previ(us permit #
-10ew ❑Modification ❑Complete Reissue ❑Partial Reissu Date previous permit issued
As authorized by the State of North Carolina, Department of Environmen ,Quali
and the Coastal Resources Commission in an pr of environmental con rr "pursuant to 15A NCAC
IL] Rules attached.
Applicant Name Project Location: County
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Authorized Agent
Affected OCw [JEW ElA ❑ES ❑PTS
AEC(te: DUEA UHHF ❑I ❑UBA ❑N/A
❑ Pws:
ORW: yes /no PNA yes / no
Street Address/ State Road/ Lot #(s)
Phone #
Adj. Wtr. Body /
Closest Maj. Wtr. Body
ZIP_
Basin
_(nat /man /unkn)
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Signature "ease read compliance statement on back of Signature l"
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Application Fee(s) l� (ieck# Issuing Date ' Expiration Dafe
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ( 'A Qi'i _ ksJE' v 's
property located at till 6&VJJ d0 UK• L:)9 Pz� C%&J4-reK9:r NC;, ZfJJ'6X
��R G n�El� (Address, Lot Block, Road, etc.)
on 9� in' &,2-tE R1=T N.C.
(Waterbody) (City/Town and/or County)
The applicant as described to me, as shown below, the development proposed at the above
location.
7 I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND1OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must flit to description below or attach a site drawing)
-Flo Rj=.vc '
I/V 7`C RNAI
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 waiv tr`setback, you must initial the appropriate blank below.)
C I do wish to waive the 16 setback requirement.
Date
I do not wish to waive the 15' setback requirement.
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city/stwelzip � /n, A hoi-0 J'
Telephone 1 i�irr/ble l� 4
Date} /
(Revised 611812012)
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
property located at
tnaaress, Lo
Dz cx�rco u, vw.t
on �EQ ate�in(Wrbod (C /row�and o
y) tY
N.C.
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 ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must Pill in description below or affach 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pro e. Owner I ormation)
17Lf -
Date
(Adjacent Property Owner Information)
Signatur 11' n / ) EA/
Print orT a Name
215 s,'dg 'DR, A 4ZYTSy
Mailing Address
,J&5( r OR Ag-r
City/state/Zip
Telephone Number
Dale
(Revised 6118,2012)
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