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Home My WebLink AboutBland, Kurt^ CAMA / ❑ DREDGE & FILL No. 74946 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 r A Rules attached. Applicant Name ; f)/ _ Project Location: County Address �! �� - t, ( Street Address/ State Road/ Lot #(s) City I . State ZIP Phone # ('� i`!) " ' ' ` CIE -Mail Subdivision Authorized Agent ',i ( y City ZIP Affected 0CW .❑EW nPTA ❑ES ❑PTS Phone# ( ) River Basin I. ,. AEC(s): ❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj. Wtr. Body .nat//man /unkn) ❑ PWS: ORW: yes / no PNA yes / no -' Closest Maj. Wtr. Body `) Type of Project/ Activity Pier Fixe Float Fing Groi Bulkl Basir Boat Boat Beac Otha Sher SAV r (Scale: ) ■■■E■■■■■■MINI ■■■■■�■ NNONE N■L�11�MMEN RIM ■■■■ iM ME M■M a�■■�■■■■■ ■■■■O�MEMO ■■■■�ION ■.■■.■ ■■■■■■M ONE ■�COONES OM■■■■O ■■■OME ■■■■■■ ■■■■■■■ MEN ■ NEON ■OEM ■■ ■■■OWIME O■■■■■■O■ME■MO SEEN ■ ■MESS O■MEN ■M■■■■JUNE �'■:'.'■:'■'.�'■'■'.'■'.M �� M'.'■: ::'.:MESS .1,"OMEN CNN■ OEM OMEN ■■■DIEM■■1rp MEN ■M■■■OEM■■■OMEN ■ ■■■■■■■■■■■■■►ID ONE ■■O -NE11'IMOO■■■■■■■■■MEN ■ ■■■■■■■■■MMOi MEMO IlI NEON NN■■®pia■■■OMEN M MEMO 7 N■■■NMOIRE C�:n:M HIMMMOM..■118.■.■■ME ■MEM■OOE■ OO■■ ■■■■■O■■■MOO■OO�■■■■■■■ milli C C■■■��■■■' C■■■ii:INN EMEMNNNNN N■■■ONO■■■OOON®�! owns NNMNMNEMEM ■■■■■■ OEM ■ ■M■ME ME■■MO■M11■O�ME■NEE �O■ M■ ■■■■■M OEM ■�MM■ME M■M■MEN■■■OOM■■ N■ SI so M No M HE M �C :::�.::�:::M .®:::::::: Mor Phot Waiv 1 n / A building permit may be required by: ; , � r /4.,i 1 " P f 1 A le sy. (Note Local Planning jurisdiction) Notes/ Special Conditions , Agent or Applicant Printed Name Signature "Please read compliance statement on back of permit" ❑ See note on back regarding River Basin rules. PermitOffcer's Printed Name Slgnat re Application Fee(s) Check # Issuing (fate Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: KL4 Ter 01- Mailing Address: t 31-f &✓I ) bfewe- g4i,etG�4; Al CG 7,7G D F Phone Number: Email Address; I certify that I have authorized —r Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining __all CAMA%p'e�rmits necessary for the following proposed development: 1.�T ) I r" ! I t> ^- at my property located at 20 e OfrrL-e"� D0 J�F piIJE jc, Je).t_ S EIS in C'�'t��--��ounty. l furthermore certify that I 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 .I 1' 1 Print or Type Name Title / n J Date This certification is valid through 17� 1 3 ( I 1 1 I hereby certify that I own property adjacent to propertt/yy� located at vU (/Qlu 1 (Address on t7p� ss k++ in (Waterbody) r "' , v'v.r . ••v —i ;k, ¢oattrl) Coup y /1D// 0(1-5 CA tr? N.C. / (City/Town and/or County) 5e 1' The applicant has described to me, as shown below, the development proposed at the above eG C` location G �� l i4_ I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOS (Individual proposing development must fill in description PF-P EAaE ILI lLl I FX/5T NG P(.A-rFokl� or attach a site drawing) FrOF0C, t rJ E tn/ Qa4r LjFr FY 1 SP VL 5L)� 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 7�eati� me. (If you wish to waive the setback, you must initial the appropriate blank below.) I do wish to waive the 15' setback requirement. 1 JAI do not wish to waive the 15' setback requirement. �I"'y (Props Owner I form ' n) (Adjacent Property Owner Information) CAA Siknraixre • /1 h l.l`1t1�5 `Zkwt.u�tcfsrtit J Print or Typ amg '54-1 l.il�a Mailing Ad s ) �;Qt (vc z96c� /artdsc�ll�ty�� 2rp alit Lit; r l'5u l/ Telephone Number/email address ��chNll�ir: rc r /tier_ �: Date* 4rj.f� (Revised Aug. 2014) =off- wry_ Dole 'Valid for one calendar year after signature' o%UJATwrNr KIrAMIMn rn r nr IT v •I ,n �-. / 1 I / I hereby certify that I own property adjacent to 1 w � �1 a/1 fredr'l L X e '8Si f rr�� II (Na t�,e of P{opa 7ner) property located at 200 Or— l� — ri✓e i ine /fin o 7 nOreS (Address, Lot, Block oa�+�atc) cow. on t++ in P ne J '1o// /r2rPf Ca�re�N.C. (Waterbody) (CityfTown andfor County) iZ 1 . The applicant has described to me, as shown below, the development proposed at the above ti( location. I have no objection to this proposal. 1 have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill in description be w or attach a site drawing) �4 FXIS7106 QLij' 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 PIeahe me. (if you wish to waive the setback, you must initial the appropriate blank below.) �. I do wish to waive the 15' setback requirement. jPr to i �, Lt, try I do not wish to waive the 15' setback requirement. (Property Owner form ' n) (Adjacent Property Ownerinformation) jCD� 11 n/ Sin dtn l Si Ohre • hi Print or Type amq Pdnl or l a Namo qq 13/ nd �r;.e ob, /' I r)1er}V/L,IJI MaN dres Mailing Address , 4e G 296oa r�r',t 'I/� Air;. ,Cily/stata/Zip. Alre2 � 9/N�79� kdJan�(�fjlgx�l4n %c.�Jly.com 15. 3l/')%/% G.'� ✓ / (�/w1 Te BI phone Number /email address Teloph no Number /(email address (Revised Aug. 2014) 'Valid for one calendar year after signature'