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Home My WebLink AboutWillis, Giles} AMA / [z,DREDGE & FILL No. 75953 A B / C/ D GENERAL PERMIT Previous permit# l/ jjew ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued As authorri`zeed by the State of North Carolina, Department of Environmental Quality I� // and the Coastal,'Resources Commission in an area of envir nmental concern pursuant to I SA NCAC r L ❑ Rule sjttached. Applicant Name_ �C7 1*_1 /'i _ Project Location: County _ State( ZIP Phone#11R) Authorized Agent i, Affected ❑ OW QEW ❑ PTA El ES ElPTS A Affecte ❑OEA ❑HHF LI IH ❑UBA ❑N/A ❑ PWS: ORW: yes (oo) PNA yes /'no Street Address/ State Road/ Lot #(s) 0"t'�' v P '/ Subdivision City (--(0 i,/r/1't ZIP Phone # ( ) River Basin Adj. Wtr. Body "' / ' " � Gnat /man /unkn) Closest Maj. Wtr. Body 1 41 Type of Project/ Activity -(U r r Q r j (Scale: """V f ) Pier Fixe Float Fing Groff Bulk Basi Boat Boat Beac Oth Shor SAM Mor, Phot Waiv SEEN N■■■ ■UN■■ length number— ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ SEES■ gt Vh rn� distance offshore ■■■■■■■■■■■■■■■■■■■■■■■■■■N■■■ ■■11N■■ ::■■1::::::■:::::::::::■::::::::�■■:�:: cubic yards .■■■■■■■■N:■■■■■■..■.■:M■N■■■■N■E■E■ ramp .■■■■■■■■ ......................■■..■■■■■ ■■■■■■■■■■■■■■■■■■ ■■■E■ Ouse/ Boatlift ::■SM■■MN■ :■■■■SEEN■■ ME MEMEME MEMO MEMO ■� IMMEMEME ■■ O E■ ....0 �I■■■■■�M AiiT/f l■iliEM M.. ML off No MEMO ■■■■ �I■Er P-lineLeng!th EMEMEMEM �E :■� ■■: ■■■■■■1--3■M■ll �■.■■■ . ■■ ::■■, OEM::: so ■ ■ ■MN■■ !7S■MN■■M■_ NM■■ ■ notsure yes no :.:.:::®.■.■.,[G:: ■,M■W►■..M1ell:::■■■.■�■: torium: n/a yes no MEMEMEM■ ■■MLI!]�i. N 11■re�irl■■■■■ N■O■ N■ s: yes . ■■N■■■■: NONE ..:�:::::::11::■■■M■ :r Attached: Yes ,.MMM■■��■M:::■■■.111E MEMME A building permit may be required by: l.. �� `� 4 See note on back regarding River asin rul S. (Note Local Planning jurisdiction) r " t(J /./�A'. Notes/ Sprcial Conditions i !. 'i 1 � be - Agent or Applicant Printed Name PermitOfflcer's PyiKed Oamee--------..— ---------- Signaty a 't' Please read compliance statement on back of permitaz" Signature M plicatidn Fee(s)Fee(s) Check# Issuing ate �piratl nDate ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to 6/ LC--!:S' 60 JO/cL-i SyIZ- 's (Name of Property Owner) property located at /S 3 J7cx.Jn home gp'qd (Address, Lot, Block, Road, etc.) on Sh A i 15 in oy C S -r<-� (Waterbody) (City/Town and/or County) N.C. The applicant has described to me, as shown below, the development proposed at the above location. ?C I have no objection to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) A)e W11—e- 6e- d00711AJZ? BL�c./c.. /.✓ �rzdn� o� �iCJl.�riese.r.L 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) Siggnnature J 2 ri le S v� GJ/u tS Print or Type Name /53 71tjnhome, 66',z-o i ailing Address r>tl cle-S7GiL� NV Cify/State"p 2-Ca31 Telephone Number /U0\/ 0- 7C�lcir (Adjacent Property Owner I ormation) Signature n Printo>Typeme/ �3`1 J 9/6 9-)-7'z-0-7 Teleph�oqe Number xnV z 20 1 i RECEIVED Dare Date "'?!/ 0 5 2019 (Revised 611812012) CITY DCM-iV IAD (11"ry ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to C�i L-6 S W IL-(-i -S 's A14ame of Property Owner) property located at I S 3 --Dau-)n hvrn(' "jg C S� FS (Address, Lot, Block, Road, etc.) on , 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. x I have no objection to this proposal. __- _-----�hav�objQ�ton�ts�this_pr_npo aL--------------- DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) GcJ� uJ1// h° tau /�JrJ. ro�� i,v Gronf- dh i3v/kh,e�o� 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. (Pro / party Owner Information) (Adjacent Pro arty Ow�mation) Signature Gies IJ 11J/4,C 2 Print or Ty �e Name 15 3 / )bt.Jn home_ T CL i ,,ling Address ,ocJC'eS rR, A 0, Fs'S City/slat— e z�� -7z5 � Telephone Number /UDC/ 7, l � Date or M ifng Addres tnil0'a'AA- J 5 - JS9 ( ,a�rFlvEo TelepaN� D J1 01 Date /ate 0 5 Z019 (Re&UM*D 4ITY W4 11 RECEIVED OV 05 2019 DCM-MHD CITY AGENT AUTHORIZATION FOR CAMA PERIVIIT.APPLICATION Name of Property Owner Requesting Permit: Z60'//es 6, 0 lj/LL/S �/%L' Mailing Address: Phone Number: Email Address: I certify that I have authorized 6A) w ce s >�, � C. -zY�� zS"L 70S` 2,6Y to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: at my property located at IS 3 b6Wy\ k oy4 2-c (V ouc&se�f in C Cc C+f Yf-"1 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 Officer and their agents to enter on the aforementioned lands in connection with evaluating information -related to this permit application. Property Owner Information: Signature Ct) %/2 aSa�- Print or Type Name Title 7-/ Date This certification is valid through ��(.EIVED DCM-MHD CITY'