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Home My WebLink AboutHarrell, Georgea , - CAMA /'DREDGE & FILL No. 74454 , A B ("- C D GENERAL PERMIT Previous permit# IVNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality tt �• / and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC r //� �-, Rules attached. Applicant Name Ce ( (' i1 S ( Project Location: County II J4 Address i I "' I I Street Address/ State Road/ Lot #(s) City Stated" ZIP % Phone # ()'-- /E-Mail Subdivision Authorized Agent TL. : f'L` I = !!; City ZIP Affected ❑CW ❑m N.PTA El ES ,(FPTS Phone#( ) River Basin ❑OEA ❑HHF ❑IH ❑UBA El N/A i �"• i AEC(s): Adj. Wtr. Body ' �,l ems% 7 t � ' t �--- (nay /man /unkn) ❑ PWS: qq � ORW: yes / no PNA yes / no Closest Maj. Wtr. Body-A!�J1( + " r MEN ■■1�■■■■ ■■■■■■■®■■■N■■■■■■■■■■■■■■■■ ■■■.�ln.,i:�E ::::::::::::::■::�: ::::MEN U � ::::::::::M■i■■:Imam=�ii:::::i■:EN lam■■■ ■■■■■■■■■■■■■■■■i■■■■►Vi■■■■■■w■■■■■■■ ■■ ■� irk,u�..�I�i�il♦■■■■■■■■■■■■■■■■n��■■■■■—�^.■■■■�■ OMEN■■■■■■■■■iil■ill li�;,�■■■■■G■ SEE ■■ ■ ■ ......■........■■■■■■■■■■■.. ■■■..■MIME w �1■■■■■■■■■■ max distance ffs o■■■.■■■■■■■■■■■■■■11■..■r�l'ID7 Basin, channel .■■■■■■■.■■■■■■■■■■■■r/ 11■■lii■ ■■■■■■ ■■ .0■!.►"�i■■■■■■■■■■■■■■�.^rlW.J.11..�■■■1■.�■■ ■■■■■■■■■■■m=mmm■1l■■■ ■ii■■■■ ■■■ ■■ ■■ cubic yards ■B■■■■■■■■■�■■■■■■■■■■■■■■■ ■■■■■■■■■ Boat rAmV'P■®■■■■■■■■■®■■■■Il■■■■■■■■■■:■■■■■■■■■■ ■■■■■ ■A■■■■■ ■■ IN■■■■■■■■■■■■■■■■■■■■ : ■o■■■■■■■■■■■■■■■■■■■■ ■Err �i ■■.: • ■■■111■Ilii�■■ ■■■■■■■■■■■■ ■■■■■■ MEN ■■■■ ®@� ■1■7�■r,IFIa�f'1',,I►:�■■■■■■■ :■■■■N■ MEN ■■MMMMMEMM■ : MEMEMMlUn■■■■ M IZ GrIEt■."�rG■'�r■■3� :E :SMIX"a MEME SEEN OP:%A: :MORON :::::::::::::: B [CI' I:::::: .� _k'k v Y('on��p Agenf or Applicant Pirinted Name A Signature "-`Pleas d compliance statement on back of permit* � Application Fee(s) Check # AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit:6LOX 1 1 tci�tT-0_ Mailing Address: L P'r-al">e' IfIc BPS/l� Phone Number: 2�- 35l3 Email Address: I certify that 1 have authorized / Contractor to act on my behalf, for the purpose of applying for and obtaining all CApMA permits necessary for the following proposed development: f3��te�*�f lly9iP� at my property located at in 10'Wv4/TW County. ,2- kf'<u 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 / % Date This certification is valid through ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to property located at (Address, on �500�Cfefk ,in. (Waterbody) County) I N.C. The applicant has described to me, as shown below, the development proposed at the above locat I have no objection to this proposal. _._-_ ----_Lhavve objf�Qtions to_this_propD-%aL__------ DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawinn11 19 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 Infor ation) (Ad' cent Property Owner Info nation) ��ZS 135y n'V %day Date T Date JulQJ�p lC l ( (Revised 611812012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT hereby certify that I own property adjacent to )(S\ a-Q ' (Name of Property Owner) property located at y lil-z l�' (Address, Lot, on�}7C<(.✓.W Croo in.— (Waterbody) N.C. The applicant has described to me, as shown below, the development proposed at the above cation. 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 sPte &as b7."; S�vii �YajS\�\S\Uh J 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 Waivethe 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 a ent r p rty wner Information) x 4 - / Signature 19��f�e Ae \AYc P, fin orType Name ailing ddress City/State/Zip Telephone Number NamR (C) Date Date (Revised 611812012)