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Home My WebLink AboutEdwards, Dewey❑'LAMA / ❑ DREDGE & FILL GENERALPERMIT ❑Neva ❑Modification ❑Complete Reissue ❑Partial Reissue No. 75759 A Previous permit #_ Date previous permit B 'C ' D 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 j // ElRples attached. Applicant Name 1 ; - ` / l Project Location: County e-r ' Address =' Street Address/ State Road/ Lot 1(s) City_,. � � State ZIP Phone # E-Mail Authorized Agent ❑ CW DEW O PTA ❑ES ❑ PTS Affected AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS ORW: yes / no PNA yes / no Subdivision City-6, <,/, ,. zip Phone # O River Basin / Adj. Wtr. Body i )`. ,' Alt t /man /unkn) Closest Maj. Wtr. Body � 4 ■N■EE■■■■■■■■SE■■■S= ■■MM■■■M ME■M■MM i=iiiiMM MOSIMy=�IE■E■�■iiiiiiiiii - ■�■■■■■■■ OMEN ■■ ■■M■■M ■■■■■■■EME■■EN■■ ■a■■EEE■■■■■■OEM■■■■NEE■■■■■■OEM■■�r�■■ 0=00 M::::: EMENEEMMEM MEMEMEMEMMEMSEEM ■M■■■■NE■■■■■NEE MONO■■ME■■■■■EEE■■■■■■■ ■oE■E■■EE=EEEENE■■■o■■■�EENNEN ■M■■■NE■■■■■■■mosommiossmomEMEMO ■ ME ■o■■■■■MEN■■ME■■MEMO ■.�,■■�E■■■■■■■M■■M■■■ M. .■■■■■■■■■■■■ME■M■.■lr■.�.�.■......■.... ... ■■ ...... .'�.. OEM ■■■ ■M■■■■ ■■■C�..��■■■■■■OC■ No MENEM ' �:::EMMEME C:MENE :::::=0000m::::�ME so CONES ■■■■ ■■■ ■ MEN MCC■■■■■�.. EO■■■o■■NEE■■■■■NEE■■oE■MM■j■■■■■■■■E■ ■■■■■ ..I MINNI■.I■■■■111 No . M ■SIMEMENo ii■■■.■ME■■MloMMEIMMMMC■MMNIHE:N ■■!■■ ■M■®1 ��:��CMEMEMS ■■�■E■■Rj■■■■E�f■■■■OEM■■■■■■■�ECIMIMSEEM ■■■■■■ moms Agent or Applicant Printed Name Signature * Please read compliance statement on back of permit" Application Fee(s) Check # PermitOffcer's rioted Name / Sign turel _ issuing Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: I (lyj e A e at.04 %(j S Mailing Address: I ESdCt. T�zt_kson.y� 11e� nlG z-`B5'`F� Phone Number: Email Address: �e-joci✓dge eev/aw • c.ow� 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: 2'13 at my property located at in (`tam` V_K--. 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: ignature Prit or Type Name Title q I AI / aorq Date This certification is valid through I I ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to �F 1 a > Y F� .> A�Zl�S 's (Name of Property Owner) property located at I G\ ;\-\ ci (Address, Lot, Block, Road, etc.) on in C+-:�t�� jX \l S� , Chime C N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above to tC� iop I have no objection to this proposal. I have objections to this proposal. DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill in description below or attach a site drawing) D 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 ycp 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 Information) Signature t ax K-LL Y�SGg. Print or Type Name -A `�l'r2T�a` C i Mailing Address CiiY/S(are27p t��cil i ow elaphona�Num�b?er1`/,o�malla- ddross'�Y�-V\QWtLF Dare (Revised Aug. 2014) 'Valid for one calendar year after signature' ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to s (Name of Property Owner) property located at 1-7 C\ Stk c' V (Address, Lot, Block, Road, etc.) on , in ,Vi�_1JT, C1 ` , N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above Iota on. 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) 10 � 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. I do not wish to waive the 15' setback requirement (Property Owner Information) IP4 1 " � ✓ Signature yeti\ FTY 1�Cr5» Print or Type Name �Sn:�.Cr`rNsz�V- C� - Mailing Address \FlfYcty .�(,�\r n\C 1Y�S�FI� City/state/Zip Telephone Number/email address W\Gw q 17=3kn Dare (Ad'aeerpt PropertpO�er orm tionSig�o,{(�1ature* Vagr Print or {Y6t-t- W 2es (Revised Aug. 2014) *Valid for one calendar year after signature* I Pao x fg -C :, Q XA