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Home My WebLink AboutNewkirk, Rachel®LICAMA/❑DREDGE&FILL No. 75073 A B C D GENERAL PERMIT ( Previous permit# ❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality �—o ,and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC CC// [. 1 Applicant Name Phone # (� Authorized Agent MOW Affected AEC(s): oOEA ❑ PWS ORW: yes / 11ho ZIP CPEW ElPrA El ES ❑PTS ❑HHF ❑IH ❑UBA ❑N/A PNA yes /,no r❑Rules ached. Project Location: County . �//l < { Street Address/ State Road/ Lot #(s) _ Subdivision City / ri J ZIP Phone # O / River Basin P Adj. Wtr. Body _>-r nat man unkn Closest Maj. Wtr. Body E:®ME ■■■■ ■■OM■■■■■M■■■M■ ■E■■■■NO■..... NO ■■■■i■EMM■■■■E■■E■■■■ ■-O■EMEEE■NEE■EMEN ■■■■■N ■MM■M■■■ME■E■NO ■■■NO■■■■■■■ ■■■ERM WEEM■■■RAM■ME MIMMEME ■INK, ■E ■■■■ . ■■NO■■■EMbiEM nA M■■■■HM■r■uE■■�a■MMMNOO■GM■ENC ■■■O ►�M�i �■EM■M■OMat� ■EMr�■■�:WENO■`■NONE ■■■NOCEFIEMOMMMNUMNEE■■■OEM■ No MEMO MEN ME 0 ■■■FAME ME ��.i is ■■MOMMU OE INMENFME■■■��ON■��EVAN NEEM■■E■■ ■■■■■■EMM■MM■■M■M■■■■■■■ ■N■EM■MM ME O ■■■ NONE ■■ MIAMME ■E■EE ME ME ■■MNO■■■�r.��r� r IMMEMEM■■■■■■iiIMMEEMiCeM■■■ iEMEEMEME iiMEMEi■MiNEENNEiiiiIMEMEMi�iiiME ■■E■N■■N ■■■■■■■EEEN■■E■■■■ E■■NO■■ENO■■ MMiiiiEiiiiii1MMEMEMEME MNiiii�0ONE MMiiiiiiiii®MMMEMEE EM .i6■ NOMMi Ci1®®■MEM■■M■MMEMEMM■M■MEMEMEMME .■ ■■■■NO ■■.■.■■il�:::�:: ®OCEMEMEMEM1■C■■■■■■iC®I No 1■E. ENEM 0 No NONE �MCMEME ■■■■■■■■M■MEMOMMEME M ■■�CM■■■■M■�■■■... Agent or Applicant Printed Name Siggai�fe `.'�'r Please read compliance statement onbackof permit" i 11l, A plication Fee(s) Check# �4't tt u AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: R c},cl r.) • c-�k, Mailing Address: ! q q (_„ i l 0- Phone Number: Email Address: I certify that I have authorized III- U , QiICd r\i(- IZ6 - 2 S-q - 02'E4 to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed /devellopment: r/& Gd �S/ 'j c 7'oN at my property located at 3i 4 in ( c rl—crr 1 County. l furthermore certify that I am authorized to grant, and do in fact grant permission to Division of Coastal Management staff, the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information related to this permit application. Property Owner Information: __44 '1/' /_� Z- 4. is Signat re 4wrJ, , I LJ, N c ,) k AIL Print or Type Name Title Date RECEIVED This certification is valid through / 2 I_�_! L% JUL 16 2019 DCM-MHD CITY ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to 7", (it 's P 1 (Na a of Property Owner) property located at / y /�r N a• 'f2 (Address, Lot Blo o d, atg.) J / on ��a,. in Ot o Ir& '.rPT Cmu vlL, N.C. (Waterbody) (Ci ylTown and/or Co ty) The applicant has described to me, as shown below, the development proposed at the above IocatV nI have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill descc/r,iptti(on belo or attach a site drawing) i<ep�ef/ -el✓� doc///nJ `�'J�/S/.ii.'S /o6/j�//tCjjf//')X/ L�G✓/�� Goit/e�cl�e SCavJ� nc7.. Zdr`Aw""f; WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, 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. (Property Owner Information) S gnalure Print or Type Name Iqq C'o J� Pnnr� 2L r•r� Mailing Address v1„r..111.1 L 2£flS'� City/stbte/Zip Telephone /Number/ email address Dale 7_ /.2 e o r ;FINED (RevisedAug. 2a14'} 16 2019 *Valid for one calendar year after signature* DCM-MHD CITY ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to --, I -)-Lee- `in < r-- is property located at 31bG.w Y W&J Z& a (Name of Property Owner) (Addresi on fl,a,7S , in (Waterbody) and/or N.C. The applicant has described to me, as shown below, the development proposed at the above locfi I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (lndfl%vidpalproposing development must fl/I in description below orattaa+ch a site draw l 7 / u./,�� COJ✓Gs-G � -J'�j ('o.vsT^t�cT'ay , �i�.owi�✓g /Y��he IVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin must be set back a minimum distance of 16 from my area of riparian access unless waived by me. (If you wish to waive the setback, you must Initial the appropriate blank below.) ___,Z_ I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner information) (Adjacent Property Owner Information) i. / 1:j: Sf ature Bait I l k Print or Type Name Ma�I�gAdd sJ e"s (i) nnit0. r4C A,,l i4 CltylSt e/Zlp Telephone Number/email address %- )-2- Jg 5ma.il Dale F1 , \J, 0 C-�VA t Ori1 r«UE.IVED (Revised Aug. 2014) "valid for one calendar year after signature* J U L 16 2019 RECEIVED JUL 16 2019 pCM-MHD CITY F 1 r v \ E 0 \ 2 \ 6