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Home My WebLink AboutBaily, George Jr.❑CAMA / ❑ DREDGE & FILL No. 75923 —. 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 71 Rules attached. Applicant Name Project Location: County Address i Street Address/ State Road/ Lot #(s) City StateI ZIP ,"A Phone # ( ) i E-Mail Authorized Agent ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Affected AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: ORW: yes / no PNA yes / no Subdivision City ZIP Phone # O River Basin _ Adj. Wtr. Body— 7 (nat /man /unkn) Closest Mal. Wtr. Body — ■OMEN■ OEM■■■■■■■■■■■■■■ ■ MENMEMEM N�1IMMEMEMEMIMMEMEMNEEEEEECEENNEN�EM.■■EMMINEEM.. C EM■■MEM■ M■■■■■■� ..MEMO■■ ME . 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DIVISION OF COASTAL MANAGEMENT AGENT AUTHORIZATION FORM Date OCng�t /2, �019 Name of Property Owner Applying for Permit: (s fol ec � IU 9/4% J/L, Mailing Address: n D111116 A n I certify that I have authorized (agent) 4/A e2/Kg5'od to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity) 4 rCcjf7�GPOCk at (my property located at) S O(1 940M iAQo4,g S Ldo� ,0 E:w g R"-1, N o A VW This certification is valid thru (date) l/f�� 202c Property Owner Signat6re ' Date ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to _99yiv /c 's �,p ,,��yr'�� (Name of Property Owner) property located at -5'W /!'/,4D9a, {' oatis /.4NE y (Address, Lot, Block, Road, etc.) on /F.4n,r' byd , in NrGv BEZA/ N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. T`T 0 1 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 a site drawing) 0-KIK4r< /919` N W Cv/OTid oc L :a u I 0 # IT Fpn"_opicy WAIVER SECTION I 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.) 715't/d I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) A'?, /a Signature GtOga P, BAZY , r/ Print or Ty e Name yN Tr p2luE Mailing Address S12v< t sPRlvc' 1n,41ye*l) 2vra/ City/StatelZip ' a Yo - 60y- Telephone Number OcroAf't- /,;2, a' lii D�agte (Adjacent Property Owner Information) Signature % Tf 'r- 1i Print o Type Name./ ql � /L1 e, ,rlg /Ll v re j L Nt Mailing Add ss nh«,, Add , Arm 'L- 22ct - c7cl2- r0 / Date (Revised 611812012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to 9)/77 2c 04 ��C 's �p M� (Name of Property Owner) property located at SLY? /Y/, 0,1, 9-0-0- is 11414 y (Address, Lot, Block, Road, etc.) on /k4n i✓ in Ar Bad N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. _Y� I have no objection to this proposal. have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) P/Vee p,rruz #7740V Fte.hVd4 9vcic 0 c� WNW+ FNR0PECY7 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.) I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) Print or Ty e Name yet IVC Mailing Address S12yfL 5-1%xJ6- /Y1e�LrG 1°ya/ City/State/Zip 2Y0 - 601- (,M Telephone Number oer6AS& /a, "/r Date (Adjacent Property Owner Information) Signature Print or Type Na e -.160��M Mailing Add s ,�i �� N� Pam'/f cO,CoL/�� 2 �'�3 � z City%StatelZip 25,2_ E3J-37JK Teleph u ber Date (Revised 611812012)