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Home My WebLink AboutGudges, Christopher^ OCAMA / ❑ DREDGE & FILL No. 75058 A B C D GENERAL PERMIT Previous permit# ONew ❑Modification ❑Complete Reissue ❑Partial 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 15A NCAC r ❑ Rules attached. Applicant Name p ^ ( ,, Project Location: County Address City. _, , `i _ State_; ZIP 7/ Phone # (!!) E-Mail Authorized Agent �( Affected 0CW EW NPTA ❑ES ❑PTS AEC(s): ElOEA ❑HHF ❑IH ❑UBA ❑N/A ❑ PWS: ORW: yes /,rfo' PNA /yes.,/ no Street Address/ State Road/ Lot #(s) Subdivision - City ZIP Phone # O River Basinil- Adj. Wtr. Body �� I �r I i (nag /man /unkn) Closest Mal. Wtr. Rnrly ( /Ul ■■■■�l■■■■■■■■■■■■■■■�■■■■ MEN ■■N ■■■�■■ ��:::::MEMO® .:: OEENMSOEM NOON:: ::OEM:::::::::::OEM. NONE ■E■ME■MOMMN ■■ FAMMU®■■■■■■■ NOON: ■■■■■■■■■■■■■■ ■■NOON : M■■■ a ■■ ■■ MEMEMMMEMMEMEM ■■OEM M.E ■■■■■■NNMM■M■■■■..■....■..■ON■■...CO..:� ■■■■■■■■■■■■■■■■..■■.ml■■EN.■■■■■■. .NO ■■■■■■MMEM■M■■■■■■M MEENM■SEMEN ■■■■N M■ME■■■■■■N■�9�:■MEN■YE■■■■■Q■■M■� ■■■MEN■■■N■EMEN■MM N M■I�JNY M■■■■O ■■M ie:■■■ M.■■■M■■�� • ::E :MOON® M UNI �8:::■NMMN:oC.EE ■IINI�■■OA■WE■M■■■MEE �N: Im on MEMO■■■■ IMMEME::: ' M■u■ ■H■ MM. ■N■ s:Ni�� EI ■M■M■■M■■N :■MENOMONEE ■■■■■■■■. MEMEMEMEM EENSSONN1::: SEMEN :::EMERNME ME: moms E:MMEMEMEMEMEMEME ':I■■■■■■MEMO■N�■:9 MENEM MEEMEMEM �■ ENIMEMEM:■:M ::::■ MN■■■■■■NNE M NONINE ON■■ 0 10 ME OEM I ell Agent or Applicant Printed Name l- Signature '-*Please read compliance statement on back of permit" '/�r' Application Feels) Check # PermhOfOcer's Printed Name , Signat 7re Issuing Date E pira ion Date AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS Name of Property Owner Applying for Permit: Mailing address: YJ Telephone Number: I certify that I have authorized At ,OK / "lu.p� �M1� (agent/contractor), to act on my behalf, for the purpose of applying and obtaining all CAM/A permits `� necessary for the proposed development of 2 6 00-9 at my property located at SA 1 3 vlrlIAjL v-8�(�a This certification is valid through /,r,yvT t 1 6CIC, %— 41 ,7-0d-0 (date). (Property Owner Information) Signature Print or Tjjhe Name Title, co. owner or trustee for property 7 �?-g-- Date �,2 -y- 3 rj o �2 Tel�ph�n'�iaettntrer° 4 0 U-e 1W E-mail Address /'r T ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to :' ; Tr ) eve i - (cc sr,/, SNa�� meProperty f Owner p property located at ( G.Z7 CGt� wr C g- 5 to u✓�S 4V i', !^yea //// //�� (Address, Lot, Block, Road, etc.) /(/ (� on CO- t" c FL /J� i in Q N.C. (Waterbody) (City/Town and/or ounty)yG G The applicant has described to me, as shown below, the development proposed at the above Iota ign. I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development m st fill in description below or attach a site drawing) cl ec c can ��TJ e\1015- 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. (Property Owner Information) (Adjacent Property Owner Information) Signature Print or Type N rpe �o� Mailing Addrgss 5'roa�(t .2 6G Ci1 Stat /Zr T phone Number Dale C,ktnZ<- n\: or T pedWame �� ;CJ( ig Address-- oraao-, Ves'r-', Telephone Number (' Dale (Revised 611812012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to r�' h V,I i�w/te - ICI lt/hrti ism to %iv 's p , (Name of Property Owner) property located at vr- /n (Address Lot, Block Road, c.) � on �G1 e civViG fw —,in Sv�Ps��s 7 1/ Z , N.C. (Waterbody) (City/Town ar' /or County) The applicant has described to me, as shown below, the development proposed at the above location �q-have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development rrlust fill in description below or attach a site drawl g) C'VI 0461 sr0"ex Ae- 5,41 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. (Property Owner Information) Signature Dnnl nr T.n Ahme Date (Adjacent Property Owner Information) Sign titre Prrnt,orT p� ame Mal g Address gd i� Pn C �P�IrY� �✓ 2t7 o City/StatelZ Telephone Number ,7` �� (Revised 611812012) �1 NG CG `ek �,�eo-d5 �`eVrv�l N G a Mo