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Home My WebLink AboutFelton, Timothy®L CAMA / ❑DREDGE &FILL a NO �7O 2 . ! 8420 A B C D NERAL PERMIT Previous permit# As authorized by the State North ❑Complete Reissue ❑Partial Reissue Date previous permit/ issued�dt` r ❑ VV TtN!v tate of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC Rules Applicant Name Project Location: County l 11 Address ! Street Address/ State Road/ Lot { (s) City' /<JState ( ZIP ` , -�1 IL I 2 � t Phone # Mail Subdivision • Authorized Agent t _i ; 1. �% q City r Affected t� ❑CW 1 ❑iW ,PTA ES OPTS Phone # (jam) !River Basin �•_; OEA ❑HHF ❑IH UBA El N/A i AEC(s): (l ' (nat /m�� nkn) ❑ PW$: Adj. Wtr. Body ORW: yes / 1 PNA yes / r) Closest Maj. Wtr. 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Name Signature ""Please readcompliance statement on back ofpaelr[miit" Application Fee(s) Check# Permit Officer's Printed Nam- �Sign turee �. ,)olo Iss ing Date xpi tion Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: TAM t9211 -F5L-ry N Mailing Address: All R �/FA I rz CZO A'D G1 IIJ G : 7I 0 ' Phone Number: -qZZ 5g9c[ Email Address: +I M 0' I C+l Frioper:�y s r c eS , CO I certify that I have authorized T Agent i Contractor to act on my behalf, for the purpose of applying for and obtaining all C/AMA permits K necessary for the following proposed development: �� I KhYri r r/' & �y I a / bDO7+ 11 a^) dl rdgt Aj _ at my property located at I in i'iounty. 1 furthermore certify that 1 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 Print or Type Name ow Title u l Date �— to This certification is valid through I 1 3 I / 20 ADJACENT RIPARIAN PROPERTY OWNER __STATEMENT I hereby Ce1lfy ±hat I oven properly adjacent to A T ( ," .c� (Name of of Property Owner) aroperty located at (Address, Lot, Block, Road, etc.) !J-C on SM l7"-{- �: —11/ 1 -"_. in 14-7-c-./r -te. (��.Yz.-(�— (Waterbody) (City/Town and/or County) The applicpfThas described to me, as shown below. the development proposed at the above location. I have no objection to this Froposal. ! have objections to this proposal -- DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) WAIVER SECTION, under5,am tr.a: :, uiei jock. n,00iing pilings. boat rampbreakwaterboathouse bft. or groin a mrnimum distance of 16 from my area of riparian access unless Waived ny a've tl,e setbac'r, you must initial the appropriate blank below A, z;aive the 15' setback requlremert I do not,-msh to waive the 15' setback requirement (Property Owner Information) ADJACENT RIPARIAN PROPERTY OWNER FF S O/WNER STATEMENTI 1 i--�bN ' I hereby certify that I own property adjacent to .((M Name of Property Owner) property located at l T 1 S OLI IJ D A 4 (Address, Lot, Block, Road, etc.) on SM I -rI4 C—A-7.1±L _,in' l� TLiFNTI � !3�/F G!� . N.C. (Waterbody) (CltyiIown andlorCounty) The applicant has described to me, as shown below, the development proposed at the above location --AN, have no objection to this proposal. I have objections to this proposal. DESCRIPTION ANDIOR 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.) ,40 � I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) (Aent�operd OWner IWorvlatfon) aVs Type Na 0o x -- )ne Number/email address Dare (Revised Aug. 2014)