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Home My WebLink AboutWall, CBJRCAMA / ObREDGE & FILL No. 74447 A B ' C D GENERAL PERMIT Previous permit# -.—J [)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 I SA NCAC . Rules attached. Applicant Name (/ w `' �' ! I Project Location: County ; .,, r ule Address 1� ) T~ �l _ i Street Address/ State Road/ Lot #(s) Phone# CL!_ Authorized Agent Affected ❑CW AEC(s): ❑ OEA ❑ PWS State ZIP (i { E-Mail -CJ EW [I PTA El ES ❑PTS ❑HHF ❑IH ❑UBA ❑N/A ORW: yes /. no PNA yes / no Type of Project/ Activity Pier Fixe Subdivision City ZIP Phone # ( ) River Basin Alee r,f'_ Adj. Wtr. Body ?-f Aat)man nkn Closest Maj. Wtr. Body 1 ' 0 J ; ce i i y (Scale: � ) ■■■■■■■■M■■■■■■■■■■■■OEM■■■■■■■■■■■■ ■M ■■■\�®■■ ■ ■■■■■■�aMEN ■■■■ ■■■ ■ ■■...W■■..C■�i......�.�;;.1■■■C...■�i�. moil �M MMEN ■E■■nE �i■ME ■E ■ 0EN No ■■■■■■C;�■■■■■■■■■■■■ii •■■ ■■■■■■■i/;Cil■^�lEENE number■■■■■■■OMMEM■■MEMO■■ei■■■■ MEN iWiEEMI■■ ■11■MI■■■■■M■E■■■■■■� M■■■E■■MM■MEMO ME■ ■ ■■ ■■■■■MMM■■■M■■'E MEN ■EMEN MEMO MIN ■EEMME■■■■■■w■E■ OEM OMMOM ■EMEN ►�■M■■■ ■ ■ ■■■■■■MMEM ■C..OEM Oi�MEN OdM■■■CM �■■■l'il1 MEMEMEMME■■■� M■N■■®M■M MEE■■■ NONE �IN ■■ E■■M INAMI LME MMEEE® ®MM aMYEili1!L� 3_��?O•JE3�EMEWEE■ MEN 11MI'M�C■.■■ �■ 1111 1■■■■■■■■ESE■EMME �WEEii4 MEMO ■■■■■0■E ■■■■■■N■■■ ■■■■ ■■M IN ■ 11MEMEO■■■■■■■Mi■E■■EE�E■■■■■■■■E MEN ■ ■ ■EM■EM ■■IiI�MN■■■. M■■■ ®■ ■M■�E■ ■■■■■ ■■■ ■■■�=r�ra■iv notsure yes C�■iC■E�C■■■■■■■EMC■■■ME ■■■ ■ '■: SC :'.:'.'. :'.'■:'.'.'. :�'■CMEE Float Fing Groff length Bulk Basil Boat Boat Beat Oth, Sher SAV Mo Phutyes n Waiv_ A building permit may be required by: `I Al,\t, 1 r0 \ 01 t t ( Note Local Planning jurisdiction) Notes/ Special Conditions ['See note on back regarding River Basin rules. I / r Agent or Applicant Printed Name' / PermitOmcer s Printed Name Signature '"" Please read compliance statement on back of permit** Signatu e 7e 7r� Application Feels) - c Check# 155uing Date 'Exp Date I hereby certify that I own property adjacent to I— I T acne of Property Owner) property located at 3 4q- �J ton 1 e iit (Address, Lot, Block, Road, etc.) on in /e GO. N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. j// 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) /4DlP Ri4-e 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. (Property Owner Information) Signature Print or Type Name ,74 D-A4,V ieWeL- Mailing Address City/State/Zip &Z/- 7919- 9/90 _ Teleph no NNj�m�her Dar(r----------- (Adjacent Property Owner Information) /Z n ) n /% , P int or Type Name T.D F7k 2-',, 1 Address nm c>OR /V 919 3-z17 <f 3 1 % _ Telephone Number Date (Revised 611812012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to %PPT t�.'Z IlZA1, L 's (Name of Property Owner) property located at D 4 r.4r4A4�r,� /YG Z9S/D (Address, Lot, Block, Road, etc.) on in '01�4'wxl'-o moo. , N.C. (Waterbody) (CitylTown and/or County) The applicant has described to me, as shown below, the development proposed at the above locatioyr d 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) j?�P�� "e<</�Goi�� d" IDD /'?`/P R-4,/ ";� WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin back a minimum distance of 15' from my area of riparian access unless waived b 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) Ygnature �i�c�T• <:-2 Print or Type Name Mailing Address �9-se.tcP�Yff�� /yC a8s �o City/state/ ip - Telephone Number Dat y must be set me. (If you (Adjacent /Property (�Owner Information) Sign tur C < Print or Type Name 5C''7 �'Il Mailin�Address 1\u UUmoht 0C aq 5 7z�- City/state/Zi, '�q rl y _ �) S GAS Telephone Number -- 5 �� Date (Revised 611812012)