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Home My WebLink AboutBright, Leslie7 u ®QERA?tAA / W6REDGE & FILL N2 71615 A B l/ D NERAL PERMIT Previous permit# U ew ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality _�f/) g�/ and the Coastal Resources Co fission i n area o environmental concern pursuant to I SA NCAC �j},� QRule attached. Applicant Name �C �! t�1 Project Location: County % ��'✓t rU ISVx I �/ C State 114(zip Phone #TVV) f " E-Mail Authorized Agent Affected ❑CW oe QPTA .p ES ❑PTS AEC(s): ❑OEA ❑HHF ❑IH ❑UBA ❑N/A ❑ PWS: CRW: yes no) yes) no r Type of Project/ Activity 1 Fixe Float Fing Groff ulkl Basir Boat Boat Beac Otht Shor SAV Mon Phot Wai% Street Address/ State Ro d/ 'ot (s) Subdivision City e, zip Phone # O ver Bin nr ui Adj. Wtr. Body c �r� `,'�� (nat Vrnan /unkn) Closest Maj. Wtr. Body t U UP r (Scale:A,rj r ) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ NMMWUNM ii iiiii■iiiiiyi+� u■i�i��ii i■iiEION ME MEMEN MEMEMEMEME OMEN MENME MMMKMAM 0 MEN ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■NEE ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■mom ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ MEN ■■■■■■■ENE .........0■■■■MOO■■■■OM■■■O MEN C■E■M■■E=■ ......■............■.■.....■■■ MINE M ONE ■■■■■■■■■■■■■■■■■■■■■■■■■■OriHammmirl"a UmmaM■■■ENE ��■`��`:wils�a�tweG...wuw�Aw.wwelAll4s.r71A��ir.i��.:.r7■e,.�w,� j�,j�jl)L� ■■ ► is Gerrllr\■\r[rC�Grrir Bulldozing ■■■■■ ■■►1■■\■�1■■■1'r■■fMIL`■■'►ls'■■Eli■■■■■■■■■ ■..■■■■■■■OEM■■■■■■■E■■■.■■■■■■■■■■■..■■ ■■■■■■■■■■■■■■■■■MO ■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■ ■■■■■■■■■■MEMO ■■■■■■■■■■■ .■.■■■■■■M■■■M ■■E■EO■■■O MEN O■■E■EM■■.■■ ■M■MO■■■■M■■■■HOLM■■MERE■■■■E■■■MOM■■■E■ 0 M ME M IN Is 0 not sure yes ■■■O�jME EMMEE W,,511UUML'r►M ZIMMOMlLA ■■III■■■EEM■ME■ME A building permit may be required by: ( Note Local Planning jurisdiction) ){ J Notes/ Special Conditions (` i ", Agent or Applicant Printed Name'" Sig 7"plepse read compliance statement on bac�fpermit iL+pp ication Fee(s) Check # Signature ❑ See note on back regarding/River Basin rules. Owner Requesting Permit: Mailing Address: Phone Number: Email Address: I certify that I have authorized G}' / o — 2 2$ ✓ Z-A 2'? 0 eve Cowt to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: i/-5- V,�ti S eats at my property located at in C,Af' 4r4-e"" County. 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: Signs ure 1 e c e S yr: Print or Type me w i0CV, Title Date , This certification is valid through I I % 4.c- ADJACENTRIPARIA PROPERTY OWNER STATEMENT I hereby certify that -1 oWn. property adjacent to 14-�-& .51 r."e Pro e or�y -lo ffio of P rt QW,ner) -a 3-f-c-flow L6�h' �Pro �e� led .�t�� qjl Ptto ). IL4 Address, Lot, Block, R6 d 0(�L on ee aeAddr N.C. (Cify wriAidloir-CountO The a' plicant has described to 'me, as. shown below, the. development proposed at the above 1 have no objection to thispro* bsal.)er✓' I have obj6of lons to thls proposal. oposa IPTIOINJAN DESCR AWING 00 001600891) DEVELOPMENT. proposing d60%pment irtust filPin deqoripffon bpfOw or aftadh a site drawing) - - - --------- AA vi"t -r/re'?16 CO ndetrandrth t pier, 66k, inoorin x 'kw6t6r, boathouse, lift , or groin must be set �ap q pilings,. 'ea b. :a minimum Orliodriah access unless waived by me. (If you NoshAt�waive the.setback, you irnuist-161tial the. -a PIro�rlate*blank below.). P. J I O.Wshjqwaiye.the 1,5! setback reqViremiqnt., I do. hot wish to waive 16' set ack re quirern6nt. (Propsei Owner Inf6rhiap") (Adjacent Property Owner Infofmation)d. zgnat4re Sr nature' e X'? 0o ptln�pr Type Name J Pry or Type Name M awlngAdd, P+djc?,�eorrroleriv 'qO A . kiwi hZ' 00 1� MiNg � ojo ppoFne u ber z Mp Date or (Revised 6118120 T2) T 1-'44 5 :dr ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to I- e SI " f S' JYl r4 r"1/J - ' A7 . 's (Name of Prope Owner) property located at �� S � 1 200 on y4�IJ�� cre&Pr in Lot, CBlock /4 'h'Road , ) Crb wK 'N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. -/ I have no objection to this proposal. d I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT MI WA 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. SIP J. 71" I do not wish to waive the 15' setback requirement. (Prop y Owner Inforrmati Signature r s Print or Type Name O. . C Mailing Address o City/State/Zip Telephone Number/ eml ad ress Date =`/2-,z '9v T t: Tint or Type Nam zio W N/7E Information) ni E /<- r.L 6Luri= 4/ Mailing Address s � a _ �, ivG City/State2ip 23 74y t3S/ Telephone Number/email address zo 041,9r , a r' e Date* *Valid for one calendar year after signature* (Revised Aug. 2014)