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Home My WebLink AboutColeman, Mikefl CAMA / ❑ DREDGE & FILL No. 74963 -� A B C ; D GENERAL PERMIT Previous permit# C ]New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality i and the Coastal Resources Commission In an area of environmental concern pursuant to 15A NCAC VRules attached. Applicant Name I I i c —IC t` 1 /11) Project Location: County � , t Lr ',^) Address I + L +_ } Street Address/ State Road/ Lot #(s) City I! State ZIP r% Phone # ( )' -' E-Mail Authorized Agent DCW ❑EW ❑PTA 1�ES ❑PTS Affected AEC(s): ElOEA ❑HHF 111H ❑UBA ❑N/A ❑ PWS: ORW: yes / no PNA yes / no Type of Project/ Activity 1= Piar I Fixed Road Finge Groff Bulkh Basin Boat BoatiJ Beac Othe Shor SAV: Mora Ph, t Waiv Subdivision City + ( 10, cit ZIP t ';" J. Phone # ( ) 11River Basin /V<1 t r e Adj. Wtr. Body JVf' :/"c' I/f'-$ n'.t an unkn Closest Maj. Wtr. Body (Scale: / l/ ) ,,vg 0 MEN MEN INNEEMEEM ■■■■■■■■■■■■■■■■ ■■■■■■■■■■eE■EN■ ■■■■■ gdh ■■■■■■■ ■■■■■■■n ■■r�rEE�r i�■■«■■■■ ■■■■ distance offshore■■■■■■■:■■■■■■6■:■■■EE■■r:E■E■■N■ �■■■channel max distance offshore ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■N■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■MENEEM■■ ubic ■■■■ ■■■■■■■■■■■■■■■■■■■■■■ MN■■■ MEMO EEO■:■■■■EE■EMEE■c9■■a■MEMO®E■■■■■OEM E■■E .■■ ■■EEE■■MME■■ ::ME E ■■E■■■EN■■■EMIR ::::::::MINCE : 1 ::::::::::::: ::■M■■EE■EME.��Ii.J/ ::: ME ENE E■■n ' 101,411111111111111 ■■■Bulldozing ■ ME■■E■■■■E■E■■E■■E®M■■®Mii�■ME■.E■■■z ■■■NM■■■■■■ MEMO E■■■:■:■:■■EE■N■EEMM ME■EM ■■ ■■■■ ■■■EEO■■■ MM■■■ ■M ■■N■ MEN ■== ■N■ ■N■ EME��■EEM NNE notsure yes no onum: n/a yes no s: yes . E■E■■■■■■■M■■M■N■N EO■■■ ■EN■■■N■M■ IE ENEM:::::::MEMES::g:::::::::�: ■■■■EE■■E■■EE■■ EMEEME ■■■E■■N■E■■ME■ ■■■■■■■■E■ :EEMEII�E■■N■■■■■■■■■■M■ 1:1:OONN■■E■:■■■N■■■■■■■■E■■E■■■N■ A building permit may be required by: ( Note Local Planning jurisdiction) Notes/ Special Conditions ,Agent or Applicant Printed Name Signature *'* Pleaseread compliance statement on back of permit" Application Fee(s) Check # cy See note on back regarding River Basin rules. PermitOffcer's Printed Name l/f Signatu Issuing Date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Mailing Address: Phone Number: Email Address: I certify that I have authorized ao� to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: C) s oM\Q 4za\ \ at my property located at _ in County. 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: +Ct ign ture Print or Type Name Title Date This certification is valid through RECEIVED JUN 21 2019 DCM-MHD CITY ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to \1C U\Q"'w 's (Name of Property Owner) property located at /.'� S5� �EtA.�.//C-�/.� �� (Address, Lot, Bloc , Road, etc.) on vi%0-:; /5 1V,5in_ A4A N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above locati9n. ✓ 1 have no objection to this proposal. Lhaves_objections- tothis _proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) 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.) RECEIVED I do wish to waive the 15' setback requirement. JUN 21 Z019 I do not wish to waive the 15' setback requirement. DCM-MHD CITY (Property Owner Information) (Adjacent Property Owner Information) Signa ure Signature r�`KS£ C q�cx nc,�l Tflwt STo n1 E Print or Type Name Print or Type Name 203 d11,494r3 ,61-4,nl d /'4 &/ Maili g Address Mailing Address / vyECoe e, tiJc 12/ds'32 /,�ay�r��.� 1 ti/r! 286-32- City/State/Zip City/State/Zip Telephone Number �— Telephone Number Date Date (Revised 611812012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT a� n4%, I hereby Cerflfy that I own property adjacent to W) �c 's property located at /55/ (Name of Property Owner) ;f3EL,4,Uti/A- RC/ (Address, Lot, Block Road, etc.) on NL�USf /��i� in c1��(i /2 . 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. _l.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) 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. Owner Information) WA N - —�1F;, Ia�2S Telephone Number Date (Adjacent Print or rim :r Information) r �v c I —RECEIVED JUN 21 2019 (Revise d6L1.8(2 4D CITY