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Home My WebLink AboutStephenson, KatiegCAMA / ❑ DREDGE & FILL N. O 78424 A B C D GENERAL PERMIT Previous permit# Phew ❑Modification ❑Complete Reissue [-]Partial Reissue Date previous permit issued As uthorized by the State of North Carolina, Department of Environmental Quality anIthe Coastal Resources Commission in a area f environmental concern pursuant to 15A NCAC ( t 1 I / Ruless ttached. Applicant Name 1 \ o t t f f I (%% ( /�'� Project Location: County Cr-1 F f ( Address City [ Phone #(r)1. Authorized Agent Affected D& ❑ OEA Street Address/ State Road/ Lot �4(s) State�ZIP_- )LL /�� ( ("�. I•i /. E-Mail 4W ❑P(A AEC(s): OHHF ❑ IH ❑ PWS: ORW: yes)/ no PNA yes / no Subdivisi n city zlP 1i` ❑ES ❑Frs Phone# ( ) ) River Basin ...,� •,1 ."4,? ❑ UBA ❑ N/A Adj. Wtr. Body % C-I i-" (� (nnat /man /unkn) I r Closest Maj. Wtr. Body all ' MINES■■■ME■ W■■ ■M■N■�■■ENMWGETiEINEE■�■■�■ W W MEN■■■rl■■■■■■■■■■■■■� ■■ENE■WSI�JN M■IJ■EIS■ ONES ■■!!e - MEMO .N �E■..C■■■. M■..�SEE ENE 0■■■ MEN ..� MINES ■® �E:E 0 M : MC.■..M■�E� :::O EM :C NM I0 MEMO■■■■NE mom ■■■MEN W ME OEM SEEN 111.. W■ ....■■ l'IDVMf�II�■■■ aiiiiiiM■i■N1ln'i■�i�■iiiiiii No .. IM ■■ IN vv��u.: :■E • M■M■■.. SEEMS M■N■■SE WOEM■ME SEE ME ■■■■■■■■ MEMO N■■M■�SEEN � W ■■■M■NM ME �M■ MR MW SEEMS _ ....�C. : .....CC. . Simi Agent or Applicant Printed Name Signature ** Please read compliance statement on backofpermit** Signature Application Fee(s) Check# Issuing Ds r j r Expi ation Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: jY4;�}- Mailing Address: Phone Number: M - Z.71- I S3-7 Email Address: I certify that I have authorized to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: R mLi at my property located at i 1 in 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 0 ffcer and their agents to enter on the aforementioned lands in connection with evaluating information related to this permit application. Property Owner Information: Signatursv -_Kph; t-J, S+c,el,e►15o.1 Print or Type Name Ow Title 12 ! f S—i 20 tcl Date This certification is valid through I hereby certify that I own property adjacent to K4 1e- •-f4� s property located at Lil�j (' �w.yi (Name of PropEftyOwner) on ",,4 v,Gp� �' ti (Address, Lot, Bloc (Waterbody) (City/Town andfor County) k, Rq'ad, tc. N.C. L in rir�6>l 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) Ll Ll 15 I � 1-1 35 r Cr LA -NO lam" -d 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) 12--rS"-tq Dare 'Valid for one calendar year after signature' (Adjacent Property OwnRr Information) or l@� rc,a r�con7 c Date (Revised Aug. 2014) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to �60A 's (Name of Prop Owner) property located at `1 �� Q�y� r pr �� ( on Ccr—s4 C--ti,c,>� (�ti (Address, Lot, Block, Road,f tc.1 (Waterbod —,in � js a_ " C'`'`�rn + , N.C. Y) . (Cityrrown 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 till in description below or attach a site drawing) L' 15 Li 1,5 C� LAtJ n l7/ wAe-c LM D 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 �-J_ I do not wish to waive the 15' setback requirement. (Property Owner Information) Lois l (Adjacent Property Owner I Fon) t n /gnalum* 'Valid for one calendar year after signature' (Revised Aug. 2014) 1