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Home My WebLink AboutSprouse, Rick®[OCAMA / ❑ DREDGE & FILL No. 75210 A B C D 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 i7911ules attached. Applicant Name `t 1 ; Project Location: County r 1 ! Address / Street Address/ State Road/ Lot #(s) City I State /W ZIP Phone # ( '') ,` ' T - r-' /� E-Mail Subdivision Authorized Agent j.� 't /' < r' �, City _ ZIP_ Affected /1*-�W D "EW _L�JPTA �.05' ❑PTS Phone# O River Basin ri• ~ S, AEC(s): LJ OEA ElHHP ElIH ❑ Li El N/A Adj. Wtr. Body Wit' /man /unkn) ❑ PWS: ORW: yes //noPNA ;yes / no Closest Maj. Wtr. Body Type of Project/ Activity Pier Fixe Float Fling Groi Bulk Basin Boat Boat Beac Oth shor SAV Mon Phot Wah (Scale: ' MM■■ 11N■■■■■■ ■■■■■MM■■■■■■■■ ME on ■■■■■■■■■ ■■■C�lira■■■i■■■■i on IN ■■■■■■■■�"C■■■:Cu■■ in Platforms ■■■ O■■■ M■■ ■■■■■S■■■ ■ NONE ■■■■Mie■■■M■■■N CN■■N ■■■■■C■■■�iM■■M■NONE ■E■ENuu■ENN■EN■ ■ ■E■� ME■■■ MEN N■■■■■NE■E MESON .N■ = ON MEN ■■E■■E■ mom ■■■■N■M■■■■■■N■:■®■■N:■:■:■■ :::■:M■■mM:C:�:: mom M �:E ■:M:NN:■■NC■C■■NMEN ■ M■■ ■■.1■■HM�■ MEMO ERNE ■,■ ■■■M ■■■MM■■■ MMMMiRiiN� ■■■C ■ENN ... ■NNE :M ■Eiiromi�::l��.':��C:::ii■■�' N■N■�NO■E .■. ■! N9�i■M■■\� .■..IN .. ■ ■■■■M moon MN■■N ME i"ii■®■M■■■■■■■MNN■■■ MMM■ MMMIN MM ■M■■ �■I■E■MM■ ■�■ MMMM ■ ■■ ■ ■■Nn I■■■■ ■■ ■■ ■IN ■N■MM■ ■ MIN ME IN M M ■ ■■■MOON■ ■■■MM■E■■ MI■M■■M■■■=ME ■N ■ ■:CN■■M ■■N:■■■■M■■■■CNN■■M■■■MN■■�■MC■ ■■ ■ M■■�NCo■■COON ■0 0 C■■■■i■■NiC�■■MN■■■■ ■No ... ■■9�■■E�= Mom ME ME■ oil ME■ ■■■NM■■ M■■ ONE ■NM■MEMO ■■■M■■M MEN :C:.B::CC:C :::CC:®I®RON NINON A building permit may be required by: l! C I 1 ( Note Local Planning jurisdiction) Notes/ Special Conditions r Signature **Please read coance statement on back of permit** ;� J Application Fee(s) Check # ❑ See noteon back regarding River Basinrules. t/ 4 ``II \ kA. c>ilii 6 PermitOfficer's Printed /N me Signature Issuing Date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: R I C K .J,01'Q US e. Mailing Address: Phone Number: Email Address: I certify that I have authorized 9� ", .,..,,..ate..,' to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: J� 461 11 S)O "PUCt-n� t 6 b4 111f- at my property located at I `j Il1 1 rAy,IYArm l :ill 10c6cCI1, NG aK-q in O t' d(7 tl) County. I 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: SignatuFe Prin or Type Name iR.[ZNt- Title _. L_tJ-1 / 1. Date This certification is valid through 1 1 17- ti C3 -11 -11 R1 C3 C3 C3 r3 r3 I- r3 D- r-R r3 M1 ■ Complete items 1, 2, and 3. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailplece, or on the front if space permits. 1. Article Addressed to: 7 6rockci+ 4un%e.r �1 �e�t-�nt:�ett1 ��r5>✓y A. Signature L [3 Agent X 1= ) ❑ Addre B. Veceivea by (Pnmod Name) C. Date of Dell D. is delivery address different from Item 1? ❑ Yes If YES,.enter delivery address below: p No �g L� 1 3. Service Type ❑ Priority Man express® r IIIIIIIII IIII Ir1111111111111111111111111 III III Restricted Delivery ❑ ,a red Mail Restricted 0 Certified Mall® a 9590 9409 0208 5146 1412 18 Certified Mail Restricted Delivery ❑ ReturnReceiplfor Merchandise ❑ Collect on Delivery I ❑ Collect on Delivery Restricted Delivery Signature Confirmatlon^ ❑ Signature Confirmation 2, Artill. Numt.. lDan. f&x /mm swrvlrsa /ahna 7 019 0700 0002 3466 0278 Restricted Delivery Restricted Delivery PS Form 3811, April 2015 PSN 7530-02-000-9053 Domestic Return Receipt UNITED STATES POSTAL SERVICE First-CPass Mall Postage & Fees Paid USPS Permit No. G-10 • Sender: Please print your name, address, and ZIP+4® in this box* E7AI]e7i-/A11 51)ezrzj5 �e r-r�Y, NC ,28�la0 LISPS TRACKING# 1111111111111111111111:11111 111 . 1:11: 9590 9403 02b8 5�16 1rf� 18 CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner: Address of Property: ig Qs a py Aay. N t i h '5L1 i) � IJesh , 6F) 6L � �+ (Lo or Str t #, Str4f or Road, 10ity & County) Agent's Name #: Fy)))G a IrI fie &n3f Mailing Address: R6;9 E7&Q64 14 r) Agent's phone #: 10 — 82-- n ZIP75- cM-5 &-"I A!G o`C o ` 6 0 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 availableathttn;/lwww.nccoaslalmanagernenY.net/web/cm/staff-listinc orby 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. (Property Owner Information) �X,Lz Signature 9),6 �nrou.se� Print or Type N me 19 N o rev �a v Mailing AdaIess I— I N To 12I56i( 6, eae-A Nr ;U46 o CityiS 164-- gos-5664- Telephone Number/Email Address (Riparian Property Owner Information) Signature Print or Type Name Mailing Address City/State/Zip Telephone Number/ Email Address Date Date (Revised Aug. 2014) Project im cc Page of Date I IT M BW ROOF. _ .51uiM fl,44�arrvi iok Ia'X14' 3' 1 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to _ Ri- lC�5�r&j.�6 's . „ A - A (Nartffi of Prdperty Owner) property located at 11V VB.7P V on ZLLO in CI' ) 7-53,1/ 17each N.C. (Waterbody) (Cit /Town and/or County) The applicant has described to me, as shown below, the development proposed at the above I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill in description below or attach site drawing) WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin must be set back a minimum distance of 15' from my area of riparian access unless waived by 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. (Pro erty Owner Information) -1e- (Adjacent P oper Owner Information) Date J "Valid for one calendar year after signature" (Revised Aug. 2014)