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Home My WebLink AboutNeese, DavidUCAMA /,O DREDGE & FILL GENERAL PERMIT `New ❑Modification ❑Complete Reissue ❑Partial Reissue N9 78403 A Previous permit # 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 �� j.'%�, r�'' - ❑R les attached Applicant Name A_ n(\]" ,"Q I' �t E� - -'�'� Address ) ��, I� f '�r �(' A � i1 l /I n City L., 7 Stat�'�� ZIP 'iln r/ Phone # (�f) i E-Mail Authorized Agent /��1,1 ('; if ri'' Affected ❑CW ,� EW ,. IPTA >ES ❑PTS AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: ORW: yes / no PNA yes /-"no L� u � Project Location: County n kA Street Address/ State Road/ Lot #(s) r/ Subdivision City ZIP Phone # (_)((r��" �ri%/' River Basin Adj. Wtr. Body I�Sh ? x r 1 /t f (nat /man /unkn) r Closest Maj. Wtr. 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Now INN' E � EEC EEE: Agent or Apelliicant Printed Name Si n ture'k'"`Pleaseread compliance statement onback ofpermit" �n Application Fee(s) Check # :VI r �„ ►► Permit Officers Printed Na h , 4� Sign tur / ) o Issuing bate Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: �[I.., Mailing Address: Phone Number: Email Address: I certify that I have authorized 3,-! BL�k_< )-, ) V 117 lL n , i) t I - b, < Jam; . ( . , ! ' .. Z 5 z .21 k,t 1 "l i" to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: T-)3 c i "� I o,), �,-. , r c_IL LX�cw at my property located at r 0 in &kmr --) County. S7 c• C tL--- 'P l 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 ins vt_ Title l Date This certification is valid through RFCFIVED DEC 0 2019 DCM-MHD CITY ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to I /13 a� 's (Name of Property Owner) property located at q l _ �- _I 4r 0 (Address, Lo Block Road, etc.) on I A U A in 3 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 have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in descriptiorf below or attach a site drawing) ET 15+,nCj L; fa 9— zS o <z z gSc . LrP5 RECEIVED DEC . 6 M9 DCM-hliHD CITY 'RE? k c2 'SCw,. A--_ l _. 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. (Prr erty Owner I formation) S7tknature !. JLiJl7 �j=XSC� Print or Type Name %ay 7Sar'rNr_t r,,, t Mailinq Address n (Adjacgllt Property Owner Information) z Si e P ' t or T pe N me Mailing Address zip City/State/Zip , le Nymber Telephone Number ) t � � �1 :✓ i 1 - Date Ioe-6--E, � .,„rl (Revised 6/18/2012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that 1 own property adjacent to Dh� 1, b n r `'� 's (Name of Property Owner) property located at 9 i J � " d L (Address, Lo Block. Road, etc.) on , in < . N.C. (Waterbody) (Cityfrown 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 have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in descriptiod below or attach a site drawing) �.S � rT`�C`c 1� 2l 2 c 18CC `i D df IC 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.) C"' I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Pr rty Owner Information) 1 Sinature 1�� de��sC- Print or Type Name la�l A Mellor Address n ( Z TS_Z 6 City/Siate/Zip Telenhone Number 1. Da e �r�e 17 L - V:' l'v><1c'iz (Z QF't2�IT. DEC 30 7019 Date bC10-MI-11) CITY (Revised 6/1&2012)