The URL can be used to link to this page

Home My WebLink About74157_Camp Caroline_20191031 .�,.,9..,,�.,,o,.•�+n ...,,,<.. Tom..__...,�-.. .-r.� _ _ - _ �) cecAMA/ ❑DREDGE & FILL 0f( ' " NO. 74157(� (o,1,SZ � A 0 C D GENERAL PERMIT -Z�p `'1 Previous permit# AJh >'( ❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued /41 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 0 7 h G S_0 0 ` ❑Rules attached. , Applicant Name G A r'\P C A,2 O(.t nl K. Project Location: County J'AM L f C' 0 Address 32 9 TA A) 1 E go Z P Street Address/State Road/Lot#(s) 339 City /a'R A1'A I I O r State p)L ZIP)85( 0 TA A)re,rz O j2 t7 { Phone#( )2QQ- 3157 E-Mail Subdivision ( Ara CAt O Lt l( Authorized Agent C A S O F'C Z(Z r City A k A UA t'O f ZIP )13 57 d ❑cw VEw 'PTA ❑ES ❑PTS Phone# ( ) River Basin N l V S/ Affected ❑OEA ❑HHF ❑IH ❑UBA ❑N/A / AEC(s): Adj.Wtr. Body DA PS0/1 C t'?L(/C CO man /unkn) ORW: yes no PNA yes(/...-3 Closest Maj.Wtr. Body N S Type of Project/Activity /1�.I�- 0 i` I l 1, /O r 1`4 0 P/A'f f 0 Rr4 4' i 0" !fI i— (Scale:) 3 p ) j Pier(dock)length gor / / �(9 / Taw. i Fixed atform(s) 140 liai 1 Floating Platform(s) ._..�A�s ` t Floa g O f Finger pier(s) 1 V t , D , Groin length �— j I 1 Lk(U� number 1 I Bulkhead/Riprap length ' , / i avg distance offshore j r max distance offshore f r�� f Basin,channel _ /L !. ` 5 d 1 cubic yards --i---)eir __ I Boat ramp `'— I I F ( ► Boathouse/Boatlift Beach Bulldozing "--- r-- I T _.�. i Other Shoreline 00O • - q� , SAV: • yes no � _ . _...._. r {��`_._. ! Moratorium: n/a yes n f I 1 v-..'4.. Photos: yes I W .— Waiver Attached: yes A building permit may be required by: PA/ '( t C O Co V ei r/ . I I See note on back regarding River Basin rules. (Note Local Planning Jurisdiction Notes/Special Conditions 1t l .0 I I l, Z CCO c C.' DSO,4 5 CciQ-lpi, q)livv/ Kt\ii� 'flier Age rApplic ed Name, PermitOfficfr's_P 'nted Name L Signature r !Please read corbliance statement on back of permit** Signature __ ff FY(.fr / �/ 6c r 201cl 11 -orSCe7 ZoZo Application Fee(s) Check# Issuing Date Expiration Date .II CAMA/ Q DREDGE & FILL No. 74417 GENERAL PERMIT Previous permit# A B C D tNew 1-1Modification CJComplete Reissue 11Partial Reissue 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 - ®Rules attached- Applicant Name `' Project Location: County_ —' Address ...._.� _.. ' '" '" �` :.:: _� _ Street Address/-State Road/Lot#(s)____<4 ,�' City i State ZIP .' Phone#(, ) : ._. E-Mail _-'- Subdivision Authorized Agent p �__--_ City _._ .. _ ZIP -_ Affected T CW Lt EW 11-PTA IES Li PTS Phone# ( ) River Basin ,(1',4., C OEA I HHF 1 1 IH n UBA N/A AEC(s): Adj.Wtr.Body: 0(}4, 5t,°. 1._ b ____._ nat man Junkn) ❑PWS: ffiORW: yes / no PNA yes / no Closest Maj,Wtr.Body i+ Type of Project/Activity (Scale: , - " ' ) Pier(dock)length ' Fixed Platform(s) t i . .. mm % F , t a f Floating Platform(s) 1 t i v�, .. Finger pier(s) , Groin length number j } i , Bulkhead/Riprap length i f i avg distance offshore ! i [ max distance offshore Basin,channel , .. • r_ ,� i _ cubic yards . Boat ramp Boathouse/Boatlift , . l ,. j Beach Bulldozing £ .� , r Other , 4 i _ r 4. s Shoreline Length o n i SAV: not sure yes � ,1 - 1 I _ i Moratorium: n/a yes no , j Photos: yes no I Waiver Attached; yes A building permit may be required by: i See note on back regarding River Basin rules. (Note Local Planning Jurisdiction) Notes/Special Conditions Agent or Applicant Printed Name Permit Officer's Printed Name Signature **Please read compliance statement on back of permit** Signature Application Fee(s) Check# Issuing Date Expiration Date Connell, Brad From: Brownlow, Roy Sent: Monday, April 15, 2019 9:46 AM To: Sullivan, Shelton Cc: Day, Susan; Connell, Brad Subject: FW: Camp Caroline? Attachments: CampCarolineShoreline.pdf Thanks Shelton. I have forwarded this to Brad Connell who is our Field Rep for this area. Thanks, Roy Brownlow District Manager, Division of Coastal Management North Carolina Department of Environmental Quality 252.808.2808 ext 217(Office) Roy,Brownlow@ncd enr.gov Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties. From:Sullivan, Shelton Sent: Friday,April 12, 2019 4:03 PM To: Brownlow, Roy<roy.brownlow@ncdenr.gov> Cc: Day,Susan<susan.day@ncdenr.gov> Subject: Camp Caroline? I think this is yours? Thank you, Shelton Sullivan 401 & Buffer Permitting Branch Division of Water Resources North Carolina Department of Environmental Quality **please note my phone number has changed** (919)707-3636 office (919) 807-6494 fax Shelton sullivan c7,ncdenigov Location: 512 N. Salisbury Street, Archdale Bldg#942G, Raleigh, NC 27604 US Mail: 1617 Mail Service Center, Raleigh, NC 27699-1617 ..0":".........."."1"...""" Ca+i.slt'S"'d'7�•d&€ti MZk&'P+E..!,aa/�,p'..T�p,�� kiwi!'correspundence to and from tiers oddres is,,4it+r>ct?u the North Cam/inn Public Records Law and may be di;losc,d'c Third naafi 1 ADJAicsy:N'' '`1g1PA{b;u,-N PROPERTY OWNER SS ATEMENT J I hereby certify that i own property adjacent to ( C.., E ') ..- • i`' -1 _'s 1 (lame of Property Owner) nr arty '^".8t�.r' 0 - 1.r� ,, .�� `_ /4. T u (Address, Lot, B' k, Rpad, etc.) y `' , in ` ', ;,, 0, , , C , , N.C. • (Waterbody) (City/Town 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. _ �,.a. e�DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill in description below or attach a site drawing) 1. C V\� ;\ -\:^ \, \ " 1. "4; A'k_: c- /`.'4.. I ' 1 \ 4 \,f ')� \;, 4 t 1,,, _... , i� , t c., 1 -fir, ` .,:% A-,r, ,: I 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 mR (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. (Prop rty Owner i n� Jt`son) (Adjacent Property Owner information) i ("-- , '''(4,,,,,A 2-4',,,,,- ,i ,_ 1 Siptature �, �'`'ti z �- Signature f-t SA,; , 4C1 s k(.`f v , �t.�$ _ _„_____ Print or T pe Name- J;, j Print or Type Name -t . tv1),,, i ____. Ma ing Address — Mailing Address } , r`-. '( tty/Sta e/Zip _ City/State/Zip ,-' 2 / li - l ___. Telephone Number Telephone Number 41 / -- Date Date (Revised 6/'18/2012) AD_ I hereby certify that I s ,r) ' t nrr,i'P,1v 'i.ftr.r1 '-' o a �a _ P11-C. on "` w o c� `j ram Z �i J 1 t...+ K �. ity)_ (Wate m, z (QY '•. e I at the above The applicant has dE �a * '' ' •i location. 1 _ E. I have l have- �` DESGFtt _ __ _.. site drawing} (9vdiuic�caaia oaosii , ) . , ; `f( \ \ Till ' t ,.., ..... ,,______, _ , , ,, ci> v,H4---- , _., ... ....„,,,,„,,, ,__,„ ... . \,,, ,), , ,; , ,,,, ,,,_, ram=- �s c '\--.,,, ,,, 'A _s1 , :eta n , _ ^' N' i 1 F yin must be set E understand that a -- - --- -� • c� by rn�. (If you back a minimum df wish to waive the s: _,,._am"_-._... _......_ c I do wis a= i; r' WAI do n +0f. ' ` y= tQ `t, cam► N' — //I .r -' 1 la 251 xe ,Pi ' 1 { C1 "�' l" d Print or 1",pe Norne �A M irtg AqAddress c ,._.�, ; ��M=�C so "'�... -- Qty�/Stafe/Zip 1`\ > __ Telephone Number . i Uate (Revised 6/18/2012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to ,''t ‘ Owner) s-( _ {( Na of Prop) rtyj (//�'�I } - - prr,�4�r-v IC��,ntfC; �t .3 � r �.._`.C.'�:. __ r, _. (Address, Lot, Bt k, Rod, c.) vim,� �. - . , N.C. (Waterbody) (City/Town 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) r c ;`t irk`' - n - L.- i 5\'\=' , . L..' \ / LH) k 7' r ( r �. 1 . i 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. (I t.. wish to waive the setback, you must Initial the appropriate blank below.) t .A I do wish to waive the 15' setback requirement. „ 1 . n1C3 I do not wish to waive the 15' setback requirementDCM4Alrit) CC"' (Property O//wnerformation) (Adjacent Property Owner Information) ,,,,, il iz -,,, , *nature,( t I _ `'',r.-i ( \ Signature ( ,\I\u ) \',,!'t v"1 ) J r,, t'14 t /f ' r j Print or Type Name 1 . Print or Type Name y 5 '''C ,,� 0 f t ,t ,� e - ,ii ' ,r 1 ? , , re. 1 Mailing Address _ Mailing Address City}/.Sta e/Zip City/State/Z?p Telephone Number Telephone Number 1 --�._r L-{- '� - t� Date —. .._._ _. Date (Revised 6/18/2012) US 'ILrtfq# First-Class Mall Postage&Fees Paid 111111 LISPS 1111111111111111 Permit No,0-10 9590 9402 3099 7124 9915 21 United States •Sender;Please print your name,address,and ZIP+4®in this box' Postal Service r] �/'\fff \VV� AI iv{65 D 'i:i1F3 2EtSi I!i'!�lluiylll��l�1flti�"Jtl�filt�u�i,y,j,il,llillll,�'Ilill LISPS TRACKING# First-Class Mail Postage&Fees Pald LISPS Permit No.0-10 9590 9402 3099 7124 9915 07 United States •Sender:Please print your name,address,and ZIP+4"In this box* PostI SergiC 7t„ _ A,(7.v.1 tt 1 1:;; 1i .t.t. . ,1+ Wi: i1: 1•;`h ,j1i:; i SENDER:COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY a Complete Items 1,2,and 3. A.Si ture ■ Print your name and address on the reverse X ,, i / r pp Agent so that we can return the card to you. U L, i / ssee 11 Attach '' rd to the back of the mailpiece, B. elved y(Printed Name) / C.pat of De very or on th t if space permits. - I h `e ;`} //v f/}�1 1. Article• , =.to: D.Is delivery ad different from item 1? ❑Yes rt , If YES,enter delivery address below: p-tdar- \DCA,,f .,77-,‘ \\,,..;,, '.•-•""•-_,, t ri Al \0` i\P,S t :d= 3. Service Type ❑Priority Mall Expreesti 1 II I I III 1111111 li 1 I 1111111 11111 ❑Certified Malmo natuatunsre Restricted DOWN Rmtateredd Mail Restricted very 9590 9402 3099 7124 9915 21 ❑Certified Mall Res6fotedDelivery ❑Return lReceipt for Ia 2911%1 W t?elivalY Marchand* ,ry Restricted Detvety ❑Signature Confimtatlon'^' 7011 0470 0003 2 518 2948 O Signature Confirmation .___Meted Delivery Restricted Delivery (over'05 0) PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt SENDER:COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY is Complete items',2,and 3. A. Signature 0 Agent A Print your name and address on the reverse X O Addressee so that we can return the card to you. B.Received by(Printed Name) �,•,,,.(3.1pate of Delivery X Attach this card to the back of the malipiece, .....--- or on the front if space permits. -- f 1. Article Addressed to: D. Is delivery addrQs(� ?le item 1? Yes i5 e� VVIIEE dress below: No t'' sr-� ' �,1�,., ,ks, .. �", �,�t\I 1'i `,\\ :1 \-. e ..'C... f' x. 3. arviceTyp �1•-.-V . � 1,0' : pM e " _, ' '-lPilo Mail a: rest III 1111111IIIII 1111 ❑Certified Si M ure `� ❑Registered Mali ❑ It Sign e ivery ❑Registered Mall Restricted ❑Certified Mal Restricted Delivery ❑Retttut m Receipt for vely 9590 9402 3099 7124 9915 07 ❑Cnuw.. y Merchandise f Restricted Delivery ❑Signature Confirmation TM 2. Article Number(Transfer from^^-°-- • S ?Oil 0470 0003 u insured Mail Restricted Delivery Restricted Delivery (over$600) PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt Applicant: CA CI 1 '� O L(A)c- A- ( P�rz lz Y pp C Date: OC T 2O1 General Permit#: 7 LI/y I7 Describe below the HABITAT disturbances for the application. All values should match the name,and units of measurement found in your Habitat code sheet. TOTAL Sq. Ft FINAL Sq.Ft. TOTAL Feet FINAL Feet (Applied for. (Anticipated final (Applied for. (Anticipated final DISTURB TYPE Disturbance total disturbance. Disturbance disturbance. a bitzt. =_ = includes any Excludes any total includes Excludes any Choose One anticipated restoration any anticipated restoration and/or restoration or andlor temp restoration or temp impact temp impacts) impact amount) temp impacts) amount) (kJ) IV A Mn Dredge CI Fill CI Both ❑ Other q c/o 1=% 2 L/6 F/ 2 Dredge❑ Fill El Both ❑ Other El Dredge❑ Fill❑ Both ❑ Other ❑ Dredge❑ Fill 0 Both ❑ Other ❑ Dredge❑ Fill 0 Both ❑ Other ❑ Dredge❑ Fill❑ Both ❑ Other ❑ Dredge❑ Fill❑ Both ❑ Other El Dredge❑ Fill❑ Both ❑ Other ❑ Dredge❑ Fill❑ Both ❑ Other ❑ Dredge❑ Fill❑ Both ❑ Other ❑ Dredge El Fill❑ Both ❑ Other ❑ Dredge❑ Fill❑ Both ❑ Other ❑ Dredge❑ Fill❑ Both ❑ Other ❑ Dredge❑ Fill❑ Both ❑ Other ❑ Hart, Kevin Brandi Robertson < From: brandiprobertson@gmail.com> Sent: Wednesday, October 30, 2019 12:09 PM To: Hart, Kevin Subject: [External] Camp Caroline $z d_ 56,'$a �e,f'' �% �.,., _d. ,F ,,�.,prv, .r ,,,,c a�> �.�ad�., -,." d — ns Dear Mr. Hart, Attached are the signed notification forms for the Camp Caroline Project we met about last week. Please let me know if you need anything else before issuing the permit. i .._.. .. ,.ate.-_ ......... asss_-fna :.a. ...__.,.._ _._. ,_.».m... _ =�$S.?3TJ`SK.'M A1a[i:(i_'hYRYW,sFFS IF & 4YKkfi{s hy/ e1t✓00,081lrt4 A11010 .1.44,,414.44,M6 404,4744^!441.411 4 444 ibx441,4 2 G37A.,V66, P+i,#':3- ! uqg y: =7ea.Va as rt on3 sem.E 104044' a Aort STF • Thank you, Brandi Prescott Robertson B Prescott Marine Construction, LLC 252.249.0149 brandiprobertson(a�gmail.com 3 1 CAMA/ E-1 DREDGE &FILL No. 74417 GENERAL A B C D ENET" L PERMIT Previous permit# New flModification C]Camplete Reissue 11Partial Reissue 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 5A NCAC Rules attached?. Applicant Name_.._ ,' ___. L._',4 . ' Project Location: County,, ." r_ _ Address - __ _ _ 1 _ __ Street Address/State Road/Lot#(s)____ e" City State ' ZIP :' Phone#( _) ____....._E-Mail - Subdivision " Authorized Agent City ZIP TI cw a Ew N PTA 71ES U PTS Phone# ( ) River Basin /t/e 4,,. ' Affected W N/A ❑o� HHF i�1 IH LI UBA Body____ 4(,,,,tss, A)_ .i .-_. (nat,Loran" /unkn) ❑PWS: Closest Maj.Wtr.Body----.....t -j+ ORW: yes / no i PNA yes / no Type of Project/Activity (Scale: - " ) Pier'(dock)length ''"' Fixed Platform(s) � i Floating Platform(s) - "" - - Finger pier(s) ,- Groin length a.. .number _ -- I Bulkhead!Riprap length E i i { ., avg distance offshore . . ;- max distance offshore g Basin,channel , cubic yards E Boat ramp i Boathouse!Boatlift , . s - Beach Bulldozing _ QthBY _ e i ' i 3 '' , t 1 , 1, ' ''' ' ; ' 1:.: Shoreline Length . ---- � a•..„w< I_ , • SAV: not sure yes no i, ( , i) ' ... I L ' . _ 1 Moratorium: n/a yes no ° , i _ Photos: yes no Waiver Attached: yes =no, ____.._ ._ __1____ ».>,---__ _:_s. �,._.,._ ._e__.. : L_. i A building permit may be required by: I.-:,See note on back regarding River Basin rules. (Note Local Planning Jurisdiction) Notes/Special Conditions " i , Agent or Applicant Printed Name PerrnitOfflcer's Printed Name Signature **Please read compliance statement on back of permit** Signature Ex iration Date Application Fee(s) Check# Issuing Date P Connell, Brad From: Brownlow, Roy Sent: Monday,April 15, 2019 9:46 AM To: Sullivan, Shelton Cc: Day, Susan; Connell, Brad Subject: FW: Camp Caroline? Attachments: CampCarolineShoreline.pdf Thanks Shelton. I have forwarded this to Brad Connell who is our Field Rep for this area. Thanks, Roy Brownlow District Manager, Division of Coastal Management North Carolina Department of Environmental Quality 252.808,2808 ext 217(Office) Roy.Brownlow@ncdenrclov Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties. From:Sullivan,Shelton Sent: Friday,April 12, 2019 4:03 PM To: Brownlow, Roy<roy.brownlow@ncdenr.gov> Cc: Day,Susan<susan.day@ncdenr.gov> Subject:Camp Caroline? I think this is yours? Thank you, Shelton Sullivan 401 & Buffer Permitting Branch Division of Water Resources North Carolina Department of Environmental Quality **please note my phone number has changed** (919) 707-3636 office (919)807-6494 fax shelton.sullivanAncdenr.gov Location: 512 N. Salisbury Street, Archdale Bldg#942G, Raleigh, NC 27604 US Mail: 1617 Mail Service Center, Raleigh, NC 27699-1617 Email correspondence to and from this address is subject?o the North Carolina Public Records Law and may be disclosed Pc third partie s 1 ADJACENT 'i=4,IPARIA4 PROPERTY OWNER S.:ATEMENT ) ,-- I hereby certify that I own property adjacent to (7 . ) (Name of Property Owner) , ,,, ) v !:-,--..kt -. :-,4 , ' ::: 1.),-\ , , - - '1\i...\, r\ --14":k 1, , - ,f"--- (- '.--e!)1:,:.)1 (Address, Lot, Biofk, R,pao, etc ) C. on --., ,, J, , ,.‘, i ,. y., , in k ', L. <...' . , N.C. ,..-=-=' = (Waterbody) (City/Town 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 ANDIOR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill in description below or attach a site drawing) -.. ( , \ A ,, , ,--• , „c )(_ , ),,: • ,,,, ' , ,. ,,,, ,\.•...4.c t,'& s ;":),. , \ , (.. k. .,. A, \, \- . > - )s ' • 4 , ; , vi ; i' ,,, 'VI \ ! , ---. \ k i ., .) —\(' 't ' 1 ..1. ,, k, ..is . .,,-‘,,, -,l. 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 any area of riparian access unless waived by mt.., (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. _ ---- _ (Prop rty Owner In,feymation) (Adjacent Property Owner information) S*Iatur _ 1 \o,'a- ') , Signature - 't ' '''''' ' V"(1 3 ' c • -, Lei..., k,„4 , : , v- , ,„,,,i Print or Type Marne• Print or Type Name iv ii,,, (' jc. ,--- Mailing Address - ' Mailing Address pity/stare/zip .__ city/State/Zip 2-) ::<.?1 7 Telephone Number Telephone Number .._ Date Date (Revised 6/18/2012) AD, s I hereby certify that 1 r,} '41 on ), �..., w (,, 1- --� dlii J 11 1► i$ l °Nate .auk �, ,i a. Sm g ° I at the above The applicant has dEo < ,im Tk .J location. I have J . `�� _ 1 have � �n (Individual proposii .�" site drawing) \ CH P.. ...,. l' -..-: 5').,ti� ,.Ci ` r R s ` S - k; ., _..��"-". -* m ``of 1 - ... "" En .. µ y _ ,Y ''rt t Ci -�"'"" ', }in must be set I understand that a ' "- "i �.-_-- ..,—= I '' by mL. (If you back a minimum diE- wish to waive the s -.:__ •- ca i Idowi ; ' +# tom+ -- ,as _ ry (Property Owner it p "' raforn9aticafi1) Si atiir(4' , ), + it i a i Artnt or Tt pe Nitre c� 4a T.m.". .... Ma rrlg Address ty/StaatelZip)4 N,J , _ T Telephone Number Oat e Date (Revised 6/18/2012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to ( Nr { .kcNa A of Prop rty Owner) pry 10 Stec at ! ,�. _ (Address, Lot, B k, Rod, &tc.). on , .. , ,;A I,.�,.,I_-.?. k , , in # ,, a ,,,, k,. c.; w - N.C. (Waterbody) (City/Town 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) ).(4,. L, \ii<eN,c, ILO \Aju.kci c ,e._,,,,,kis4L )\/11/4k-'' (----\ ‘2-k--Q-- - / '—'.. ‘. ..,-1 6. 1 .f.) .S-- 'm k, ;',-, IA fL f 0,i t\ \--1,-.)-A-N,A.,.1 t- \cva forrAA, 1• 5 +. fo J 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,(( L wish to waive the setback, you must initial the appropriate blank below.) . .;w ,,M 93 I do wish to waive the 15' setback requirement. y R 1 ,,�� I do not wish to waive the 15' setback requirement. ati4Atip CITY (Property Owner formation) (Adjacent Property Owner Information) — ( ( i7 , Signatures ;� ; ,.- Signature( p \/\� `•,. `\ I �, �� ,kv'vt, {C.t.`f�°.r (- J 11'4- iii'j' It t - l'ij };. - Name Print or Type Name Print or ype � �;� ;. 7 .�� , . r .� 2 °i i /t.�` ,i 1 i,i ; i— Mailing Address Mailing Address ,J., \,:uti� ,AJ ..?',i 5 f--' City/State/Zip, ),p )i 1 dity/S (.-6 a2- 2.Zip'' 7 _ Telephone Number Telephone Number Date Date (Revised 6/18/2012) USMINitityp# 111111 First-Class Malt Postage a Fees Paid USPS 11111 IR.Ifil Permit No,0-10 9590 9402 3099 7124 9915 21 Unitetai d States •Sender:Please print your name,address,and ZIP+4®in this box' Pos Servi , G,, , Cc,..4,..)1\sA.Q...._- ),. 1—, 5 A(g.k ,Ao(-? ..) - c). 3.--i0 C,) D---'ii".1628913 111,1111,,,,ilisilifilliiiiiillililtiniviiiiiI111111111#1101 USPS TRACKING# 1 II II I 1111 11111 111111 1111 Fpirosstt-gr8s,Ft Vleaei sl USPS Permit No,G-10Paid i ; 9590 9402 3099 7124 9915 07 United States -:4..- •Sender:Please print your name,address,and ZIP+0 In this box* Poe*Serve , vt (1.,,C1,-e- b i i 4i A I A...)C.— i /1 "?.f A IA---,ti.. ,I? , c/o illilYailli111101\1\i"\.11111111\i11111011111111111111 SENDER:COMPLETE THIS SECTION COMPLETE THIS SEC/ION ON DELIVERY III Complete Items 1,2,and 3. A. SI tura ■ Print your name and address on the reverse /I ! Agent so that we can_ return the card to you. X ji v L / ClAddfassee ■ Attach th;"'rd to the back of the maiipiece, g eNe y(Printed Name) C.Pat of De very or on th if space permits. - o 0,l(e j . 4I�f� I /i 1. Article A.! ed to: D.Is delivery address different from Item 1? ❑Yes '-' If YES,enter delivery address below: p-No— t Pk A"4-1 e\ct A S {y‘4 3. SerVICe Type d Priority Mail&mese I III 1111111 1 1 1111 1I 11111 0 Adult Signature DAdultSign Ire®Restricted Delivery O istereddMall Restricted Certified Meilvery 9590 9402 3099 7124 9915 21 fled Mail Restricted Delivery ❑D�pe�turn�Receipt for q CQllectQn Dellvefy Merchandise ,ry Restricted Delivery 0 Signature Confirmation*" 7 011 0470 0003 2 518 2948 Ci Signature Confirmation i (over ___odor..._tHoted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY Is Complete items',2,and 3. A. Signature 4 ❑Agent a Print your name.and address on the reverse X ❑Addressee so that we can return the card to you. B. Received by(Printed Name) .elpate of Delivery A Attach this card to the back of the maiipiece, -- or on the front if space permits. -- * i 1. Article Addressed to: D. Is delivaty addngr"den o item 1? Yes + r, ! 1i address below: No m. 41 ''It;\t.: {11 .3 \ ' \ 1�33.��*,,'•„, f\,...(-- lj )1-04 •�v Air ?31 ✓ ',1 3. ervle°Type-rr,,. ,. -,'- }priiorityMallExpress® I'I III 11 I111 1 'f'I It El a CI CI CertifiedItSign re r Crewe-ry r 0 DeliveryRegistered Mail Restricted 9590 9402 3099 7124 9915 07 CI Certified Restricted Delivery 0f ectmiarr ptfor nature TM 2. Article Number!Transfer Irnrn-^-4Q�0 3 2 5],8 2 c1 Ea 3 y Restricted Delivery 0 Signature Confirmation 7 011 0�,7 0 u insured Mail Restricted Delivery Restricted Delivery 1 (over$600) PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt