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Home My WebLink AboutKennedy, John❑,CAMA / ❑ O N. DREDGE h FILL 78414 A s c D "GENERAL PERMIT Previous permit# New ❑Modification ❑Complete Reissue []Partial Reissue Date previous permit issued As autho ized by the State of North Carolina, Department of Fnvirogmental Quality and the Coastal Resources Commission,in an area of enviroMmental concern pursuant to I SA NCAC --- ❑Rules attached. Applicant Name 'I \I _ _ fi ---- Project Location: County Address Street Address/ State Road/ Lot #(s) State ZIP City l ( �.%f I �' r ; l Phone # (�� 7� / �-Mail / � Subdivision Authorized \hAgent T �I t lla f (� la. t'•-l-t` City ( ZIP__ Affected \�W YEW❑PTA \ES ❑PTS Phone# (� �7[ /' River Basin 0 OEA E0HHF DIH LZ UBA ❑N/A AEC(s): ❑ PWS: Adj. Wtr. Body (nat /man /unkn) ORW: yes / no PNA yes / no Closest Maj. Wtr. Body Type of project/ Activity N■■R I111■■■■■■■a■■■■■■■■■■11' ■Il■I■ir!AA!■■■ 00■F1 00■■■■■■■■■■■■■19ME =■■■■iSiW■■■■■■■■■■■■■■ 1[I■■■11l�IIl� M■■INtiI ■■■■11®■■■■■■■■I■■1 ■l��uwNN■■I� — Ilea■■■I�I�i■■�■■■■■■■■I�■r?ul■■■■■Im ■!fir'■■i�Jl•J�■��■■■■■■�■■! ■C+■t1111 0 N■■[2M\II ■�■i��■■Nib)�7■■■■■1/;l�i■�>I�1■■■■■liii7M'iill ■■■■■EVEM■■■■■■li■■■ltlr rl■t ■■■�iN71 �■I....wwl�■■ M. ■■■I E ■U■NM■■■B ■►Fi11111 Neu■■N0■■lag■■■■P�jl■■�y1■■■■■■1'r1 ■ Id'�■w!�■■�r�■■■cup■■■u■■■■In■c■■�■■■■■■■a-e■i■ ■■1110Ilri+993'NCI■■1■■■■11■■■■�■I■■C�■■■■■■■■■■ ■N■h■■■■■■fi■■11�■■■11■I■11A1■■►le■■■!�■■■■■■■■■ •■■�!NI■1/Itll'■f■■rl/.r✓■11■ilr;:v■■®ui,Nlll]■■■■■■■■■1■IH■ '' jrl.NZn!■r�.■■1■I►1u�'sll■1■■n■■■■■■III■■.�■■■■■■■■■�■ -■■I•\:M■■■■M■N■11■■■■��e■■■■■■■■■■■■■■q■ ■■■■■■■■■■■■■■■■Il■■■I■■III■■��■■■■■■■■'■■■ ■■■■■■■■■■■■■■11■■■■11■ill■Emil ■MEN ■■■■111 MEN EMESEEN HPI VA Is in Ol Agent or Applicant Printed Name t s tj Signature r• Please read compliance statement on back of permit r Application Fee(s) Check # PermitOfficer's Printed Name Signature / 1 Issuing Date Expiration Date Pik Type of project/ Activity N■■R I111■■■■■■■a■■■■■■■■■■11' ■Il■I■ir!AA!■■■ 00■F1 00■■■■■■■■■■■■■19ME =■■■■iSiW■■■■■■■■■■■■■■ 1[I■■■11l�IIl� M■■INtiI ■■■■11®■■■■■■■■I■■1 ■l��uwNN■■I� — Ilea■■■I�I�i■■�■■■■■■■■I�■r?ul■■■■■Im ■!fir'■■i�Jl•J�■��■■■■■■�■■! ■C+■t1111 0 N■■[2M\II ■�■i��■■Nib)�7■■■■■1/;l�i■�>I�1■■■■■liii7M'iill ■■■■■EVEM■■■■■■li■■■ltlr rl■t ■■■�iN71 �■I....wwl�■■ M. ■■■I E ■U■NM■■■B ■►Fi11111 Neu■■N0■■lag■■■■P�jl■■�y1■■■■■■1'r1 ■ Id'�■w!�■■�r�■■■cup■■■u■■■■In■c■■�■■■■■■■a-e■i■ ■■1110Ilri+993'NCI■■1■■■■11■■■■�■I■■C�■■■■■■■■■■ ■N■h■■■■■■fi■■11�■■■11■I■11A1■■►le■■■!�■■■■■■■■■ •■■�!NI■1/Itll'■f■■rl/.r✓■11■ilr;:v■■®ui,Nlll]■■■■■■■■■1■IH■ '' jrl.NZn!■r�.■■1■I►1u�'sll■1■■n■■■■■■III■■.�■■■■■■■■■�■ -■■I•\:M■■■■M■N■11■■■■��e■■■■■■■■■■■■■■q■ ■■■■■■■■■■■■■■■■Il■■■I■■III■■��■■■■■■■■'■■■ ■■■■■■■■■■■■■■11■■■■11■ill■Emil ■MEN ■■■■111 MEN EMESEEN HPI VA Is in Ol Agent or Applicant Printed Name t s tj Signature r• Please read compliance statement on back of permit r Application Fee(s) Check # PermitOfficer's Printed Name Signature / 1 Issuing Date Expiration Date Pik Agent or Applicant Printed Name t s tj Signature r• Please read compliance statement on back of permit r Application Fee(s) Check # PermitOfficer's Printed Name Signature / 1 Issuing Date Expiration Date Pik AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Mailing Address: S3 Phone Number: 1' /d - sw - � a y ?l Email Address: �1pnn�4 � ac h c . r /- , � /I,- I certify that I have authorized lti eAmlzi ,ruz_ Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: zLe , at my property located at S3 S o 7,)41t, e , in �,-2-j& 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 RECEIVED DEC 09 2019 Print or Type Name —PA txs, &,Cr� DCM-MHD CITY Title 9 12 Date This certification is valid through ),2 / 3 / //9 3 I hereby certify that I own property adjacent to __.-„�� S 's (Name of Propertq Owner) property located at on P N.C. The applicant has described to me. as shown below, the development proposed at the above location. I have no objection to this proposal. 1 have objections to this proposal. DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must flit /n description below or attach a site drawing) John Kennedy 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 waivod by me. (if you wish to %0?U%%ba9cvovou must initial the appropriate blank below.) I do wish to waive the 15' setback requirement. do npl{gilitpg ppj(i flj� ack requirement. (Property Owner Information) 910-580.0249 .Signature Prm! or Type Name 11/11/19 Mailing Addmss QfyfStatemp Telephone Number / emal address (Adjacent Property Owner Information) "0110) Ti RECEIVED DEC 0 9 2M DCM-MHD CITY ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to oAK Kep s (Name of Prope Owner) property located at S3� /��1`LtN� 7)riUe-- (Address, Lot, Block, Road, etc.) on in h a �r Ft rr f N.C. (Waterbody) (CityrTown and/or County) The applicant has described to me, as shown below, the development proposed at the above location n ��--.. /j I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMEN r (Individual proposing development must flll in description below or attach a site drawing) �r.P.t-/--j�u�-./ZPc'tJat-C-Q, B-✓I /J.��- G?�vrd�'!� lL- , t uil John Kennedy W eJ-0 �"'O `� ne bow- C4a 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 toMIMAA TLtAevou must initial the appropriate blank below.) RECEIVED I do wish to waive the 15' setback requirement. DEC 0 9 2019 1 do nQ It7A t K e 2&aback requirement. „rM_nnHp CITY (Property Owner Information) 910-580-0249 Sralure mn r. torTypeN'a{na 11/11/19 1p Talk. Mailing Address 535 Iyenflir.e- �i— Cit /Statelzip Z,ern Moroi NC o�`6Sg Telephone Number/email address qic Sgo Da�9 Dole % 18 �L-0I1 "Valid for one calendar year after signature' (Adjacent Property Owner Information) Signature* -r Print or Type Name 3 3 % /✓ 7 n . Mailing Address (�d c i �— /JL Z!J City/Sta elLip M < 7e) � j Telephone NuMberlerhail address _ / Date* S/31 (Revised Aug. 2014) 0 .r, i1 yam,^^•.. �� VFD 9 Z019 jD CITY 3 f0%�'t 3 "ar.C.1.4t.j 5Pa w a. t � 0 9 '�019 �G_e�W® G�� I1 Ici (� LV'j&,