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Home My WebLink AboutBassett, Earl®F�' AA / DREDGE & FILL No. 74943 A B C D ffMJO❑ AL PERMIT Previous permit # `O`fe _ ♦ odification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As authot-zed by he State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to I5A NCAC ,❑ Rules /attached. Applicant Name `` .}� Project Location: County / Address t % C/ C:i %" Street Address/ State Road/ Lot #(s)_ t ` State .'�% -ZIP Phone # o Ef.Mail Subdivision // r 1 i, z- 11 r° j.' ZIP Authorized Agent �/f i "•�C City .- EJ E;I AA ❑ES ❑P7S Phone # ( ) / . River Basin. AEAffected ElOEA ❑ HHF D IH ❑ UBA ❑ N/A Adj. Wtr. Body 1 _ (nat /man /unkn) ❑ PWS: ORW: (�yes_,/)no PNA yes //no Closest Maj. Wtr. 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ENE 0=1 1 0iONIIINEENNE110 INiii ,agent or Applicant Printed Name i Signatp" r+ Please read compliance staters fit on back of permit*'s 'A lication Fee(s) Check# AGENTAUTHORIZA71ON FOR CAMA PERMIT APPLICATION Lm,-.- 0,;.- NW)L:Vi f —2w � n/1 Name of Property Owner Requesting Permit: S� li t "0,rJ,0 35ta t %C Mailing Address: _ M (3 Lost t` (_,u-a- t -,,,g `R"e (J, VC z'?tad3 Phone Number: QI I c, tO I cr 7 Z. 2- Email Address: c [ I certify that I have authorized Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: at my property located at 4a``Lr)_ r S^l 1�.°.0 Z� . i F-svF in _ j° i\� iF S2I C County. I furthermore certify that I am authorized to grant and do in tact 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 Pdnt orType Name S 1 I/aj Date This certification Is valid through,__I ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to T_OQ (' `= Is (Name of Property Owner) Property located at _�pc`2.�Z t�(x a h 11 ��(? on , in F 1 >F �`RL1� \S\ f Waterbod (City/Town—— -� F� N.C. ( Y) and/or County) The'gap Ilcant has described to me, as shown below, the development proposed at the above a no objection to this proposal. I have objections to this proposal. t DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill in description below or attach a site drawing) i c �4 I 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 me. (If you wish to waive the setback, you must initial the appropriate blank below.) I do wish to waive the 15' setback requirement. 0-M WIsh to waive the 15' setback requirement. (Property Owner Information) (AdJa Ppt PropeX4di ner Information) Signature Print or Type Name uate cum Telephone Number/email address Date" *Valid for one calendar year after signature* (Revised Aug. 2014) OI� /1 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to 's property located at (Name of Property Owner) a�� 7. ��('i✓Ip. )� �� (Address, Lot, Block, Road, etc.) on in � \:' _, N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above locat)op,, I have no objection to this proposal. I have objections to this proposal. utSGRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill in description below or attach a site drawing) WAIVER SECTION 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 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. (rroperty Owner Information) Owner Signature i nature* Print or Type Name Print or Type Name LIS t_u' l C.cs � � �, 20I C:�t''/ Mailing Address Mring Address j =9� Vz�\,\.•r 2lLuJ /Ctty/Statemip L 'Z 7 _ C'ty Stat ip _ l �ilU�lslDi" i) ��% (` xilVPx:`.�klPs ��\\ .Ly,-S�1 �' ( qe( q -5 1 Telephone Number/ mail addre s TeleIhon%Number/email adds Sl7`l l Date Date* `Valid for one calendar year after signature` (Revised Aug. 2014) r �/ Y6 T \j V • j 00 A N N N O c 3 n 0 9 NA N AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: ':j7q . SA % rA (Y- E Vn,Qxn rY 1St¢ NC- zs yc( ,/- Mailing Address: �9l"3 t�ST Crve_ L. vu Phone Number: q 19 (o (c 1 a -I zL Email Address: C r ;may, Cter ? i l Ut- Low I certify that I have authorized 47. r L;1 Q. Agent f Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: E y O ock- at my property located at ILA- 22 iil+wtCX v'y� r_ vl�a1'c�(� 35t- a c, in C.c Ay-(ti-'-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 Ems( Bwss�t� 17 Print or Type Name Oi..-N4i ✓1. Title Oc 1_(17,&/g Date This certification is valid through ADJACENT RIPARIAN PROPERTY OWNER STATEMENT hereby certify that I own property adjacent to 's (Name of Property Owner) property located at o 'EVAV (C {=;II S�\. \' \-,k on in N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. 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) P- \ 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 me. (If you wish to waive the setback, you must initial the appropriate blank below.) 1 I do wish to waive the 15' setback requirement. 40 1 do not wish to waive the 15' setback requirement. (Property Owner Information) (Adja nt Propeyty Ownar Information) Signature !g lure fA , JJ1, 17 _ Date C.GC'1 Mailing A" , City/S e �J-oqS) Telephone Number/email address (Revised Aug. 2014) "Valid for one calendar year after signature` ADJACENT RIPARIAN PROPERTY OWNER STATEMENT 1 hereby certify that I own property adjacent to Is (Name of Property Owner) property located at S—Ae ] �(y �V \j �C-lt (Z �l �L\ �t r (Address, Lot, Block, Road, etc.) on (Y. a 11E in a-Ay--1-1 k-M 1 l5l 1 N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above locatio I have no objection to this proposal. I have objections to this proposal. \ DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT 1 l(Individual proposing development must fill in description below or attach a site drawing) �n \ 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 me. (If you wish to waive the setback, you must initial the appropriate blank below.) / xe r `' I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) (Adjaj9" Property 91&ner Information) Signature MQ Vila, Date GOM Teleppone t)lumber/email address (r, vat." / (Revised Aug. 2014) "Valid for one calendar year after signature*