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Home My WebLink AboutGiesey, Ella�P'CAMA / ❑ DREDGE & FILL NO. 75728 A B C, D j!NERAL 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 /- �• ❑ Rules attached. Applicant Name�� ` . % * r Project Location: County �' City ( ' �r /l i State ZIP. ' �r 7 ' �E-Mail Phone # ( )� t J Authorized Agent ❑ CW ❑ EW ❑ PTA i ES' p PTS Affected AEC(s): ❑IDEA ❑HHF ❑IH ❑UBA ❑N/A ❑ PWS: ORW: yes / no PNA yes / no Street Address/ State Road/ Lot #(s) Subdivision City ( <. `�' ' ZIP ;I� Phone # O River Basin' Lf f Adj. Wtr. Body j '' �y' r /� nat� man unkn Closest Maj. Wtc Body i Type of Project/ Activity / r( , i! I �4 ir 4 Pier Fixe Float Fing Grol Bulk Basit Boat Boat Bea< Oth, Shor SAV Mor Phoi Wai, (Scale: n„r I ', ) ■■■■■■■■■■■■■■■■■E�®ENEE MEN ■III ■■■■E■■■■ ■■■EEE■■■■■E NOON■ ■■E ■■■■■�'._'0■E. 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Permit Officer'sPrintedName Signature Issue Date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit:%�lGt �j,eST� l vd�rr�S' Mailing Address: Q I✓01 Phone Number: Email Address: I certify that I have authorized C Lks- z y -7 rlfl/'rnCck!{,� �[SG�P.v� C,I�YFfL�/ GU�t Agent to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: 4aII r evvsr ah e-F at my property located at 1 7 t boa ✓'t n, aK in CC, ✓iL✓ County. WE 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: Signature Print or Type Name Title 1 & 1 LU! Date This certification is valid through RECEIVED AUG 2 3 2019 DCM-MHD CITY ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to ri cea (Name of Prop rty Owner) property located at /S/ 4Zi�n nn Kb (Address, Lot, Block, Road, etc.) on eg4g2Fx1 in ��fJsl�£sY'?-!2 /�/r/ N.C. (Wa et rbody) (City/Town nd/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. -- DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill in description below or attach a site drawing) heee, oz wsm-e-L- 76- 4/2eexr API,' ro P2/v:;- ivy RECEIVED AUG 2 3 Z019 DCM-Mi-1D 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 your 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 15' setback requirement. (Property Owner Information) S`ignature N4PcwLw_. ,v A) Prin rType Name PO /')my I q tiligg Address 2-4( )�L City/Statelzip S Z 77 qq Telephone Number �-'-Io' 14 Date rlformation) VJL- Print Type Name T`ALC(+t}�� R{ L L V Mail' g Address t5� R 0 RnC City/S ate2ip 15 z g Telepho/�5r�b 12R- I73 g Date '(i- It)- Y-pl1 (Revised 611812012) Hurricane Florence and TS Michael Replacement/Repair Request Form Date of Request: �— 4 — / q Property Owner Name: ( v 0 rn e( ,J -e Address of Property: Telephone Number: Type of Work: TI BQOWIVka-w " Z5-1-16C1-3z'Z � fIV e(r eft vo 0-f Pin /v'?;-- 4 Ge✓�� uiw iv �ccr'✓! cam ht NOTE: • The Emergency CAMA General Permit 2500 is for repairs and replacement of water - dependent structures damaged because of Hurricane Florence and/or TS Michael. The replacement, reconstruction and maintenance excavation activities shall conform to current standards and rules. All work under the Emergency CAMA GP 2500 must be made in the same footprint of the previous structure with no additions, expansions, or enlargements. • If any portion of a structure being replaced is within the 15' setback of the riparian line or access area, signatures of the adjacent riparian property owner(s) must be obtained acknowledging the notification and waiver of the setback on the forms provided by DCM. • Any maintenance excavation or dredging requires signatures of the adjacent riparian property owner(s) on the notification forms provided by DCM. Signature: AU5 2 8 Zp I)CM-MHD CITY