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Home My WebLink AboutHurley, Daniel®f ❑CAMA / ❑ DREDGE & FILL No. 75753 A B C D GENERAL PERMIT Previous permit# JNew ❑Modification El 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 i an areaI envir nmental concern pursuant to I SA NCAC i / v ules attached. Applicant Name G ^ P V/1�� Project Location: County _V �r"'k-A t f1_.✓r /// y Street Address/ State Road/ Lot #(s) f State A% ZIP Phone # (Q!A>J L 7r9 { ' E-Mail Authorized Agent - /1 v) 1 /"'r✓l f v �MCW ❑EW ❑PTA ❑ES ❑PTS Affected AEC(s): ❑OEA ❑ HHF ❑ IH ❑ USA ❑ N/A ❑ PWS: F.. ORW: yes /) no PNA yes /r'no Type of Project/ Activity A, � E ` i�I,J ( (I "7_-t Y/ Pier (dock) length_ Fixed Platform(s) _ Floating Platform(s) Finger pier(s) Groin length number Bulkhead/ Riprap le avg distance o max distance, Basin, channel Boat ramp Beach Other Shoreline Lengths�^ I SAV: not sure yes 60 Moratorium: n/a yes t n Photos: yes n Waiver Attached: yes no (� !r f r A buildingrmit m �retki fired by: ( Note Local Planning jurisdiction) �' Notes/ Special Conditions Agent o, Applicant Printed Name Subdivisio(n (J City K'y Y r., ri ZIP c7 Phone # O River Basin �. - �' ",f r JU :- ° �' / - (Chat man unkn Adj. Wtr. Body f _ Closest Maj. Wtr. Body Cr-�--' N-! & L J i,_aylI-✓ (Scale:,,4r`/f" ) ❑ See note on back regarding River Basin rules. er Signature " Please read compliancd statement on back of permit** J Application Fee(s) Check# } ( Exoira on Date DowSign Ernehpe ID: 907446E2-3D92-43FF-9208-4A30178A3945 AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: hfl if�e l gg / IPZ Mailing Address: ftC�►vl �oGl� ✓ �✓ .� oudo n !113,70 r7 Phone Number: 16.3 • S8'.2 -1— Email Address: q U;c,1ry i ckQ- ctn P r7c, 7rlp SO ri LQyK o I certify that I have authorized I N M4 N q u t„` Agent 7 Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: at my property located at--/—, in Art?r,ef— County. R l 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: 5Zg eU by: 0.c Si'.ed by: �— e Signature_ Lrliel 4 urLtV Pnnt or Type Name 10/,1/2019 / 10/1/2019 Date This certification is valid through —/0l DowSign Envelope ID: 9A5OE3DD-79B1-011G9F7B-COCODDDA6B66 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to �n ;e ) ,j. S q r)P4 's Property located at (Name —ofProperty_wner )103 lj4iers�`d on ,Bk k o r, „al (Address, Lot, Block, Road, etc.) ' in P vw� i Y ers T�Jgn�t !?arlrnL N.C. (Waterbody) (Crtynown anti/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) a t / .�C�C' H'l�kc�tt�t' �i'uccl;nq WAIVER SECTION I 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.) I do wish to waive the 15' setback require ent. I do not wish to waive the-W setback requirement.S�`' (Property Owner Information) Stg atisre/� vawa Name Owner Information) A)cex.Vie f 'Valid for one calendar year after signature (Revised Aug. 2014) Do Slgn Envelope ID: OF60178E45AE-43CF-892F-AECCE2FFC45A ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to -�Nn;e j,H SUd •�k r/(+y 's poi mprty wner) property located at103 ur�)C Ni Af oe 14 N 4 on 18Ac �,S,r,n(Address, Lot, Block, Road, etc.) ' in_lL�ikers T</e„ Carlin+ N.C. (Waterbody) (City/Town an/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 I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin must be set back a minimum distance of 16 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. /pr Per•d�e�i /tPs�!''c�r°obi ✓ I do not wish to waive the �T setback requirement. roperty Owner Information) mature lk)"2" ✓1 Dale (A ��erty Owner Information) SIWggqq� xx Tarl C93%AEW4B... otOiPµly YiCIrQ LL< Print or Type N me $oa' Fr'On�- Str•nv f Mail' g Address ytSPa��rr-i-flllL aS�SI b Clty/State2ip /.44, AU 2bVO dArad)Le�ev Zptigll -Corti Telepl�prte yN018er/email address Dale* 'Valid for one calendar year after signature` (Revised Aug. 2014)