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Home My WebLink AboutAndrews, GeorgeC� AMA / ❑ DREDGE & FILL N271612 A B C D ENERAL PERMIT Previous permit# ew ❑Modification ❑Complete Reissue4,. []Partial Reissue Date previous permit issued As autho ized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of a vironmenta] concern pursuant to 15A NCAC - I.I Rules attached. Applicant Name �i 1 ! 1. - Project Location: County ( I Address f ; i Street Address/ State Road/ Lot #(s) City ��t;4'�l� C%�� StateZIP Phone # (44P n / i. Ejs(ail Subdivision i o ,� II Authorized Agent i � -- (-'�'�� Ci d-i _� ZIP ❑CW ❑EW ❑PTA ❑PTS Phone ) l, iver Basin Affected ElOEA ❑ HHF ❑ IH 0 -BA ❑ N/A �� AEC(s): Adj. Wtr. Body\1. I , ill!! . to-, f, r (nat /man /unknEl PWS: ) l,e^�� Closest Maj. Wtr. 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Please read compliance statement on back of, permit" i { Application Fee(s) Check# i Permit Officer's Printed Name AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: 4caLc-P Mailing Address: Phone Number: Email Address: I certify that I have authorized \3'D ov" (? hot C' r- �I ar�� (�606' . 'vc ci t°i. 31,X- `� I k- to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: fe-4(cce 5ea,.je II at my property located at - 1 3 � t-�OoP ?'Ae C� in t c�c V&-ACounty. I 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: �4a24a " RECEIVED Signature nn I JUL 31 ZW9 Print or Type Name Dcul-WHI) CITY Title Date This certification is valid through �_/ —72- l 20 ■ Complete items 1, 2, and 3. ■ Print your name�and address on the reverse so that ive can return the card to you. ■ Attach this card to the back of the mallpiece, or on the front if space permits. 1. Article Addressed to: Tole U, Rd R.; k ftlL 2K512 3. IIIIIIIIIIIIIIIIIIIIIIIIIIIIIII'IIIIIIIIIIIIII 9590 9402 4706 8323 964842 2. Article Number fpansrerumu � •--- 7019 0140 0001 0233 1938 PS Form 3811, July 2015 PEN 7530-02-000-9053 APLETE THIS SECTION ON DELIVERY signature ❑ Agent ❑ Addressee Received by (Prl to ame) C. Date of Delivery Is delivery address different from item ? ❑ Yes If YES, enter delivery aadddrless VE®below: [3 No JUL 31 2019 service Typ 'o Mall Express® hilt Signature ❑ Registered Mail" ❑ fuit Signature Restricted Delivery R11serred Mail Restricted ,rdfied Mail® ❑ Return Receipt for artifed Mail Restricted Delivery Merchandise ollect on Delivery ❑ Signature Confirmation*" ollect on Delivery Restricted Delivery O Signature Confi matlon Imtricted Delivery Restricted Delivery pomestic Return Receipt I USPS TRACKING # First -Class Mail PostagIIIIIIIII IIII Iillll IIIII IN IIIII IIIII 111111 LISPSe 6 Fees Paid Penrnt No. G-10 9590 9402 4706 8323 9648 42 United States 7Sender: eprint your name, address, and ZIP+40 in this box• Postal Service " (A 16 k � b m� b�r�Y L��p ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to property located at Vbl) (Address, Lot, Block, on e— SoI , in l (Waterbody) (C of Property Owner) and/or County) I N.C. The applicant has described to me, as shown below, the development proposed at the above tion. 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) "edp��5 eN�sk=� ( � ��CEIVED ( r°Q641 JUL 31 zu19 DCW-MHD CITY WAIVER SECTION ' I understand that 1pier, 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. (Property Owner Information) Si natut Print or Type Name AM1ffr W'r.Frssra Date (Adjacent Property Owner Information) or Type City/Statelt Telephone Number Date (Revised 611812012) s s 0 E pys, H bi c," p �� .r�y' .R. � 2 �p C' o A , fD 3 s° a 00 a �q .. a. "Iwi `° b s. D p tv y� d °�° ro a Z l7o p� b �ro f�D ty�f 7zd cC y m '3 F N\ N p w w x N r O x '�' 00 x O m q A O ��yyyyy 00 N 0 $' SH n gam 3 ^ ? �� et �gj a 000 aUlw � rn "s� O N =os r z tD smmay_ .e :y .� •' m � Y . • F w.. � 1 -. P�� r'F + i 1. ..'°`�,. SRA Ro w + O a tF lip a • tlla. L KR C k •t" �+H _�. •µme i ., F�'. _ __ _ _ .. � � n ry# +� $ Y.rti eS).•