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Home My WebLink AboutColeman, MichaelCAMA / ❑ DREDGE & FILL NO. 75300 GA ❑ENERAL PERMIT Previous Permit# Bew Modification ❑Complete Reissue ❑Partial Reissue Dateprevious 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 I SA NCAC n 4 <<-C-� ll ( 1 + .�Rules attached. Applicant Name 1 I -II (`_ l )nrtd I �yt k?l %1 Project Location: County Add �O j L��i "'t c _7 Street Address/ State Road/ Lot #(s) e E 1 City n h� State ZIP Phone#(n-C"'y>� Subdivision Authorized Agent f� 1✓dail`S City f'L( ZIP Affected E CW 'Mr -OPTA _ bos ,u.wrg - Phone # ( ) River Basin l�n-1w AEC(s): DOEA ❑HHF ❑IH ❑UBA ❑NIA Adj. Wtr.Body_✓tJe'-P(r-(°.- U i nat man unkn) ❑ PWS: �/'nb' ORW: yes ) PNt] A yes([- Closest Mal. 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C Wioit6e Coastal Resfrif4roVti 6 1 ''J I s Apfflicant Name , '�tJ d�'d ' fA4ress' one # ( ) j F . • AuthorizAgent 'El CW ❑EW Affktee f1C A`a' v U A'EC(s�:-' OOEA -ElHHF (71H R dow"O ygs', / no - PNA yes / no ` 1,1. 0 i of Project/ Activity I Fixe Floatp Fing Groi r� Bulk t -J ?Basil I Boat Boat ue ❑Partial Of Environmenta Nb. 75300 & u Sf Previous permit # Date previous perm,it,J' Lunmental concern PumVum Project Location Gounty Street Address/ State,RoaW Lot 'Ip e+Subdivis'ion_ r ciry�h ]PTs ' Phone #:( eta/A y Adj. Wtr. Body {t ,.; - d Closest Maj. 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Basin Ufes. ti. + Agent or Applicant Printed Name Signature "'Please read �tf 0�L 3fatement on back of permit"" Application Fee(s) o- � '; �, Check# ' le A�f Permit Officer's Printed Name Signature Issuing Date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: ��VQ'4 cLle(c�0+.i Mailing Address: Phone Number: I — a5a_. � Iyas Email Address: I certify that I have authorized / 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 _ in � c c�N.Nce �l County. 1 furthermore certify that 1 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: Print or Type Name Title Date This certification is valid through RECEIVED AUG 3 0 2019 DCM-MHD CITY ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to M ( (Sk4 W IR %W) 1 Na of Property Owner) property located at tNoaress on K494— , in (Waterbody) and/or County) I N.C. The applicant has described to me, as shown below, the development proposed at the above location. I have no objection to this proposal. I have_ objections to this.proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT Individual proposin development must fill in description below or attach a site drawing) RECEIVED w;: 1 3 0 2019 DCM-MHD CITY ('(� "", "" \\ W_APVER 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. V I do not wish to waive the 15' setback requirement. (Property Owner Information) ieiepnone Number Date !- (Aojac t Prope#ty Owner X P Sig te�trcn P K �S0. 6� Print or Type Name X /SIDS Fz aa �� Mailing Addr��s ity/State/Zip Telephone Nu ber Date (Revised 611812012) Terr� ADJACENT RIPARIAN PROPERTY -OWNER STATEMENT l 1 hereby certify that I own property adjacent to IX\ , OIeM®uJ s (N"ne of Property Owner) property located at X:� t-\MCt� ��cX ,1 (Addre , Lk, Bl^oc�, Road, etc.) on 1 iw�c�z \vie f , in tt�C ems C( PetC N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above 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 below or attach a site drawing) RECEIVEp AUG 3 0 P019 DCM-MHD CITY 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. Date (Adjacent Property Owner Information) X. , ae>l? Date (Revised 6/l a/2012)