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Home My WebLink AboutRogers, MartinXCAMA / ❑ DREDGE & FILL No. 74496 GENERAL PERMIT Previous permit# 5New ❑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 [:Pftules attached. Applicant Name / , ` C + i ' Address C% <<" f .� v S r City I i i ( �rF,)I 'wft�r;State nLZIP Phone # ( ) `% ! ✓ r'� E-Ma11 Authorized Agent ❑ CW 0 EW _IPTA ❑ ES ❑ PTS Affected AEC(s): ❑OEA ❑HHF ❑IH ❑UBA ❑N/A ❑ PWS: ORW: yes / n�.) PNA yes / Ro Project Location: County , i ! t .-C (_t Street Address/ State Road/ Lot #(s) A Subdivision / City i ZIP Phone # ( )( River Basin Wit i .. Adj. Wtr. Body I i '.> i l't (nat / an unkn r Closest Maj. Wt.. B_d, I ' i 1 ' l /i i �wLir•' ■■■■■■■■■■■■■■. ■■■■■■►,*9■■■■■■■■■■■MEMO■■ OMEN �iW■■■■■■■■■■■IMEC■■■■NOEM■■■■`E■■■■M■■� ■■MIR■M■■■■■■■ ■■■■■■ M■■■ ■■■■N■■ ■■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■M■■■M■■ ■■OEM■■■■■■■■■■MME■■H■■MEN■■■M■■■M■■N ■■■■MMM■■■■■■■■■M■■■■■■■■MwMw■■■■M■■■NONE OEM MENIMEMEMEMEMEMI MEN 0 MEN ■N■■NNE■■MN■■■■■OEM■MN■■MEN■■■ MEN M MEN ■E■■ME■E■EM■■■■M■ ■■■■■■■�■■■■■ ■■■�M■■ ■��■■■■�■■■M ME ■■■ M■■M■■■■■MMUMM■■■■■■■■■NEE■■MM■■■■�■■■N M■■n M■■■ No MEN IMITA l FA ME mom M.■■■■NEEOEM■■■NEMUNM■N ■M■■■■■■■E■■C'�1M■■E■EMM■■■ ■M■MM■■■M■EE ■M■■■■ M■M■■■■MM■MMMM■■■M■■■M■■MM■ IN ■ �mom ■■■E■■■MME■■■■■■■..........�....... ME No ■. • .......M■�i■■■■■■■MGM■■E■■E■ M■■N■■M■MUCCC CC CCC�CNOZONE EMEMEM■■■MEN R'�rE'. ENW.!I■■WOM■■ ��■■��M■■■■■MMI MNMMI�Mmom ■NI■■■ ■■ �■■E■SMMEN■min M ■■ j ■■■NEE■■■ �':1JMMMMMMMMM■■MMMNM MMENEMM1lMMWaMNE11M1�1�■ C■■M■■■■MIj�l�R11nalMmlilE11Y ■■■■■■■M ■■■■ ■■ ■■M ■ C■■..i ■CN0■..iCCM N1t NIC'.s'.'.'.'.'.�'.B�i C■ �C'.:'.'.�MEN /^ \ 01 Agent or Applicant Printed Name Signature ra Please read compliance statement on back of permit'r* Application Fee(s) Check # Permit Officer's Printed Name Signatu e Issuing D to Expirfition Date ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to /i'1%�I� "%�- s() 'I- T\, Z:F )\ ,s _ (Name of Property Owner /C Z property located atL/4 U)gF�Y C t (Address, Lot Block, Road, etc.) on t- in "A)f '.c/ULJ ", , N.C. ( aterbody) (City/Town and/or County) The applic t has described to me, as shown below, the development proposed at the above atio . 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) Dock ,-x7-,FV 7- reV -- A DU oN -To �X � �T,t/� h6 r< , sT.z�c/G s~T�.�k's Wit. hoc u7ff� 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 wai the setback, you must initial the appropriate blank below.) C�-1 do wish to waive the 15' setback requirement. t I do not wish to waive the 15' setback (Property Owner Information) Signature p .n44,e Z-Zt/ Print or Type Name lO �vt U�A/P- M fling Address ibrw�Ff/D[ L S%1bQl`S �iG Cit /State' Z 2- 03 9,�1- tl�o s Telephone Number LJ- /4/-moo/� Date Sign ure P�-r-ck S4-1,,06E-P—S Print or Type Name / o (� /,I uz!U-U-�Y c l Mailing Address PT,Ur KAI-OZ-1- City/Statelzip Telephone Number _ i Ll �o / 9 HECENED Date (Revised 6/18%F)j 3 Z019 DCM-MHD CITY ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (� I hereby certify that I own property adjacent to /Y1. L77.) t tLiUl I\t.,C��'s (Name of Property Owner) property located at on I- in, _N.C. (Waterbody) (City/Town 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. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must flll in description below or attach a site drawing) DOCK t--XT; ,t/ 73oN - AU) ON 70 Q6t<. 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,st initial the appropriate blank below.) I do wish to waive the 15' setback requirement. I do not wish to waive the 16 setback requirement. (Property Owner Information) (Adjace Property Owner Information) Signature Sign` wAe 9. r�r. / fin/ z P .i t z �+ RpiI C_ or Telephone Number Date C?` / 0 City/State/zip RECEIVED Telephone Number Date MAY 13 2019 (Revised 6/1&26&-MHD CITY ILL �n i RECEIVED MAY 13 ZW9 DCM-MHD CITY