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Home My WebLink AboutWatson, Sam�CAMA / ❑ DREDGE & FILL No. 75927 A B c - D GENERAL PERMIT Previous permit# 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 U Rules attached. Applicant Name l , Address' City 1 .� , / State ('d l� ZIP ! / Phone # / 0) % ' /�/� E-Mail Authorized Agent �� i I/i S ' r ' Affected - b cw 0 EW 'PTA ❑ ES ❑ PTS ❑OEA ❑HHF JIH ❑UBA ❑N/A AEC(s): ❑ PWS: ORW: yes / no PNA yes / no f Project Location: County Street Address/ State Road/ Lot #(s) Subdivision City ZIP Phone # O River Basin Adj. Wtr. Body i (fiat 1/man Junk,) Closest Maj. Wtr. 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I■■■. ..� .■■�� O■■�i�C ME■■■ ■■■ ■ ■■■■■ ■■■ ■■■ .. .. ...■■■ . ■ ■■......M■..■...■...■E.®■■ MEN ..■M■■.■■■■ • MEMO ■■M■ ■■ MN■■■ EME ■■■E ■■E■■■N O ■■■■i�i ■N■�■■ll M■■■�■■■C ONE ■C■�■■.■iC■ MEIN:'■'■'■MMMM:M'■'.:a::�'■:'.'■::'.�'.M s Elm00 giiaimiiiiii®�� Ni D '�� C �CE�■ .�E C �®■■ i■■ ii .. � ■■N■N■■�C.■NMCNMEN®■rd�EEM�■■■1�■:■MC■u■ 1Age� o Applicant Printed Namp"x Signature **Plea3.e ead compliance statement on back of permit** Application Fee(s) Check# Permit Officers Printed Name Sig re Issuing Date Expiration Date U uV NFIL AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: _ , ) a m w e l G . W e4,56 n Mailing Address: Phone Number: Email Address: I certify that I have authorized 040 f hnd u ,'Lk 5havc,s Or 919- A18- 2140 AWVII%/ l UFI11aULUl to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: —r)'X 1 D6' 17 I eV, 1 a1 X ►01' at my property located at 943 Chad wick 5hhrep5 Dr V2 , in 01161dliJ County. I furthermore certify that / 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 evaluating information related to this permit application. Property ner lnfor{na�tio�n/:` Signature S� t. G tj,-rSun/ Print or Type Name Title 1 u I !10 Date This certification is valid through ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to 5(m u e I 6. u ktf'm n s ��.� oProperlwner) C�lC�5property located at huI sE on �Eulkd (')rak Naaarein (Waterbody) N.C. The applicant has described to me, as shown below, the development proposed at the above location 2c.C] 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) 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.) Date I do wish to waive the 15' setback requirement. ,ZR W-do not wish to waive the 15' setback requirement. Information) or Mailing Address r-40 Cl' 1914-f--a City/State/Zip `4Ob ele o%eNu ber/email address //iT71q Date* (Revised Aug. 2014) *Valid for one calendar year after signature* ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to ,� n m u e / G c,(d 6o n s , h I I (Name of Property Owner) property located at I / (Address, Lot, Block, oa�tc.) on �Q r(� l ,E�+ K in "� (3e (( - ej r(1 N.C. (Waterbody) (City/Town and/ok County) The applicant has described to me, as shown below, the development proposed at the above locai-. __t�b - 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) See Mlac&d Draining 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. Print or Type Name 843 r9 -V LC4' 5k Aqs 2 . Mailing Address S�v EFIlA I C- 7.0 City/State ip Telephone Number/email address I,,."•Zots (Adjacent Pro erty Owner Infor ation) f Sig ature* 1, j4tr4CL T. �� Print or T pe Name Mailing Address W'3 rJC 261'73 Cit /State/Zip jay. S i 6 ( 21 7 Telephone Number/email address Date Date *Valid for one calendar year after signature* (Revised Aug. 2014) I em C/1A&01Gk SitOVCcT r----- a11' —� 84,