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Home My WebLink AboutMitchum, William Jr.'KCAMA /l DREDGE & FILL No. 73493 A B ` C D GENERAL PERMIT Previous permit# M wew ❑Modification []Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality 7 // and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC Rules attache{d-. Applicant Name Project Location: County (� r-t..`< r C ! n Address Street Address/ State Road/ Lot #(s) rFAIM Phone # fl 1!'! Authorized Agent I -, im 1 A l7 I J'A t'.1 Affected ❑CW �bg EW PTA MES [i PT5 A Affecte OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A O Pws: ORW: yes / no PNA yes / no Subdivision City t I-J --r 1 ZIP Phone # ( ) . River Basin !`k (,f Adj. Wtr. Body-+'�tr' _t<(na�1/man /unkn) Closest Maj. Wtr. Body h ON ■■■■■■■■■■E■■�1E■■■■■■■■■■�■■� WINNERS! ■r�:■■,■■■■ ■■.■■■E■■■■■ ■rr1��0■■..■ r ■a■■■■■■■■■■■■■■■■1�■la�i[Rl�fl■E.Cr�El .■■r Crr E� EEC■CIMMEMEMEMOMMEMEM■E■E ■■E■■■EE■■CNiEEE■�I■E■EEf■■E■ C■ mom CC■C■■ mom ■■OM M SEEM CCC t:CCCCCIEMNo�CCCCCC EMNJIMO ME avg distance of shoreMEN ME ■■■E■ ElmR� ■■■■■■■■■■ SEES■■■ .■■■■■■■■■E■■■E■S■■SCE■■E■■EEE■C■■■■■■■ Basin, channel ENE ■C■■n1 mm ■■■■■C■Cr.■■■■■ MEN ■■■■Ell■■■MEN SEES RISEN NONE al■■■■■■■■■Iif�: G,ES151 ■■ MEN .■C■E■■C■ MEMO ■CM■■■■■MEMO E■iECCYEf�C■E cubic yards mom .. ME ■■E■■■ ■■E■■E■■■■I�r�■E' E�1°'"' ■■ Boat ramp MOM ME mom ME .UM ...■■■ON E....ME.■IrJCC®CCC Boathouse/ Boatlift CmomC:i:C�i� CC 'C� CCU ®E Bulldozing MEMMNEMEN M�0MIBeach an • ■■■En■■E■■■ ■!\■E■ E\■■E ■■■Eil■■■■■■;�■ ■■■■�1■E■■■CCE\■■■K\■■■CC■■■IY■■■■■■It■C E■CCCiCC■CCCCCCCon aCMEN C■in■1 CICCCCI� Shoreline Length /190.EEEEE■CMEEE■■EEnEE■■CC ■i■iCC�9'I�C�S■SEE■ •• •• •■• ■■■CCCCCC�CCC :CCCCCCC�C Moratorium: yes I no ■■■(rr!■■■■C■■■■E■■■■■■■ Photos: yes in CCCCC■CCCIMMEME Waiver Attached: yes no) YMEMO I1�77CCCCC.C::C .. Agent or Applicant Printed Name _ Signature "Please read comp(lance statement on back of permit'* / Application Fee(s) �� PermitOfflcer's Printed Namel'� Issu�g Date Exp ration Efate iL AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS Name of Property Owner Applying for Permit: 4 I Lt.f l it t U t ITC 14 of H I JS ' Mailing address: 1 C % CJJC Uk 2 l cVV ICEE, N (L z 7935 Telephone Number: 05 I certify that I have authorized /!h to act on my behalf, for the purpose of applying and obtaining all CAMA permits necessary for the proposed development of 1�GIL,L�f� J/ � 6X- t AI-6 at my property located at .+vim This certification is valid through 1 /f (date). (Property Owner Information) ref Signaf re Wiwtc lm P,1119re°f/tadl,�% Print or Type Name 0 V"VL-9 Title, co. owner or trustee for property Db to Telephone Numberr, Email Address s s CERTIFIED MAIL RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT JACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM AD Name of Property Own' Address of Property: (Lot or Street #, street or node, �Iu , - A)Q/e Mailing Address: _ Agent's Name #: _/ � Z (�55 Agent's phone #: 1-W 50 '07 � > to er# The individual I hereby certify that I own property adjacent to the above referenced propapplying for this permit has described to me as shown on the attached drawingthe development _ they are proposing. AA descries o� drawing _ Ath�mensions must be provided with his letter. I have no objections to this proposal. t 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 wtfhin 10 days -cG5 is oip o} Contact information l 888t cem.4RC0AST.^lnar web/cso ..:, 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. Aeowner lnf rmati Vj ta14Mk!&K8Mi ' Print or Type Name Wa;tin .606 �'A vILL6�!e -2 o City/StafeMp 16901 (me 252 -0 NI 5�5 tDtir Teleph eNum)er/Em tlAddress Date (Riparian Property Owner �information) SignafuM Clr�,A - Prnt or Type Namey (5c�15 2c� Mailing Address City/Statez ip 33iP-�.4-`i,�8� Tetaphone Numbed Emaif Address Date (Revised Aug. 2014) 1 id v , CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Owner: Address of Property: / vvU k11i tVG .°-• (Lot or Street #, Street or Road, City & County)) Agent's Name #: Ahy_S_&Wailing Address: Agent's phone #:. 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 larcpcoirg. A des cr coon a. drawing witk dimensions nusi be Tovided with this letter. _(7%�,.::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 hftp:!/wvnv.nccoasYalmanagement.not/weblcmistaff-listina or by calling 1-888-4RCOAST. AJn ramin»cn ie rnncid»reA M. Gamer ere nn nhiarfinn if vnl, have hoan 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 regtnrement. I do not wish to waive the 15' setback requirement. 4(Prope y Own r ht ormatto)ij Print or Type Name 1ph&4o6 ar ing Address /City,/�sttaattel zip CT�.-�r�- iu TolephoneNumber/EmailAddress �- ( i"Irian Pr Ow r information) It .Sr�naillure �j l Print or Type Name MailingAddress C i V,.r l-Y� tic cilylstatelzip T&lzfiene Ntiinber/Emal1 Address ij— (Revised Aug. 2014)