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Home My WebLink AboutGray, Nadiaa ®w ❑CAMA / ❑DREDGE &FILL No. 74901 A B C D ENERAL PERMIT Previous permit# New ❑Modification ❑Complete Reissue ❑Partial ReisstGe ., Date previous permit issued As auth rued by the State of North Carolina, Department of Environmental Quality and the'Coastal Resources Commission in an area ofenvironmental concern pursuant to I SA NCAC _ ❑Rules attached. Applicant Name Project Location: Countyy`,' J Address 7 - Street Address/ State Road/ Lot #(s) City_ ) l I Statei'll ZlP + )'— Phone # E-Mill Subdivision Authorized Agent ` (( ( (. /I, ` 7 City l ZIP ❑ CW HHF W TA ❑ ES ❑ PTS Phone # ,(; >� River Basin ' Affected / AEC(s): �OEA IH ❑USA ❑N/A Adj. Wtr. Body (nat /man /unkn ❑ PWS; ORW: yes / o PNA yes / or Closest Maj. Wtr. Body Type of Project/ Activity t i f i (' ` / l t. ' ). V / C// (Scale:) �✓ ) Pier a Fixe Float A Groi Bulk Basi Boat Boat Beac Oth Shor SAM Mor Phot Waiv lMilOilliill�EM�l ROOM r OMOMME■■E ONE NNE MEN ERNAWFUN JEMEMEMINN iMEESE MENMIMEMIMMNEM ■ENE■■OO1 ■■■■■■�■■■■■■■■■■■■■■■■■■■ONE ■■■■■■■■■�■■■■■■■■■■■■■■■■■■■■■�■■■�■■� ■■■■M■E■■ ■■■■■SEEM■■■■■■■■■■■■■■■■■�nr�■ im iiiENEEM■ EMENEEMEM ■�nMEMINEMMIN MEE■■EEM■M■ON■■■■■■■■E■■ ■■E■EE■■EM\ME■ ■■■■M■■■EN ■■■■■EN■■■■■■ME■■■■M■■■■EME■n ■■■■NIM■E■■IME■■■M■M�■M■■■M■■■■■■■■■E■w■(II E■■■�IMP,9ME■■■■S■■S7r: ■EEUES■■■■M(�Snll(sISE.■■■EM■■■■■M■■EMM■ �■■■MN■M■■M■ME■NM■N. n�In��S■S■E■■Mw■Mr(■S■;n�S■■■EM■■■■N■■■■■■ iWROMEnPS�■�11>14■■M :fl �(■■■■ESN■■■■■■■ SEE ■ 31MOMMEN MMr�Mwa��■ i�ES■■■■■■■■■■■■■ ONE ■ MEESE so MEMO M—�I��_` �r_/Il ,�■01511■■ww�SSrrE■ ■■■ ■■SEESNE ■SEES■■ ■■INEZ ■w■■M�iiil■<cAN ■■■■■ ONE ■■■N■■■■OM■■NEON ■■CI■i■G I E,O■N■■■■■OEM■■■■■SEEso ■■■ M I�■■NIBZi ■0�1■■■■■1IM■■■■■■■■■■■■■■ ■■■ '" ICIM■CNi ■■■■■■■■■ ■ ■■C ilpil ■■ M o■■ ■ line Length i MORE N ■■ ■M ■■■M M■ ■■■ ■■■■M■■■ SEES■ ME ME iMEESSIM MEMiiiMENEMMi % ■i s: yes Attached: yes , no ir MESSEEM MEEE iwi��E�iiiuiiiiiiiiiiiei' Abuilding permit may berequired by: ( Note Local Planning jurisdiction) -\ , , / 1 ` Notes/ Special Conditions J ( i t r ,* c. 0/1.' Agent or Applicant Printed Name Signature •* Please read compliance statement on back of permit" Application Fee(s) Check # ❑ See note on back regarding River Basin rules. Printed Name. Signature11 irA ( 1c Issuing Date etD Expiration�— A, ip E North Carolina Department of Environment and Natural Resources Division of Coastal Management Pat McCrory Braxton C. Davis Governor Director Date Applicant Name / I/-. 61 iac < ra: Mailing Address 1-6 7 A( /os4o vv AV e" John E. Skvarla, III Secretary I certify that I have authorized (agent) /- rr; C to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity) This certification is valid thru (date) S ,J 2 a JJq Signature at (location) RECEIVED MAY 13 2019 DCM-MHD CITY 400 Commerce Ave., Morehead City, NC 28557 One - Phone: 252-808-28081 FAX: 252-247-3330 Internet: www.nocoastalmanagement.net N rthCaiolIna An Equal Opportunity l Arr�rmative Action Employer X144(rallY ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to 4/ J; « �r� y s _ (Name of Property Owner) property located at Ayr' (Address, Lot, Block, Road, etc.) on �vA N. r3 (Waterbody) (City/Town and/or County) 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) gx 10 s -�- ey6 0 J( " n WAIVER SECTION 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 m2 (EJ/E® wish to waive the setback, you must initial the appropriate blank below.) do wish to waive the 15' setback requirement. MAY 13 2019 I do not wish to waive the 15' setback requirement. DCM-MHD CITY (Property Owner Information) (Adjacent Property Owne,rr Information) 17'r P( �r Il( Sign t/re Siture / /� v gn Print or Type Nj?me 7', ) NMe. Print or r'ype Name 9,0ti mall,%r ZomrHnr✓.0 Maif yddress ,�J 14 w-f,'e R a 1 A)' 'Una Mailing Address 04-7,4 4-b x4.7, --),s a: ?CP. z /-''(`t/ �iTelephon NUmbe fig Date q'? '-' '� 0(o 11 -� a Telephone Number '—b-/iq Date (Revised 611812012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to &4 c' ef s—a yl 's _ , _ (Name of Prope Owner) property located at on (Waterbody) (City/Town County) 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 proposing development must fill in description below or attach a site drawing) /S ' 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.) RECEIVED I do wish to waive the 15' setback requirement. MAY 13 Z019 �I do not wish to waive the 15' setback requirement. -gRKD CITY (Property Owner Information) (Adjacent Property Owner Infotron) Signature NO.Jia , re, x Print or Type Nam S02 ((ir✓S�o,J>!�J� M 'lin Address / City/State/Zip Telephon Num er yfzd 1q Date /J1.o- Signature Print or T pe Name //1 (^ cs-f Qqjling Address 6rr-e-r Sf oLggS l city/Sta06 i 320 9216 Telephone Number -rh )n Date (Revised 611812012)