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Home My WebLink AboutHatfield, Randy�CAMA /,M DREDGE & FILL No. 74966 GENERAL PERMIT Previous permit# A B ° lC„' 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 I SA NCAC `❑ Rules attached. Applicant Name i'`. `� : r I _{ i (f /� Project Location: County Address ( (r; -Ili Street Address/ State Road/ Lot #(s) CityState !.l i ZIP - )C Phone#(��)�`ij` -E-Mail Authorized Agent_ Affected 0CW AEC(s): ❑ OEA ❑ PW5 ORW: yes / no ,MEW __[IiPiA Li ES ❑PTS ❑HHF ❑IH ❑UBA ❑WA PNA yes /,no Subdivision Phone # ( �17 _ River Basin ' % " r Ik Adj. Wtr. Body r "v r t 'i' (hat.'/ma/n /unkn} Closest Maj. Wtc Body /' I ' } Milli ■R■:::::mMMEMEME 1:�■■■E■E■M■■I��■■ ■■■�1■111■_■■■:■■:■�H �■■■■■ :■ ::::: : :■::■■:■■■■■■■■■■■■O■�■■:E■ ■21■ ■■■■■■■■■ ■E■N■■■■N■SEEN■■■■■■■■■■■■■■■■■■■■■■■■■■ 0 NJ MONROE MEMO IMIMMMMMMMMNIMMRI ■■■:■■■■■■■■■■:NN■E■ IN ■ :■■■�iFAMMEME ■E■■■C■■■■■■■■ ■■■�■■■E■�■®®®:®::: MEN IN MEMO N :::::o �:::11�m NEIMENESE ■■■■■ ■S■■■■ SEES■■ ■■■l1■■■■0■■■■■■■ ..■■■........■■ .....■■NNE........ ME ME M. NONNI IN ME :■.��■■ ��•• ::■::■m■■: ■■■■::::■■■■■M:■::■■i■::�■■�:.■■:■■■■■■ N■■■■■■■■■■■■ IBM ■■■■■■■■■■■■■■■■■■■■■IEEE • ■■■E■■■■■■■■Eli■ON■■■■■■E■■■■�■■■■■■■■■■■ 111 ME OEM IN MENEM MEMO IN MONSEEME M ME No UN ME MOON MENIM 11111111 IN :■■■■■■■ENN■■I■■■■■■■SO■■E■■O■ .■NO EMMESS :::.. ■■MESS .■■::::�•■■■.■:M::::I::::::::::::: MEMO.. :'EN MEN IMMENS::1::::'. :■■■EEEeei :'.'.'.::'.'.'.'.:'.'.:'■:'■'.' Agent or Applicant P in ed IN a Permit0(flcer s Pn�nted aim/JJ Signatur ' "Pleaser ad compliance statement on back of permit" Signature / J Application Feels) Check # Issuing Date Expiration Date ADJACENT RIPARIAN PROPERTY OWNER STATEMENT V, I hereby certify that I own property adjacent to V"a r.UD Y i 4 tq-T- F ( (5, t% 's (Nam"f Property Owner) property located at '3V C Lt5:! Y'or k) T 7 (Address, Lot, Bloc�f, Road, etc.) on 113 ay 6 (cam ��,.� p , in (tU a [y r C (F , 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. 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) WAIVER SECTION 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.) NI do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property' Information) ig lure OM/Si LSLXp ITR-1 S Print or Ty e Name /4-1 74�12LeCt)OO[, M ili Address T l k(q4 City/State2ip ti L 2--7 6 b 7 Telephone Number/email address -7i 9- Date J Mailin ress / Nl7i,u City/State ip�— Telephone Number/email address ? —3 37 Date* ,4/ 2i-/'( (Revised Aug. 2014) *Valid for one calendar year after signature* CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Owner: V� e_ot4 ✓r V- \AAA ✓1<. Y A% f-l-QS Address of Property: Agent's Name #: Agent's phone #: 3D 0 Se v,�, `Vs CA,- (Lot or Street #, Street or Road, City & County) QV-4-�r,C.f Mailing Address: aqOS Ct91-Lt.✓Ylar/y�r!a/� N c I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit has described to me as shown on the attached drawing the development they are proposing. A description or drawing, with dimensions, must be provided with this letter. I have no objections to this proposal. I have objections to this proposal. If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is available at http://www.nccoastaimanagement.netlweb/cm/staff-listinq or by calling 1-888-4RCOAST. No response is considered the same as no objection if you have been notified by Certified Mail. WAIVER SECTION understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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. ,F0rope y caner of rm on) (Riparian Property Owner Information) i�gna ure Signature jI ;e&o-ts Print or Type Name Print or Type Name Soy s�,4 �i� cos c wlar,a� c Mailing Address Mailing Address � r z4p,4--w 9AL.,�k, 0c a76(3 City/State/Zip City/State2ip ,?5�P - 3L� l 9 -)7 0- A 4 ",v, Telephone Number/Email ddress Telephone Number/Email Address 01A i%. c0yv\ Date Dale (Revised Aug. 2014)