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Home My WebLink AboutPage, Allen�^ ❑ CAMA / ❑ DREDGE & FILL , ; No. 75984 A B C D dENERAL 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 C mission n area of environmental concern pursuant to 1 SA NCAC / CT EAR es attached. Applicant Nam//e '' j ,'� r,^ � _ e. Project Location: County K"_ Addracc t_ �" . /'" () I r /, , !` , r, Street Address/ State Road/ Lot #(s) City Lh State/ (, ZIP Phone # O E (/" (; ' E-Mail Authorized Agent i Affected OCW ❑EW ❑PTA DES ❑PTS AEC(s): OOEA ❑HHF ❑IH ❑UBA El N/A f p PWS: ORW: 'yeO no PNA yes / not r Subdivision o ' Phone # O - River Basin✓ (�, Adj. Wtr. Body " E(nat /man /unkn) Closest Maj. Wtr. Body ■ ■N■■M■E■■■M ■..■°..■■.■°ON ■■■■■■■■M■■O■.■■■■N MECCM M■..E■..■■■E■M■■■■..■:■■C■C■..■°..°■.■°■■■°■■ moms ■■■■ SEEN ■ME ■■■E■■■. MEN MEMOS ■■■■ ■■ ■■■■■■■.... OEM ..■■■■■E■■■■■■■■■■M■■■■■.� ■■■■■Gy111 O■■■IrM M■■■■■■■E■E■1 ■MM■■■■■ MEN In °°CC°° EMEM11.41 ■■■■■■■Y<I■■ MEN ■■■■■■■Y(�■■C41■■Y■■■■■■■■■ ■E■ ■■■FM ME■■■■■ MEN ■■■MEN ■■■■■■■■■■■■ ■■■C ■■GM■■ ■■■■■ MC■■■■■■■■■■�Il■■■■■■ ■■ ■■.■C.. ■.■■C■■■■■ ON FINE .■��■■.Ell ■■■■■■1� MEN A■■■E■MI�■■EE►t■►IMM■/Eli/ ■■■■ ■■■■■■■ ENE IJMIl41 ME►/t�E■[!%!■MnE■QE■►AIL■ICi■■■ ■■■■ ■■■■■■■■■■■■■ MEMO ■■■■■■■■■rI■■■■■■ ■■■■ M■■■■M■nOMEN ■ ■■■■C ■■■■■■■■■■■ ■ ■ 0 ■■■C '1L°°UC°°°CC°E°®r�C�CC■C■CIn ■■■■■■■!I■■O��l■■■■■■■�Tiu■a■i■1i■■■M■MrrM■■■■ • ■■■■■ ■■■■ni ME■■■MM■■■E■■ MEN ■■CM■Omni ■■E■■■■■u■E■■M■ ■■0■E■ MEN ■■■■■■■ ■M■ ■■■■■■■C■M■ ■C MEN ■■■M�■■0 MEN ...■ ..00..ME..■CC. MEN ■■E■ E■■E■E■■■■■■E■M C ...0 ■■■C.■. C �. ::.E C� CCC°■CCCCCCCC°■CCCC®CSEE ME ON ■■ ■■■E■■■■■■■■...■.■■■■■. ■■■CCCC°CCCC No CSEE :CCCCCCCC....C....0 ONCCCCCCCCCC Agent or Applicant Printed Name - Signature •'r Please read compliance statement on back of permit° Application Fee(s) Check # PermitOfficer's Printed Name Signature' Issuing D to *Ep1Vt,,nte AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: C. Mailing Address: G l 0-1 N C- Phone Number: '3 le Q�13 \\U7" — Email Address: 11\ ,.-. A , C- I certify that I have authorized 'U )Q C C ci 0A ", c f (nnS L -1j— Agent 1 Contractor to act on my behalf, for the purpose of applying for and obtaining all A A permits (� necessary for the following proposed development: at my property located at (�S) O 1 :�PUW-J jr)y2, FI in Ca�� er< -4 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: . ) 3igPt re Print or Typ Name Title Date FiECEIW':'D This certification is valid through / DEC 03 I)CM-MHD (;I i'Y ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to k1le-y , a a 's came of Pr perty Owner) property located at 91� wunrA c�� mel��al (Address, Lot, Block, Roa , e c.) .(� on )OWip SoUrA , in E rvveofix L' �,� N.C. . (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above loc taign. I have no objection to this proposal. _-- I ha_ve-obj-clions-to_this_pro posaL__---.----__ _ _ - _.— __- .---- ------------- - DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill in description be/R.W or attach a site drawing) xis�itt Y cltacK waS �e \ov�_A rT tin Wet AIVE TIO I understand that a pier, dock, mooring pilings, breakwater, boat Ouse, lift, or groin mus 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) (AdjaFentYroperty Owner Information) Signature R stxludmli ffxC-4,' Print or Type Name Pr .' t or Type Name took 1 2`% 1J 2 /6td 2', Owe Ma'ling Address Mailing Addre Elp ss G a ] S City/State ip --�— Cit Sstate/Zip � !1po, ib I Telephone Number Telephone Number Date Date RECEI FRID (Revised 611812012) DEC. 0 3 2U19 [)CM-IV.HD CITY ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to )!pertOwn:er)::— 's (Name of Pr9property located at a� �l sc7Ur'd Ar -" C'�(el (Address, Lot, Block, Road, etc.) on (�csr�e SU't� in M cai cl 1�.1n , 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 havobjections to this proposaL. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) T I i-lcx15;k V" \Owe \ Q� -FINE i5 ",i6tc kA`e olel � dark was 1��hvi�G WAIVER S ON 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) 1 Si nature Print or or Type Name) to t � rJ Mailing Address ('J L r°)�n "I City/State2 p 331-4 `aI-�!> 1\�� Telephone Number Data 4djacen.�' pe Owner Information) ignat w�e— rint o 70-3UZam§P,,42R oW (7ON /1- &%V k- lailin 55c/�1dd � , C_ �1? 0 � ;ity/Stla�teAl�dl�l01-1'f96d- 7elephone NubeRECEIVED _ f 1 Iti4�l°l Date ❑❑ r� (n� (Revised 6/16i 9 2y s 2019 DCM-MFID CITY