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Home My WebLink AboutMansfield, Melva J.®-CAMA / DREDGE & FILL No. 75910 A B/' D GENERAL PERMIT Previous permit# ❑New [-]Modification ❑Complete Reissue ❑Partial Reissue Date previo s permit issued I g As authorized by the State of North Carolina, Department of Environmental Quality 1n( and the Coastal Re;� rces ommission in an area of environmental concern pursuant to I SA NCAC % PRules attached. ApplicantName� 4,Project Location: County Address _ _ Street Address/ State Road/ Lot #(s) _ G- City IP Y State _ Phone # (, ) Ajl Subdivision Authorized Agent ) I. )'k i City _ ZIP_ Affected El CW ElEW El PTA AS ❑ PTS Phone # O - _ ,River Basin - AEC(s): ❑oEA ❑HHF ❑IH ❑UBA El N/A Adj. Wtr. Body (nat_ man /unk_n) :.. - ■■■■■■■■�a7�■■ ■■■■■■■■■■■ ■■■ ■■ SEES C CC:: CCMEEEEEEEEEEEEEEEEEEE�EEEEE:EE ks ■■■■■■■■■■■■■■.■■�■■■■�■■■■■��i■■■■�■■■+■� ■■■■■■■■■■■■■■ ■■■■ ■. 111 ME■I.11■■■■ ®EE■■ MEN ■■■■■■■r/IVA ■S awws :ild■■ES■■■■ y ■SEEN .�SSIL�RII■T��f]■S� 9 'lll ES■ ■■ -■■S■■■E ■■■ MEN ■■■■■■S■I■ ■■E■ li'Ei' ■f�a■EI■H■■S■■■■■ ■■ SEES ■■E■ �EEE■■C■■■■■■EEE■■►I■ %A■�... ■SEES AE■■ ■■■■■■■....E■■■SEE■■■E■�S■E SEE■E�E■m _r r1E.-!415111 ■■fir /ESNo Ell MEL..EE0 WEJ■:E'. ®■El(11�SEE■■.1�E■■� ME M.■■SG/E■E�IIfi■��in■i as No ■ `, Noun E■�SE■E■ E ■■ SS. NINE■■ ME or E ti■1111 ■■S■E . Ei■ 1 E� ■ ME ■ ■■■ ■ ■ ■■■■N■■ It■■E■■t/ SE■■E■►I■ SEES • ■■ES■■■N oil E ■■■SSE� ON III11val =IS �■■■- SEES ■E■■E■■I ■11l�1E■■ESEE■S�I■Eso am ■■ ESEr��i■ESE Ill r EE 1 Bull 5 M SIRE MI No OMEN CIEEEECC' Eo�EEEEEE:�CEE: EE EEE;;E�E�INEE EEE�EE SEE: 01 1111 4 II signat Please read cGmpliance statement on back of permit Signatu e Tr Application Fee(s) Check# •. Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Ivi ib J uL,&, A4�SF,E`-b Name of Property Owner Requesting Permit: � Mailing Address: -' .I o ( .5 �5-r h"b S '� Phone Number: Email Address: I certify that I have authorized 2 FG5- bo7 2-z U G. (/1 e Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits N Fstj r&LqL..i40� necessary for the following proposed development J� at my property located at t V t , t-! r�r /Tt r---%--� in t;f} � county. ��% �� r S 7 I 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: )Cl A lj UM &,W �-Signature fvlel a 1(0�'VIC. ietg Print or Type N me Title Date This certification is valid through ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent Melva J. Mansfield I (Name of Property Owner) property located at 2101 Shepard Street (Address, Lot, Block, Road, etc.) on Bogus Sound in Morehead City N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. X 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) �cwSfilarli-PAP AlIv\(al.':i) 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 requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) fV1,19A\10, Signature Melva J. Mansfield Print or Type Name 2101 Shepard Street Mailing Address Morehead City, NC 28557 City/Statelzip 919-607-2217/ mjulemansrield@gmail.com Telephone Number/email address l0 Date *Valid for one calendar year after signature* (Adjacent Property Owner Information) 'Signature* Print or Type Name Mailing Address , Cry/State/Zip _ Telephone Number/email address Date * (Revised Aug. 2014) Exwific— bock ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent Melva J. Mansfield I (Name of Property Owner) property located at 2101 Shepard Street (Address, Lot, Block, Road, etc.) on Bogue Sound in Morehead City N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above�ocation. 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) �'t, iisActl,,J i;."i, I l�l,i,, ,I,l i,11it(Ii-b 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 requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) Signature Melva J. Mansfield Print or Type Name 2101 Shepard Street Mailing Address Morehead City, NC 26557 City/StatelLip 919-607-2217/ mjulemansfeld@gmall.com Telephone Number/email address w *Valid for one calendar year after signature* Property Owner Information) 1 ,(I k.D � G' ' ��.1�ALLV Print or type tvame Dare* '2 6 v (Revised Aug. 2014)