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Home My WebLink AboutHirasawa, Regina®VCAMA / \4 DREDGE do FILL ,ENERAL PERMIT �elew ❑Modification [-]Complete Reissue []Partial Neiss e As authorized by the State of North Carolina, Department of Environmthtal Quality and the Coastal Resources Commission In an a reiof environmental concern pursuant to N9 78413 Previous permit #_ Date previous permit A B C D I SA NCAC ❑Rules attached. Applicant Name __ i f; yProject Location: County Address Street Address/ State Road/ Lot #(s) 7_ \ City !' State ` { ZIP Phone # ' iL`�!` /' Subdivision ( V 1 �l 1 ,t-Mail ` - Authorized Agent City V ` \ ZIP ❑CW DEW El PTA y�ES El Firs Affected ''❑UBA ❑OEA ❑HHF ❑IH ❑N/A Affecte ❑ PWS: ORW: (r'�i no PNA yes, ior1 . Phone # (J Y� River Basin Adj. Wtr. Body_ Closest Maj. Wtr. /man /unkn) .r N■■■■■■■■■■■■■■■■■■■■1f■■■■■■■■■■■■■i�■� ®■■■■■■■■■ ■■1ii■klquisi1■■■ ■■■■■■QI�■f1l■■ MOM ■■ !►�1■■■ ■■■■■■■■��1 ■\t1�1■■■■■■■■■■■■■■■ ■■■■■■s■■■■� ■■ ►�■■■■■■u■■■■■■■Q■W■■■ ■.■�■■■■■■■■■■■■r.;I■■■■■r11■■ ■■■■■■■■ ■=Mju ■■■ �t�i�■■■■■■■■■■are■■■■■■■■■■�■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■�►�■tiles■■■■■■■■■ ■■■■■e■■■■■■i■■■■■■■■■■■��■■A■■■■■■■■■ ■■1�i11■ii■■■■■�1■i19171■■■■■■d�i�■�■■■■■■■■ ■■■ ■■ ■■■■■�■gym■■gym■■■■■ �iQQ�QQa ■MEN ■M■■ ■ 0■■■■��■■■,1■■li■il■■fi■f■x:r ■■■■■■ ■■�1■Il■■■■■■■■AIL ■■111■Is 11J■■ ■■■ ■■i-- w fil®�I�■ • ■■■■■�■■■■■■■■■ii■■■■■MOVE 'SEWI®■ ■■■■■Q■� QQQQQ®■■ �iiiiiiiiiQ■i�i■�■i�ii�iei�ii a■■■■■■■■■■■o■■■■■■■■■■ ■ ■ ■ ■ME ......■■■.■■■■■■■ �...■.■■■.. Q .■■■■■ ■■■■■■■■ ■■■■■■■■■■ Agent or Applicant Printed N/ame Signature ** Pleasereadtompliance statement on back of permit" Permit Officer's Printed Signature 11 IssuingDae E piration Pate Application Fee(s) Check # ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to property located at oL.z J�Ffr"'r` (Address, on in (Waterbody) E Name x t",q N/24-,4 w-4 's etc.) (City/Town and/or County) N.C. The applicant has described to me, as shown below, the development proposed at the above location. 1 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) 1 S ' Sew bta� RFcF-N D DEC 16 Z019 I)CM-MND CITY 941.KOCH KNIGHT, LLC 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 Information) naMre — re Print or Type Name A Seo- Tt`QC2 a�ve IiUfe (Adjacent Property n r Informai o ) Sig tur Print or Type Name /Z-,) R2vot'v/ram l%l� !U� IS-,' Felephone Num Date (Revised 611812012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to _ property located at 'jrr4 u Jer- C 0 7 1 (Address, Lot, BIACk, Road, etc.) on I7ogu� So��G in Oe�pod , 1JC 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) RECEIVED DEC 16 Z019 DCM-IAHD 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 you wish to waive the setback, you must initial the appropriate blank below.) qI do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) I �Signatuh Print r Type Name SecJ- Tn1C2 t-0.�%L' Mailing Address /\\Q� �oV-'\- N N. C- '; 9tQ� Cityty/Stat A a- -I - �tct C) O Telephone Number Date (Adjac nt roperty Owner Information) Si nature re-U554 ?. Urh')nti� Print or Tye �I Name 114 �rr-(a T' Mail'ng Address J(- a-S5-�0 Clty/25Stat fe ip 25h- 14o`1 Telephone Number I2,-jl-I`1 Date (Revised 611812012) : 11 RECEIVED DEC 16 2U19 IDCM-MHD CITY e A