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Home My WebLink AboutIndian Beach Fishing Pier, LLC®6CAMA / ❑ DREDGE & FILL No. 75100 A B C D r 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 and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 47 Rules attached. 1 / Applicant Name � ii�r ir�, i i •;� �_( ` Address City —� �( State ''d;^ ZIP Phone # O !,( 1'L!(n E-Mail Authorized Agent _7 u i Affected ❑CW ]EW ,V PTA El ES ❑PTS AEC(s): ❑OEA J❑HHF ❑IH ❑UBA ❑N/A ❑ PWS: ORW: yes,/' no PNA yes /(ono. Project Location: County F Street Address/ State Road/ Lot #(s) 11 / I t y rni NG. d Subdivision ) I 1 Y ( ""w 1 City ._-r h ,, / �, ZIP Phone # ( )_ River Basin Adj. Wtr. Body natp man unkn Closest Maj. Wtr. Body ■■■!looms■■■■■■■■■■■■■■■■■■■■■mosammom ■■■■■■■■■■■ EMISSIONS IN 0 M so BE ■■■0■■■■ ■■■■■■■■■l■■■■■■■■.�.m�7■ ■1.■■. ■■■EN 0■■�1■■■■ ■■summos■mm■m■■■■■■■mom ammo ■m■■■■■■■■■■■■■■■■■ ■■■■■■■�■■■�■■■■■■ CSEE .■. moms■■ mommommommi MENNENN=. :No ■.■.....■os�r:■■■.Im■I■d■■■■ MEIN ■MEN ■■■■■■ IN MEMO No MENEM mommossommmlsmmoi.■■■■■■■■■■i■iON MEN ONE MEN ME I■■ MEN ■■■■■■�Nsom■■■■ i■■■■■■■mmm■■■■■■■■I■■■s■■w0■■■v■o■■■■■ ■■■■■■■■■■■■■■■■■■■.�■■■■ ■■■■m■■■■■mmm■■H■o■1■■s■�■s■■■�■■■■ ■E■■■ a■■■■■■■ ■■■■ :ClOimommosisINNso:J1�"C:::�C::�:::�E:::: ■■■oommm■m■■■■■■I■..■■.......■■■■■■■■. •.........s■■■■■I®I■.■■ . .■.■.■■■■■ ■■■■ ■■■■EN ■■■■■m■■ CC ■■■i■..■■.■.■■a�ii■�si ■■■■■�■■■■■s■s■■■■■I■.�■■...IN moss. . ■ ■■■ ■■■■■s■■■■m■■IPIi■ ■■■■■■■ss■NEE ■■■■■ ■MMMMIMM ■■■■■ ■■■■il®iilimmil iIIIMMMNiiiiC'■�■e ..■■■■ Im®■ ENEMIES Ili■.■■ .00mmommosomm mMEMEMME ME WEIIIIIIII Krim also Agerif or Applicant Printed Name Signature ** Please read compliance statement on back of permit Application Fee(s) Check # j - J l' PermitOffcers Printed ,Name, , Signa ure f / Issuing Date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: T Mailing Address: Phone Number: 354 a —313 6-0 Email Address: I certify that I have authorized I t m TJi)/ AC Agent I Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: 6,0,k at my property located at in L0GvA ,n,T-nc[v ' l3 —il 1 Z l ei Io Dam 1 furthermore certify that 1 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: rint or Type Name o� AaVL6 h Q Title V I Date' This certification is valid through ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to % , YYOr•, e— 's (Name of Property Owner) property located at (Nam avn L r1 (Address, Lot, Bloc{, Road, etc.) on, L' - 1� , innc(e4 n 3 eaC� (Waterbody) (City/Town and/or County) N.C. The applicant has described to me, as shown below, the development proposed at the above locatio . I have no objection to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) ro�oS�d +fi cc ln6>�r 404� a �`If el le r w 14r 1 tin (! le<4r )C 6 -c 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.) 1 do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner // Information) /'- 4�4rirrA —� Suture t Print or Type Name ,�03 0)d-/ratI b✓ Mailing Address ^ tC -7 7 � ;/,r awe city4l9 l ,q- Telephone Number rJ - a01 - / 9 Date Owner Information) r() /'ov 338 Address / 10 C//W cityzt a Telephone Nu ber Dare ?_ z ZO/9 (Revised 611812012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to -71r'l ilol-n rE — 's (Name of Property Owner) property located at 4Vja� `6�(ACDn, Lv1. (Address, Lot, Block, oad, etch on Z`C V.( , in '7`n to ✓t k"'. N.C. Waterbody) (City/Town and/or County) The applica/has described to me, as shown below, the development proposed at the above I have no objection to this proposal. __-- --I hav_e ohje-ct ons t-othis_pr_oposaL------___-_._ _. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) —+"eaed rDjeel 1664A 114' P'' C, UJ A j e<k ckv- . 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) (AdjaceA Pr6p'e>ty Owner InJWhation) YIe^ Z/br✓l Print or Type Narqe Ak- a 77 City/Statel � Telephone Numbeyy 71 z 2M Date City/statelLi Telephone Numb Date 6;?,?s/-Z (Revised 611812012)