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HomeMy WebLinkAboutKilgore, John-.�' CAMA / ❑ DREDGE & FILL No. 75221 A B C D _IENERAL PERMIT Previous permit# SfNew ❑Modification ❑Complete Reissue El 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 ' j j ❑ Rules attached. Applicant Name. �(Jt I f ` aC? r r F Project Location: County `/ !♦ c `— s _ Address t`a e� 6 Street Address/ State Road/ Lot #(s)_ ` City L StateA/C ZIP;TP) Phone # (170 v �' t E-Mail Subdivision__ Authorized Agent City �e��rc" `�{� Zip C� Affected ElCW PEW i]PTA [I ES ❑PTS Phone# O River Basin r AEC(s): El OEA ❑ HHF J iH ❑ UBA ❑ WA Adj. Wtr. Body (nat /man /unkn) ❑ PWS: ORW: /(esyno PIMA yes / no Closest Maj. Wtr. Body SEEN ■;■Nrl5.i00 ■■ ■iI■■■■■■■■■■■■■■■■ ■ ■■® ■■■■■■��■MEME■IMIN N NNEE■■■■■■■iNi■�ti ■®■■■■■■■■ ■MOV11/■rr'%iL':■■ ■■■■■■■■■■■■NEN ■®■■■■■■■■■■■■■■�■■■■■■■■■■■■■■■■■�■■■■■ .®...........■,■1■■■■■■INN■■■■■■■N ■E■ ■■■■■■■■■■II�r\1■■■■■■■■■■■■■■■■■N■■■■■ ■■■■■■■■■■■■■■■I■■■■■■■■■■■■■■■■■IEEE ■ ■■�■■■■■■■■■■.�.■j■■ ..................■■■ O■■■■■■■■■■■■I N■I■■■■■■0INN■■■■■■■■NONE :-. .. JOMN I ■ ROMMMEMEMS! Sol ,,. ■■■■■C■iN■■■■■w■■■� C MEMEM ■■ IEEE :CE®C:S��MEMEN 0®II'Nunn :� CME ME NUMNLIM 0 ME 0 MEN Agent or Applicant Printed Name Signature , dA ,-,r9O,- "Please read compliance statement on back of permit" Signature'_ %r Application Feels) Check# Issuing AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Mailing Address: S2 C t P) t)y-e S-�.:nc' O r a Phone Number: 11 9 D. Email Address: k 1 gc.re "Z cc, (e-. /� b,M certify that I have authorized _LZ l�or4c So1� iivr�S % I�au c& �i� c•�5�� Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: �'d Ski oc�r-t. at my property located at Si_i�tn k,Cg }� S� u l�r- CYO r7�\ ci Mx- Z S9�-A in COX �U'CCounty. l 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: Signature Print or pe Name owner Title Date This certification is valid through / / CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner: �ohn Address of Property: —S20fv §0�uc $o.,ir V9- Dr,vC CMcrgtci 1SIc 2gS9`-i (Lot or Street #, Street or Road. City 8 County) Agent's Name #: Mailing Address: Agent's phone #: I hereby Certify that I own property adjacent to the above referenced property. The individual I,ppfying for this permit has described to me as shown on the attached drawing the development they are roposing. A description or dMwina 'rh dimen r X must be Provided with this letter. G I have C7 no objections to this proposal 1 have objections to this proposal. rti u Ifyou have objections to what is being proposer!, youmustnotNy the Division of Coastal Management (OCMj in writing within 10 days of receipt of this I/.Q IIO notice. Contact Information for oCM offices is av all ableathfto:/Avww nccoastainianaoementnet/web/cm/staB Ilsdnp or by calling 1.8884RCOAST. No response Is considered the same as no obfecdon If you have been notified by Certified Mail ' ' l— WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.) X �-- I do wish to waive the 15'setback requirement. I do not wish to waive the 15' setback requirement. (Prpperty Owner Information) Signature Print or TY-0 Nom f. Mailing Addres ��"��� Isli Nc zgs9y City/Srate2lp 15a �41.119z(�tii ofe 2�ec.rr.ra,..\ Telephone Number/Email ddress f3t,Ity Da/e Gregory£. Murphy, MD, PACs Pms N. Eastern UrologlcelAssociales, PA Cher awsien of Umlogy Affiliate Pm/essor a Surgery Eesl Carolina SPieel a/Medtine ( rian Pr party n) !f re O r Informatio �'�' fr�Oor�ry Print or Typa Name Marli tldrass a 2- 324 -zygi , Telephone Number/Emailga ss Uafe (Revised Aug. 2014) CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner: kA�t r-e Address of Property: SZ-0 o 30gvfSOvr\& or-'ki eyvLercilc( hlC ZMiIiy (Lot or Stree #, Street or Road, City 8 County) Agent's Name #: Mailing Address: Agent's phone #: I hereby certify that I own property adjacent to the above referenced property. The individual for this applying permit has described to me as shown on the attached drawing the development P they are proposing. A description or drawing, with dimensions must be Provided with this letter. x „W I have no objections to this proposal. I have objections to this proposal. q if you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writing within 10 days r of receipt of this notice. Contact Information for DCM offices is r available at http:Owww.nccoastaimanaaement.ttetAveb/cm/staff-iist/nn or by calling 1-888.4RCOAST. No response is considered the same as no ob)ectfon if you have been notified by Certified Mail �} f �^ WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.) 0 i 1 do wish to waive the 15' setback requirement. a �a" N I do not wish to waive the 15' setback requirement. t� (Property Owner Information) (Riparian Property Owner Information) z .^ W, 4 Signature Signature J�l�t, K�t�-t,�e /-Grey � it ay Pdnt or Type` Nam Print or Type Name / /� Q led izoin &,Qt!e �iivrl( �1-. 7401 /::1-c N'f oo le Mailing Address' Mailing Address fcVy, x-aAxl 1 c 1,c , W c. 21� C ri q r g 1 e, .S (t, lik R ws City/Stata/Zfp City/State/Zip WSJ41 11ui��,iklrtore.2( tC.rr.rpn 3/96Zf Z83h /a..ryPgy�� Srwbi�.Co�+/ Telephone Number Email ddress Telephone Number Email Address I �4 R �, ?/ZJ zofq Date Date (Revised Aug. 2014) asn of a4lpneaq IIA,fa>waf Eeu pin npaw1n11aalimen8lw awp Ndn'J Wln'J "als sip iw Paualuo> n .4euW >IOU'pfu>4inwanp aV pVl rYpwAW�+V ac wpeuuoylflV landa�pppmsPw»,a:pM !mlemdpaw ssa»aprr>wfe eu o pw uro>pgn'J anwnyVYjamn 10Y0 waWllroipp wpeww, u: aip nl Nf!gewtls>, ... ou s.u.nsu Alam�lwa,c�-elpsyluopwpµm Vppuuyul Wlp ugpayyan ry gIMUO>eq groyf ranoauo¢wryu upoPw'e'eN'v, io:IPi:,l+o>s:P�-'uopa:Pfnl�upwWp,punlAsd>b lral0/aWw.mI WpW WaAdfiq;gf,A afp AgpaNl�ipuapwnlulaVl 6I filoz'psnentl Psi d A ��' .• .':o _ - �' ups.-„„ b swooa�rysfl b :swooaWfl } r >!o ol+ �' -' `r. o :aleQ Pa u zbL / 198 Sail Pa u �•# x :adAjgoH bz/bl'PH leld I 6z£'o aaaad S19 IS£0:saJav papa (j :anoZ ZnOPd o$ :aaiad aleg :Iana-I asloN Lgb'919$:anleAleloy �t9 PIZ, ` ^'. zooz :llingaeai [Sg'Sz$:anleA aaylQ 996'z :1dbsiojgple gz6'96£$ :anlaASPlfl o6S£ :xg bS P1H Spill goL'£bz$ :anlaApueZ Lzoo95 :QHHN t " susz �vluaHmsHx :asn xvo H.LIHM :di4sunoy 9SS1 aalalslQ xey y� :lalalslU aagl 1 a' • :laulslQ anasag e H'ISI QztlxHwH :sAlw)'I A47 / [ czloHz£oS1 :bHd aoiad / H'ISI Q'ItlNHWH 1zg £-1 :uo.IdlaasaQ ledaZ • b6S8z OH H-ISI Q'IvxHWH Hu QNnos HnDou 9ozs „� :ssaaPPtl $uHlow H'ISI O'IVxH WH xQ QNOOS HnoOH 90zS :Ss JppV allS 0009Lb0996140£9 :NldlnaaanO VNVHQ Xfl.LH IN NHOf"HHOO'IIX :aau.nQ N' B; u n o a a a a e :uoi3eluao;uI la3aedxey