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Home My WebLink AboutQualman, Rodger❑'CAMA / ❑ DREDGE & FILL No. 75792 GENERAL PERMIT Previous permit# A B C ?/D U'mgJ New ❑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 15A NCAC yles attached. Applicant Name f''Y (i� i " i Project Location: County # f r --i Address_ _ / Street Address/ State Road/ Lot #(s) kr City —State ZIP Phone # ( ) E-Mail Authorized Agent Ll CW � EW ] PTA J ES J PTS Affected 00EA C]HHF_1IH ❑UBA Li N/A AEC(s): ❑ PWS: t ORW: yes / no PNA yes / no CityZIP Phone # O River Basin ! r I Adj. Wtr. Body I` ' � Lat)/m„ an /unkn) Closest Maj. Wt,. Body::: 11 e ■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■�■■■■■■ �®iimmoomm mom No iiNEI IE■■i®®�=�■ii■i ■®■■■■■■■MM■N■■■■■m■■■■■■■■■■■■■■■■■■■■ M mmom:::■:�■■■■■M■•N■■■M■■■■• CMENEM OEM MEMO. .■■■■■■■.■.■■■■■■■■■.MC■■O■■ ME ..■■■i■■■■. ■■■■■■■■■■■■N■■■■E■■■■N■■■■■■■■■■■ NONEMENESEENEEN ME M somommommmms M 0 MEMNON= =Omani iii0®iiiiiso N®��iME N iM. iiiiiiiiiiiii■iiiMm■i�■NE�0 ME 0 idlimommmommimo111 ■■■■■ ■■ N■.. ■MEE MEMON■■■■■■jjjj�E■EMN�II!MIl1M�1N NMMMMOM■■ MEN m • E�IMMMHM■■■M■M.IN...M.0 M■E■■■ ■M■■M■■■■ ■ I ■ als. l■■1■■■■■ M■■■MOral I� M■M ■■I■■.. ■1 ■■ IMOM•MM■■■■I■■M ■■�M■■ Nl�\� ■■1■ii� ■■ ■ ■MOOI�O■■■M!■NN■M■►� mimmu ��31a ■■I■■■� .G■ ■■1�■M■IL'NMNI■■0 i ■� NEI1�■Or■■■ ISMS ■ MEN 1` 0:'�iM ENEL��I/MMENm1■■E■■ ■■■■MOO■Y�Awandam amQ6IMMOMMM ■'�■■III MCoi��.E ► ONME■ION ■ I■■■■■ ■■■ N1M1�■�.: WIE M J Agent or Applicant Printed tjMe Signature**PleaseTeadcofnypliancestatement on backofpermit** Ij Application Fee(s) Check# ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to Lx z r C" '�`�� I n(� 1N a of ProperF>eeUtyrOwnler) — property located at osDt'�4 is>�.,� �I�a2�S j �ce�--}}--o rrtt Ad ess, Lot, Block, Roaetc ) on �a Creek in +��e>a��r,r� 1Je N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above locate. 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) i ��c�i rlo�)LI _,Jb- 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. Information) (Adjacent Property Owner Information) KoG Print or Type NarYte ail (Q r(anajL Mai in Address � t autee-r /P�, c / ,zas/L' City/state/Zip 8C13-aas, -7K55 Telephone Number Date ' - ' Date (Revised 611812012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to property located at m (Waterbody) (Name of Property Owner) (Address, Lot, Block, Road, etc.) ,in (City/Town and/or County) I N.C. 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) blocks �ac&d � erperKA;zalsr �o ex 5,�'O� 54oCV p ask 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.) /Lt4 I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. _.(f O ner ormation) Strature Print or Type Name !� 5`{ k 05pre-1 1 p 0; n{ K.ou cl Mailing Address l ?) a U i- o r } / t'i City/StatelZip 8q3 -z.zLl - -71455 Telephone Nu be J Date (Adjacen Property Owner Information) StT ure — Print or Type Name . Mailing Address City/State/Zip Telephone Number / Z Dare (Revised 611812012)