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Home My WebLink AboutPiercy, BrendaOCAMA / ❑ DREDGE & FILL F No. 73409 A B C D GENERAL PERMIT Previous permit# C�(Jew ❑Modification [-]Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality / / /�D( and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC / / �I%, f �Ruljsattached. Applicant Name I C/1 s'/c 1 of r ` Project Location: County ( (i f Address L/ �✓ / IC/! Street Address/ State Road/ Lot #(s) . City � / � � State IV(ZIP Phone # (on ) �T l a3 B_Mail Subdivision Authorized Agent Affected ❑ CW ❑ EW ❑ PTA AIES ❑ PTS AEC(s): ❑ OFA ❑ HHF ❑ IH ❑ UBA ❑ WA ❑ PWS: ORW: yes/no) PNA yes / no City /tom zip 1 : /Kr Phone # (_)fir River Basin 'i ! /_ " Adj. Wtr. Body �� M ° (Jr` nat man unkn Closest Maj. Wt.. Body 'E.....��.......� .■E■..yE..■�9�... ■ .■■■li C ■■■4��A ■■ ■■■■ ■1�■ ■■■ ■0■■■■■■■�O■■■■■� ■I�Q ■■■■■■■��■■i■LI■■ ■■■■■■■■■��u..rare.�l■■■■■■■■UM■■■■■Ki■■■■IREM :::®E®® ::C::: momom ®:�::C::":�:�: ��j.. IN .:�■...■..■. ■■■■■■■...■■......■rr,IN �■■I.■ .■■■■■■■■■■■■■■■■■■■■■ ONE ■■■■■■■■ too ■■.■■■■■■■■■■■■■■■■■■..■.....■■■■it■■■.INS ■■■ ■■■■■■■■■mmmm'911i:e■■■■B■■■■■■■■I.■@N■INN ■■■ I■■m■►s■■ii■ '/. IIIIII I■ :CNN■ ■■■ ■■I�■fi4ir■1�■ ■N91LF1rl■■■■■.■■■■■N`n.. ■�■■��■■■RI■■■■NI■ 11111 ON IN MIM 0 HE IN MIN ■ 11011 MENEM 0 MEN IMM NINE! ■■■■■ ■■■■■■■L i7■■ ■ • ■■& ■f.l'lNERE■ ■1101O1A�l■111►..�ammi�iC.■■.■■ ■■■■■■\�■■■■■■■■ ■■■■■Fin B■.■ .■ MEI.■ No ....� ® 'I ■®Cif■■ :::: :M 0 0:C•� ■■■■■■■■■■■■■E .-.MEN ■■:■.ji.:::N .... hair :•■N■ .N.11 IMM:�0■■■�®::G1�C:C:L� .. o-ME 01�■■■■■■■■■■I■■N■■iI■M■■H �'Aiiiiiii■ �■p■■■■l o No NOM■iEE ommu !SEEM IN Agent or Applicant Printed Name Signature "Please read compliance statement on back of permit" Application Fee(s) Check# Signature ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to 1-0—` 's (Name of Property Ownei property located at 'y 7 ( e (Add(•ess, Lot, Bloc , Road, etc.) on in it- 2 , N.C. (Waterbody) (CRY/Town an/or County) The applicant has described to me, as shown below, the development proposed at the above location. / 1/ I have no objection to this proposal. ______lhaye_objections_to this -proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach, a site drawing) R 2A \ ^il Zweul (Cie 1 s sZ WAIVER SECTION 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 1 do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. I --q-l� Date JAN 10 2019 (Adjacent Property Owner Informatic LZljn6a�� S' nature ru urn Print or Type lyame 112 S RN r) f� PW J7r M ding Addrss P_ au Z C a SS I 6 Cityy/State/Zip Telephone Number Date n e(( f do -a- 7a5- t92-y (Revised611812012) UiVITEDVATES - - January 4, 2019 Dear Brenda Piercy: The following is in response to your request for proof of delivery on your item with the tracking number: 7017 2620 0000 9585 9133. Status: Delivered Status Date / Time: December 8, 2018, 8:05 am Location: CARROLLTON, VA 23314 Extra Services: Certified MailTM Street Address: 102 LAFAYETTE POINTE City, State ZIP Code: CARROLLTON, VA 23314-2736 Signature of Recipient: r� loi ltft�h6 �4Rt Address of Recipient: Gku+.yl Kd Ity Note: Scanned image may reflect a different destination address due to Intended Recipient's delivery instructions on file. Thank you for selecting the United States Postal Service® for your mailing needs. If you require additional assistance, please contact your local Post OfficeTM or a Postal representative at 1-800-222-1811. Sincerely, United States Postal Service 475 L'Enfant Plaza SW Washington, D.C. 20260-0004 CERTIFIED Postal o RECEIPT r^ Domestic Mail Only m Lrl� ; 0 Certilled M ae unEr $ Extra SeNI & Fees cbackbmaddf...PA, Here) C3 ❑Rehm R.10 WOW S L% �, - C3 ❑Return R.dPt(elec 10 $ ark, 0 ❑ cenifled Melt ReeMuted DelNM $ C3 Adult Signature Required $ Adult Signelure Re aadNINe $ ru r1i$°�'�e . S b RECEIV N Total Postage an �Pe 4_ - ED s r Sent mfyt-{ �- -. ffSi-k`Sak�c ....... --- 0. BAN 10 2019 Sere ox 1~-p Cltate,2�;:4a-.............. DCM-MHDC1Tyof on �33