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Home My WebLink AboutPeterson, Tery' �CAMA / L DREDGE & FILL GENERAL PERMIT ONew L1Modification ❑Complete Reissue ❑Partial Reissue No. 74426 A B &D Previous permit # Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality 1 /�1 and the Coastal Resources Commission 0-an area of environmental concern pursuant to 15A NCAC / El Rules attached. Applicant Name I a Project Location: County_ t C. I �i c'°I Affected I�'EW CHEW LIPTA El ES ❑PTS AEC(s): ❑OEA ❑HHF ❑IH ❑UBA ❑N/A U.PWS: �i ORW: ryes / o PNA yes t'no.) Street Address/ State Road/ Lot #(s) Subdivision City �.i , i , j:- / ' l i. t ZIP 0 S Phone# O nrerBasin '✓ 6, l Adj. Wtr. Body at)man unkn Closest Mal. Wtr. Body tj'"',f' ✓ " � 1 ■■■■■■■■■■■■--■■■■■■■■■■■■■.E. ■ ■NUM E.EE:EEEEEM EEEEEEEME:ENEMEE:EEMM.�■■■■ME■■■M r ■■■■■■■■■■EiM�i■■■■■■!■■E■EME■■■MON■EM■i ■INE■■■■M■■E■MONFIZiPM■■E■■EE ■■■■■■■■MEMO ■ ■■■■■■■■■■.■MEMM■■O■■EM■■■■OEM■■■■■■ EMMEMEMMEEEE MMMMMEMEM CEEMM ME::EEE:E IEEEMEMEM IMMMMMHMMMEMMMMMME� MMMME'E::E MO■■O■■■■■EOH■■ITEM■.■■EE■■OE■■■■E■EEO■O • MOO■E■■■E■■■■M■■M■M■■■ mom ■ ■■■■■■■■■■■■E ®CEEEE 111MMEEEEEEEM EEEEE'■EEEEEMINE En■■■■■■ ■■■...■■.. ■■■■w■■...■...... ■■M■E■E■■ E■■■ma®w■■■�■e®w�:■■■w■�■■■■■■■ M■E■■E .EE.. ... MM■M■IMMMME■MMMMME■E ■uiiEE■®EiiiE■� ■■...O.■■...EM ■■■■MEO ECi�Ci�EEEiiiiE�.�'�E ■■off■■®i■■n■■■■■■■ Yeoe®■■i1�ii�iEi�EEiiiiE ■ Agent or Applicant n)ted Name r �7j� Signature, * Pleai�e read co pliance statement on back of permit" Application Fee(s) Check #i PermitO ficer's Printed Name ' I � Signatu��----- *1,,u,nate Elration to AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Mailing Address: Phone Number: 1 q 2/115- D (f0 -] Email Address: �(r CSDel a��j/U q /, • CAN` I certify that I have authorized AS'qL.e'/ Quay1CS Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits J necessary for the following proposed development: n `P GK amy' 6oi4-h (4- m 5 Albg-haI-\ at my property located at 701), Soc4&4D'el VF— in `��5T—County. 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: `iJ. Cw -1� Signature � Y. 1 CA Print or Type Name bu-) t1P.(' Title 3 1 28 tr9 Date This certification is valid through 12 1 3 :., kA T F 3 �a U VI ■ Complete items 1, 2, and 3. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: �1�.�/ 2 (�, �aaf�/C � so„ 1�►uE, ►�� IIIIIIIIIIII81111111IIiilIIllllillllllll 9590 9401 0140 5234 4302 97 2. Article Number (]master tram service taboo T16 0340 0000 4150 6122 PS Form 3811, July 2015 PSN 7530-02-000-9053 ■ Complete items 1, 2, and 3. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front If space oerrnits. CA -al Put ✓i s 3oq v�� Ca*OL, P2.� GKY Mou X t fjo"f \,41/r B. eived by (Panted Name) I C. D. Is delivery address different from item 1 Y ❑ Yes If YES, enter delivery address below: No WAY s e a. aervlce type C Prioriit, Mail Express& -Adult Signature ❑ Regia!ared Meoi"' G Adult Signature Restricted Delvery C Ragia!e-e. Ma: =. Certified Mails Deincr: u Certified Mal Restricted Delivery - Reum Receip± tr, 7 collect on Deliver, Mar..:u�'Me Cdkt on Wiivery R.Woted Wiva, •L Signature Confirrnaeo-" C In Mail signature confinnab. C Ins�red Mel Restricted Deliver• P.ea(tr eted Delivery Domestic Return Receipt A. Signature X ❑ Agent ❑ Addresses B. Received by (Ranted Name) C. Date of Delivery � 11 s 1 .0" n It t o d- u —114 D. Is delivery address different from Rem 1Y CI Yee If YES, enter delivery address below: ❑ No f■■ �8o`F 3. SBrviCO Type Prionty, Mal Express® II I IIIIII 111I 1111111111111 II II II II I I I I t 11I I III Q cenified Melloistered Mal'- fta i INed Deivery DDeg X'd MO Restricted 9590 9401 0190 5234 4303 03 v collect oMDeRery ided Delivery _ Return Merch&diept for 2. Article Number (Transfer from service label) G Collect on Delivery Restricted Delivery := Signature Confirmatiorl- G Insured Mel C Signefure Confinr anion 16 0340 0000 4150 6115 D lnwred Mal Realnded Del,vary Restncted Del wy _ (over$500) PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt