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Home My WebLink AboutBruhn, ThomasR to / ❑ DREDGE & FILL No. 74947 PE1ERAL PERMIT �P-New, A B C D Previous permit# ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As aut}iorized by the State of North Carolina, Department of Environmental Quality / and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 7 1 ❑ Rules attached. Applicant Name Project Location: County Address �, i Street Address/ State Road/ Lot #(s) City f ` State ZIP }�` , -" Phone # �10 1 7 ` S) (. )�E-Mai�l Subdivision ` I `, L11 J •. % = Authorized Agent ri r J J cr . City ,- - /. - ZIP r ❑cW pavii ,❑PTA El ES ❑PTS Phone# ( ) River Basin Affected El OFA ❑ HHF ❑ IH ❑ UBA ❑ N/A AEC(s): Adj. Wtr. Body L A *" }' J - (na't dman /unkn) Pws. ^^f] ORW: f )/ no PNA yes //no Closest Maj. Wtr. Body Type of Project/ Activity v :2 K, r ' 44 r /' y / Pier Fixe Float Finge Groff Bulk Basin Boat Boat Beac Othe Shore SAV: Mor. Phot Wail (Scale:,; /_."! r" ) MEN 0 NEON 0 MEMO :■■■■■::■■■WAiNE ■:■::■W 0 ■■MEME■ MEMO ■■■a MENEM MEN MEME■ ■ I MEMM: IN MEMO M: MEMO ■■■ME■ ■q■■■■I■■■gM■q■■ M■■EME EM■■■■■ME■ gM■■q■ ■■.■■■■■■■■■■■EMEM■■■M■q■n1fiM ■■EEO■■■■■■■■■O■■MM■O■■■■■qM■■ME MEN ME ::::::::�:::: ■■■■■■■■M■■■■■OE■OM■qE■■■E■■■■ME MMI■■E ..■NEEMM .■■.. ■E■■E■■■ : :■■q■M■E■■MC■■ ■ . ■■■■■■ ■■■■ M■ ■■■■■■ ■..M. I .. ■ ■:■■■■■■::FNr,F:AS �Ma�M�e�r�EMIM::■■ ■ 10411i■■■■■■I�OMM�JM2:!%1i�IrE'"J`I& fZROK ■E ME■■■■E■■:'�:EEEEEEEM■M■:■DEEM ■ME No ■■■■■■M■qMOMMMEN �M■E■■M■■M■MI■■■NSE MEIMEMEM ME so line Leng JI MEN not sure yes no' ::: :M:MMEN MEMO:MEZER::::::MMMMI :INEEM s: yes .■■■■::■■■■■■::M■■■q■■■MM ■:M■NEW OI■..■■:■■ A building permit may be required by: ��' `t-` ` ❑ See note on back regarding River Basin rules. ( Note Local Planning jurisdiction) Notes/ Special Conditions ( I �� i Agent or Applicant Printed Name Signature ** Please read compliance statement onback ofpermit Application Fee(s) Check # if i Permit Office irin6 ame Signature qq J (' /i/9 Issuing Date i v //'? ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to oni,gS' d- j a/0 „-7 3 r 6F P' fv 's (Name of Property Owner) Property located at /.5�35< .�scniil n )�sl, (Aanress, Lot, Block, Road, etc.) on �3•� G k Socc�/vi in _ f%Ao2K� :b— e-.9a s7 , N.C. (Waterbody) (CRY/Town and/or Countv) The applicant has described to me, as shown below, the development proposed at the above location.y I 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) /fir,-r7 j?ocK /A/ rKolilT" 4�> 15' Ex/Si..VG 74 TT 6)oobzd �1YL/tJyE4D D 5�J Ai37LJ2 D/a�7/961c01'7 RECEIVED MAY 3 0 Z019 DCM-MHD CITY 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.) do wish to waive the 15' setback requirement. I do not wish to waive the 16 setback requirement. (rr`i�ner m/�tion) aJu,c rj �C 119 'Valid for one calendar year after signature' (Revised Aug, 2014) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to 7'4-.J 1,4 j, ga >a*v 's _ _ . (Name of Property Ownerl Property located C z7 k ra IS (Address, on jj 1CK-<cgy✓?, in (Waterbody) N.C. The applicant has described to me, as shown below, the development proposed at the above loca6o . I 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) /*V-t7 jioGv JA/ rs�onl % D r rxi.si"A/C' '74 r% LJoovcr7 WAIVER SECTIO 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.) A0 S. I do wish to waive the 15' setback requirement I do not wish to waive the 15' setback requirement. (Props nor Info [on) (Adjcen/t� Propel ner Information) S s'3 / �I Qist e`17� Date "Valid for one calendar year after signature' 2sa RECEIVED (Revised Aug. 2014) MAY 3 0 2019 AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: /4/�V �.O 52 a 1�x� Mailing Address: Phone Number: Email Address: %SL,09 ,;P,S>- &3'Z-�S%5'9 ri4 I certify that I have authorizedLout oo Agent / Contractor o� to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: /4 i> D h'o 6 K ZP �A-D ?1 7i e F" 1^xi.s�6)iy4 �5.4cxNe9 n %o '5r'oZ5 L IzLr- at my property located at /� J V it , A9�1C��' �5-9!!F' in G Aje,W C ; County. i 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: ' ll Signature Print or Type Name Title aI ;?- ?- I Ol 17 Date This certification is valid through DECEIVED MAY 3 0 Z019 DCM-MHD CITY Trn VRGI��f N Web A Aof'45, Iv,44. Bea I3 dk 5eafd #PR pq /00 tov/5 O e4ko 2 gwq/vwa C_ 70'7, I( K (k'' RECEIVED I pA1ditS MAY 30 2019 DCM-MHD CITY i