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Home My WebLink AboutMills, GlennJ6AMA / O DREDGE & FILL No. 75097 ^� A B C J D �ENERAL 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 i ules attached Applicant Name !� Project Location: County Address Street Address/ State Road/ Lot #(s) City � r — ---State ZIP Phone # O E-Mail Authorized Agent Affected ❑ CW QgW . 3 PTA ❑ ES ❑ PTS AEC(s): ❑OEA ❑HHF ❑IH ❑.UBA El N/A ❑ PWS: ORW: yes / no PNA yes / no Subdivision City ZIP Phone # ( ) _ River Basin Adj. Wtr. Body I (nat /man %unkn) Closest Mal. Wtr. Body ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ :C:::C:::::::C::C::::::::::E:': :�::::: ............■.�.........■�::e:.ME iiiiii■iiiiiiiiiiiii■iiiiiiiiiiiiMONSOON ...........■■■■C■■■■■■■■■■■■■■■►�.l■■.MEN ■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ FINE MEN ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ FAME So ■■■■■■■■■■■■■■■CEMERM.'■"E'�.;::r'�C®® :: wiiiiiMEMEMEiiN■■■C1��MM■ii■■■woi ■■■■■■■■■■■■■■ ■■ • ■■■■■■■■■■■■■■ ■■�■■■ ■■■ WHEM■■I■■■■I��11■■■■ i■■■■■■ ■■ ■■ ■■■■■■■■■■■ ■■■■■■■ ■■■■■■■■■■■■■■■i■■ ■ ■■.W■■■■■■■■MM■■ iii■iiiii■iiiiiii ■■■■■■■■■■■■■■■■■■■ ioiiiiiiiiiiiiiiEMMONS ■■■■■■■■■■■u■■■■■■■ �C1.■■■■■■■■■. ■■■■■■.■■■ NOON ME 11101001110 �■■■■■■■0Y�II■■■■■■■■ .. ■■■■■■■■■ . ..■■...■■■.■..IMEM Hill Agent or Applicant Printed Name Signature •r Please read compliance statement on back of permit*• i. Application Fee(s) Check# PermitOPocer's Printed Name / R Signatu a ) '; r�f�rl Issuing Da a Upiratiod Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Cam. 1e� Dn% s Mailing Address: 1, I to CAP ,LI S 12_' Phone Number: J-52-9i7--6L/ Cot( 20-7/q-1 �6Z Email Address: I certify that I have authorized Agent / to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: Fwck-E if\!� boc',k SLi`a-e.rr. at my property located at 111Ln W( (nu k C WC. (Q / t?K S , in Co_r- -fft k County. 1 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 Signature '-(C j Print or Type Name C�WGV el - Title RE(`,�V `D / 0ate 1 DCM MHp CITY This certification is valid through / / RECEIVED CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT JUL 12 2019 ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER OMMHD CITY Name of Property Owner: L C, �eo N `I \+ U 5 Q Address of Property: w? WC � V � C, I o-e \ + Kyr— �,luw S V� )1 S L (Lot or Street #, Street or Road, City & County) 3 S J 'l Agent's Name #: Agent's phone #: Mailing Address: I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit has described to me as shown on the attached drawing the development they are proposing. A description or drawing with dimensions must be provided with this letter. I have no objections to this proposal. I have objections to this proposal. If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) In writing within 10 days of receipt of this notice. Contact information for DCM offices Is available at htta //www nccoastaimanagement.nethveb/cm/staff-listing or by calling 1-888-4RCOAST. No resoonse is considered the same as no objection if you have been notified by Certified Mail. WAIVER SECTION 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.) do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Pr ` r w 'r Informatio ) a r Print or Type Name I1(QysC,l(L,,,+C;V-C. Mailing Address PIA,L I-Iwu City/State2ip Telephone Number/Email Address 1at-/l Date (Riparian Property Ow er I formation) +:e Signature Print dr Type Name a 0 C `Z Z�� CityState/Zip 911-3 :.Z d 5 JC�e,4@0,f-Ficut Telephone ber/En ail Address Date (Revised Aug. 2014) RECEIVED CERTIFIED MAIL • RETURN RECEIPT REQUESTED JUL 12 ZU19 DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER90MUHD CITY Name of Property Owner: S l I eoN t �LS Address of Property: We (Lot or Street #, Street or Road, City & County) �S ( Z Agent's Name #: Agent's phone #: Mailing Address: I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit has described to me as shown on the attached drawing the development they are proposing. A description or drawing with dimensions must be provided with this letter. 'ARC f have no objections to this proposal. I have objections to this proposal. If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is available at http.*//www nccoastalmanauement.net/web/cm/staH-listing or by calling 1-888-4RCOAST. No response is considered the same as no objection if you have been notified by Certified Mail. 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.) I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. Print or Type Name Address Telephone Number/ Email Address /ta (< / Dat� (Riparian Property Owner Information) Signature p (�. �\% \,�4t,�e� Print or Type Name l [4 vyc,,\,,W AC�Vc Mailing Address V, 1 N eJ Ll S�,ti�� s N C kS! 2 Ctty/State/Zip a u t Telephone Number/ Email Address -�I. I1 Date (Revised Aug. 2014) I/W IA RECEIVED JUL 1 ' DCM-mb, -