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Home My WebLink AboutPKS Properties, LLCCAMA / l DREDGE & FILL NO. 75917 ^ A B C D GENERAL PERMIT Previous permit# EINew ❑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 attacf]ed Applicant Name Project Location: County Address ( T Street Address/ State Road/ Lot #(s) t Phone # O' i Authorized Agent Affected El Cw AEC(s): ElOEA ❑ PWS ORW: yes / no State % / ZIP E-Mail Ll EW ❑PTA ❑HHF CIH PNA yes / no I El ES ❑ PTS ❑ UBA ❑ N/A Subdivision 'City l - ZIP Phone# ( ), RiverlIBasin )/1�'�(.: %r Adj. Wtr. Body `• '\ �' a 1 1 nat h ,an? unkn Closest Maj. Wtr. Body N■■■■■■■■I ■■■■ ■■■■ ■E■■ ■■■ME■■■■ ■■■■■■■■■■■■■■■ ■■■ E■■■■■■■ ■ ■■■ C ■■..M.........C....■■■.M ■M ME...� ■■■■■■ ■■■■■■■■■■■■■■■■E■■■■■■■■■■■■■MEN MEMO MEMINEEM ENECCCOMENEEMCCCCCCCE :� MEMO ■■■O ■■■ ■ ■M■■ ®■am MEMEM EOOEM MCCMCMMEN INN MEN ■■■■■■■■■■■■No Mm■■ 0■■ESC ■■M■■ E■■ man 0 OEM ■OMM■E■ M■■■■■■C■ ■ ■ M■■■■■■■■E■S■■■ MEMO ■■ MBEs ■C■■■■■■■■l�l�■■■r■�iEeni■■ MIME ......■■..■�C■M■M■■■E■E■E■■■MCCEMECCE■■■ ■■■■■W M■ MEE■■■MM■■MORM ■ ■■ ■■■E■uM ■E■ ■MR ■■■ EMME■ENMEME■■mill■ME■■■ONES •" MEM■■■EM■E .NEE■l�E■CC�i'CCCC �■■■ N■O ■■M■■M■■SS■■■■■ ■CII■■■E■■N.■■■■ ■M■■ ■■E■.E■E■ ■ !� E■■u■■ NEE■ .■ ■ SO ME■■■■S MEMO ■E O■EME■■■■ ■ MM■ME■MEM■ ■ 2[■M■�l■miumE■■OS■O■■loom SE■ M■M■ IIMIMMMMIEMMMMMMIII ■■■■ ■ MENE■■■ ■■■EMMMCI■EEMO■■■EEO■OOO ■E■■■MCMM■EM LIMNo so OMCMCOMEC'■.00MCCMMMCCE■ OOCCONo MEMO Agent or Applicant Printed Nar?0) Signature `•Please read compliance statement on back of permit" Application Fee(s) Check # r PermitOf(icer's Printed Name Signat¢re. i Issuing Date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION i Name of Property Owner Requesting Permit: , 4i<5 Mailing Address: > 4 O--7 TI vn be r la Ice- C } . Ltnr5-4," , W.c. 2'�sSo�) Phone Number: 25'Z '7 t"-) 333 Email Address: @ a o i . C Z"" I certify that I have authorized rn U b '6 u 4- fm I 'Patz O6 rng -J n z , Agent /Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: SST' q Nam. P I I vS at my property located at in 6fe.-f-4-t; 1 County. I furthermore certify that I 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 evaluatin�gc infFBation -related to this permit annliratinn REal% OCT �9 /16A DCWMHD CITY Ms2 Title 0 I'Z' I11 Date This certification is valid through ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to ? 1Lg fro0:5/ /eS s (tyame of Property Owner) property located at 9 (Address, Lot, Blgck, Road, etc.) on C.A-�"` w 1 n i , � N.C. (Waterbody) (CitylTown 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. ________ _ ___1iv_e-objections_to_this_pr_oposaL___ DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) �cSc 1 1 V4 r v E7cis.} i w5 ws•L11�s D 6 e-\4— RECEIVED OCT 2 9 2019 DCM-MHD 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.) I do wish to waive the 15' setback requirement. I do not iqg to waive the 15' setback requirement. / co nag/t+'S C V ture � Print or Type NNArne 3uo� I /M 4'km J M i "'9 ",dress I� l r✓4 �-o .� ,, ' L Cityy/StatelZip \ 2S2 ?t 1 3133 Telephone Number \ 19^24,-t5 Date Print or Type Name 3�ia 7Te m h e� 14k� t`T,' Mailing Address Kir.ed.N )J•t, 28So`� C/Sztaje 4I') 3333 Telephone Number )0 t4 Date (Revised 611812012) --------------------------------- ----- - yes 1 hereby certify that I own property adjacent to �� t» w, `i r o c. s �� (Name of Property Owner) property located at ° - 4A 2Scr (Address, Lpt Block, Road, etc.) on A in ICv,ulNSHvC,z:S N.C. (Waterbody) (CitylTown and/or County) The applic as described to me, as shown below, the development proposed at the above to io . I have no objection to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill in description be/ow or attach a site drawing) a9 m RECEIVED OCT 2 9 '319 WAIVER SECTION tp1�f�'+ � f I understand that a pier, dock, mooring pilings, breakwater, boathoust,9iiWo�r 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 th�ack, 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. r- (Property Owner Information) ur Print or Type '314a1 -Ti h-, Eger• (okls' mg Address Citystatelz Telephone Number 1rJ-29-- I-P Date ;r Information) r� Pri t or T Name ' Mai 'ng Address 2 —�s�� "ty/St telLip TeLep one e Number ,J. C� DG5 Date 5, /�Y�g I / (Revised 6/18/2012)