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Home My WebLink AboutBurd, Mikev XCAMA / ❑ DREDGE & FILL No 71626 A B �C� D QENERAL 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 f%,%1 .:✓ is nt Rules attached. Applicant Name 1 4i ; 1 f� ! 1 Ai Project Location: County L( / Address �� (� >/'a � 19 s' 4 Street Address/ State Road/ Lot #(s) n t"` City�1 State �� ZIP .'cWi��o'-✓ E- Phone # O i —� C Mail Subdivision N f / $ ! 7 q Authorized Agent I "t= `" '� ( < ri' City ZIP El CW PTA ❑ES ❑PTS Phone # O River Basin Affected AEC(s): ❑OEA ,AEW ❑ HHF �IH ❑UBA ❑N/A Adj. Wtr. Body l A2,1' < N 1(i V4.7fam'{nag)/man /unkn) El PWS: Closest Maj. Wr R rig ORW: yes / no PNA yes / no Type of Project/ Activity SOME - ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■SEEM■ ii■iwiiiiiiiiiiniiiiiiiiiiiiiiiiiiiiim■i N:::::::: :G:= :M ME ::A::I:::: ::I 0 ■■■■■.■■■■■■E■EE■E■.■■■E.■.■E■.EEE■■■.■E ■■■■■M.■■■■■E■EE■.■.■■EEE■.EE■■E■■■■E■■E ■■■■■R■■■■■■■■■EMS■■■■■MI>•IM miTi.■■■■■■■■■■■ ■■■■■�l■E■■■■■■■■E■■■■■■ ELM, 91iGr7' i■E!/E■■■SEEN ■■■SM■■■■■■■■■■SE■■■Err■■I1GRE11■■M■■■■■■■■ ■■■■MM■M■■■■■■■SEES■ME1 Ski ■i WEEM■■■■■■■M ■■■■■■E■■E■■■E�i■Eti■■■■■■■■■■■■■■■■■■■S■■ ■■■■■■■■■■■■■EYCQI�I.J■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■EE■■■M■�tiPi4E■■■■E■■■■M■■■■■■■■■MES ■■■■■■■■■■■ME■■■■■■ ■■■■■■■■■■■■M SEES■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■E ■■■■E■ ■■■■■■■■S�1i - �1SEE■■■■!Ylfi//_■■■■■■■■■■SEE■■■E■■�7E■!■■■■■■ ■■M■■■■■■1�■■■■■E■■■■■■Ems l■■■■■■■■■■■■■■■■■■■■■E!1■■■■■■ ■S■■■■/i■■M SEEN ...■■■■■i�■■■■■EM■■■uM■■■M■■■M■■MC NONE ■■■■m■■■■■EM■■■■■E■■■■ME■■■■■M■■■■■ E ■■■■■■■■■■M■■■■■M■ME■■■■■■■■EME■■■■■■M■■ ... ..■■■®EEO■.....NEE ErEEEr�EEEEE�.EE■■■■■■ ■■■■■■■■konmEmo■■■MQ■■Mli■■■ ■■ ■■�■■■■■■■ ■■■■■■■■NUM■■■■■■■E■nRiSiE■■■■■■h\ ■■■■■■■ �Tf statement on b6c k of permit ** Application Fee(s) Check DIVISION OF COASTAL MANAGEMENT I hereby certify that I own property adjacent to �) k E I•CL (%z� $ j (Name of Property Owner) property located at / � � � �� p� `� (Address, Lot; Block, Road, etc.) N.C. (Waterbody) (City/Town and/or County) Agent's Name #: Mailing Address: Agent's phone #: He/She has described to me as shown belowthe development he/she is proposing at that location, and I have no objections to the proposal. ----------------------------------------------------------------------- DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) t Ok t 5 I �b It you have objections to whatis being proposed, you mustnohfy the Division of Coastal Management (DCM) in writing within 90 days of receipt of this notice. Contact information for DCM offices is available of httnJlwww nccoastalmanaaemenLnet(web/cm/staff listing orby ca/ling 1-888 4RCOAST. A,- ------ IN (P�r"wner formation) rg at r IIe Print or Type Name o4( PA(600L ( I Mailing Address ,fjtw te-kc; Nt- P8SK' City/StatelLip Teleph Aftimber/Email Address ' Date I 1 1 have AA�y kIC.") �zx Print or Type Name ((1 ` MallingAddress City/State/Zip Telephone Number/ mail dd s rl� Date (Revised: Aug. 2014) AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: / Mailing Address: rP4 Phone Number: Email Address: I certify that I have authorized 7 A� ✓1 114 r, S (- `;-lF Agent / Contractor to act on my behalf, for the purpose of applying for and obtainin� all CAM>A permits necessary for the following proposed development: (j( at my property located at in OC2rt County. l furthermore certify that l 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 Type Name Title Date This certification is valid through I United States Postal Service .— a6S 314S 111111 First -Class Mail Postage &Fees Paid USPS Permit No. G-10 ender. Please print your name, address, and ZIP+4® in this box* SC�S /ALL/ G�4Y O� Lo0 f° RZ 111111111111111111111111111111111111,141. 11111,11V1t1111111)1111 ■ Complete items,-1 j,4and3. ■ Printyour nafne,a`riq, hitaddress pn the reverse so that we'cansretti�the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: /274I� /—ourSE PdU< 7X-149TcE d4J ip /cAmfSLEi.bOfi A� q�ol%S) M D Is deliveryaddress different from Item 1? ❑ Yes If YES, enter delivery address below: IyNo A II I IIIIII III 3. ice e EI Priority Mail III I II1 III I II IF IIIIII,IIIII lsignatur ❑ AduIS Signature Restricted Delivery l�e 11 gI ❑ Registered MaiRested9590 9402 3815 8032 1049 42 D Cartined Mn® Delivery ❑ Cedffied Mall Restricted Delivery ❑ Return Receipt for e. Article Number [Transfer from service label) ❑ Collect on Delivery ❑ Collect on Delivery Restricted Delivery Merchandise 0 Signature Confirmatlon•M ' 7 017 2400 00111 1864 0296 ❑ Insured Mail m Insured Mal Restricted Delivery Inva, CSMII ❑ Signature Confirmation Restricted Delivery Domestic Return Receipt