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Home My WebLink AboutClark, Jeffrey❑CAMA / ❑ DREDGE &FILL GENERAL PERMIT ONew ❑Modification ❑Complete Reissue ' r ❑Partial Reissue No. 75263 A B G. D Previous permit # 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 7i ^1 /o (' ❑RuI sattached. Applicant Name % �{ j' ` Project Location: County 0 Address ( G' f / 1 f. Street Address/ Sta o d dot #(s) City ti �` 1 r� ^ +' �) State /V ZIP _irj `k� Phone#(JK)7i0 (� E-Mail J r Authorized Agent ❑ CW f3Ew ❑ PTA Affected AEC(s): ❑OFA ❑ HHF ❑ IH ❑ PWS: ORW: yes /-'no PNA yes / no Subdivision _ City jc� �,_� ZIP CUES ❑ PTS Phone # O River Basin- ❑ UBA ❑ N/A Adj. Wtr. Body - ^ / i, i ` .(oat /man /unkn) Closest Maj. Wtr. Body ' /?:" Agent or Applicant Printed Name PermitOfficls Printed Name Si ture 'f Please read compliance statement on back of permit" Application Fee(s) Check # Signature Issuing Date Expiation I att. AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Te6�P, C(A,& F 4-14rq T Czd< Mailing Address: 16,,I t .i 6. v nc�son v://C �G 2r5VO Phone Number: 9/0 - 330-- d / 7/ Email Address: /��961I3^^icf{'I/c��,gnru, I certify that I have authorized IT KtLK Al� I NDY I Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: tZE.Tt�mt,1NG W �I waAlcwau * A ede- $ 6 Ddt L Jh at my property located at �03 i #e- 5-Z. f clsafl lleyiG 075r/d in 045l0w County. l furthermore certify that / 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: /i ,,, V�1 ill Print or Type Name �vy�r.S Title Datt e This certification is valid through / CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Owner: Je-F'r e-1 P. C IQ k 4- jiedl-A T ClU Address of Property: Z o,j iit # fit. XX 2X5y0 (Lot or Street #. Street or Road, City 8 County) /� Agent's Name# Ci`Iel �In IYIOY► Mailing Address: ZlN IAAYVIS LtC Agent's phone #: `iio- 3�O'SSdn scickaNV iWt t�►! S) 5� D 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 proposing. A description or drawing with dimensions must be provided with this letter. I have no objections to this proposal. I have objections to this proposal. If you have objections to whatis being proposed, you must notify the Division of Coastal Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext, IMlmington, NC, 28405-3845. DCM representatives can also be contacted at (910) 796.7215. No response is considered the same as no objection if you have been notified by Certified Mail. 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.) I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Inf motion /� g atureeee ,J? aa,k Print r Type Name 7 oz /AAG fit' Mailing Address Ja �,fDilyi�� City/State/Zip 9/O- 330- 07 Telephone Number 201 DatN (Adjacent Property owrpr Information) Si !f e elt Print or Type Name Q Mailing Address NC- City/State/Zlp 9�o SAl5' 07i(-1 Telephone N/uMber �u F —J�—�� Date Revised 611 W01 2 CERTIFIED MAIL - RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner: I/C Address of Property: Zo f�int $� T cLsw�'iYe �C yPSyV 11� ,((Lot or Street #, Street or Road, City & Cou ty)� ` Agent's Name #: �pC1z\ C Ic if lu6 Mailing Address:i 1N V�NI S CY pt 1�A• Agent's phone #: GMI- 3�0-.55ob Scx kk,prwV )i e WC. ZbSLI 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 are proposing. A description or drawing with dimensions must be provided with this letter. th r ( L 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. Correspondence should be mailed to 127 Cardinal Drive Ext, Wilmington, NC, 28405-3845. DCM representatives can also be contacted at (910) 796.7215, No response is considered the same as no objection if you have been notified by Centfied Mail. _ 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.) —1 1d I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. IL G / �/ .,r Jeff,,, P. rJ-4 Pala i . C-rk, Print dr Type Name z AHr: 0 Mailing Address t/Q c%Sa�a/��- il%G Z85yD City/State/Zip 910 - 330- 6� Tellfephone Number f}L�usL /3- (Adjacent Property Owner Information) Signature MLA �Q�s1i Print or Type Name ir�T 13kv517 �Sldal, Mailing Address �JAe155ond I�� Ne 20"o City/State/Zip �(o, 3414 ' 3MD� Telephone Number 1' IAt Lt�j � 3 201 p Date Revised 6/18/2012