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Home My WebLink AboutPietras, TimL CAMA / ❑ DREDGE & FILL No. 76000 -� A B C D. GENERAL 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 - l` % <^` and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC `' r °' 1L u Rules attached. Applicant Name-T. 4 l I f � r Project Location: County ' Qr I Address f- LL� '' { 'fGi �.�t�y I:r7��14{ Street Address/ State Road/ Lot #(s) (ell( ZIP Phone #..( 7 � U070 E-Mail Authorized Agent ( C1. .k AAffected �CW AJEW ` ]PTA DES ❑PTS Affecte D OEA ❑ HHF ❑ M ElUBA El N/A ❑ PWS: ORW: yes ,/ na PNA .'yes / no Type of Project/ Activity Pier Fixe Float Fin& Grol Bulk Basin Boat Boat Beac Oth Sho SAV: Mor Phot Waiv Subdivision City ZIP Phone # ( ,) River Basin /U [(- /. ... Adj. Wtr. Body/!� � (( nar'/man /unkn) Closest Maj. Wtr. Body RaC f,f- I W-y (Scale:( % 320 " ) ■■■■■■■■■■■�■■■■■■■■■■■■■■■■SEEN■■MONO■■■ ■■■■E■■E■E ■ fiMONl1•i� ■Nl�IMM■■■NEE IMEEE►WMEMENESEIEEEENNEas �MM■■MM■■ ` lengtM■■MM■■■M■M■■MM■■■■■MM■■■■MM■■■0■■MMM■M ■■■■M■■■■■MWWMM■ MEMOS IN EMMMMMMMEMEMEME■NNN■NMMMMMMMMMMMMM=29MVE numb r : CCSOME CCC :CCCCCCCCC:�CCCC: :CCCCCCE avg distance offshore ME EE ■■■ M■■,M max distance offshore■■■■.■■■■E■■lQ■.�.�E■E■EEMEN OCE■ECC■..AC ■CCA CCCCCC channel CM■' �yi�iCCCC� :CCCCCCMOEN C■M&2L11M�10Inimmilmiis cubic yards MCMi CCCCCCCC0C ramp■■MM■■■E�#.�dl■��E�.�.IEMEN! M■■■■MM■■oM■OEM■M 0 CCJ CCCCCmmommm '�l M11iMNI NoCCCCCCi■CCME CCCC CCCC►EQIi :�.�CCCCCCCCVV�CCCCCCCC1111 ENEMCMM■■MNMMM�M..MMMMMMMMMM■MMMMMMMMMEM■M MEMO MONSOON CCCCCC CCCC CCCC®CCINNEEMOMMINCCCCCCsso ME UYNe�L�=MECIMOM ■NOON■■MN■E■■ ■■�q■■E■■OEN ME■■ ... M■■ ■■■■■■.CCCBCC� MEN CI EEElEE■CCC....... HCCCC�ME ' ■E■i.E■■■■MME■■■■uml_ ■ ■� EEEE�ME ■EEE� 0 0 :CCE=mmmmCCCCCmluiNO��MEMOS I NoCCCCC■ A building permit may be required by: t �, ,t) V f } L ( Note Local Planning Jurisdiction)//% Notes/ Special Conditions /I I' jl lh`. t i '—t�--)1, titoil t Agent or Applicant Printed ISatAs Signature ** Please read compyance statement on back of permit Application Fee(s) Check # See note on back regarding River Basin rules. Ii F'_X, AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: )ffn r NCR A"LrAAi Mailing Address: `) g/ i-t v& c' Ml1 PA - Phone Number: 15) L � 5 - v Ky 9, Email Address: I certify that I have authorized %,v &,,,4 C44-3 Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: RwOt r'It � tesri �Jat t.c. at my property located at_ y96 Ltv�� vA-V Dui, , in P, AI7 d-ol County. i furthermore certify that / 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: B J .— Signature li �n O- /` / i r-4d j Print or Type Name Title Date This certification is valid through I I_ /S 1 '2o ADJACENT RIPARIAN PROPERTY OWNER STATEMENT hereby certify that I own property adjacent to % I %lvNt - 6 �7%ifls 's ( ame of Property Owner) property located at U (u 4 C'i Alz /%p YA&ie Zoe / /v/• C• 16 � (Address, Lot, Block, Road, etc.) on �rc,,JA_ev ('Qe-e/ in '4aV rr l'.v. ,N.C. aterbody) (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. I have objections to this proposal. DESCRIPTION AND/OR 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.) l,/� ' I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) fin." Signature ,) Print or Type Name 17eL1l, L.Gc e)A� l�rL Mailing Address ve [oe l— MO. City/state/Zip Telephone Number/email address 2,j _- �44 ��/A Date (Adjacent Property Owner Information) 7 G'odfk5iy' ClL�c 4�/SC>u.,t/e,✓1-Jssvd-. �Rel,�rd City/ tgte/Zfp Tel ho a Numb r/e it addr s �r� Date* /C".�^ // (Revised Aug. 2014) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to / M /I U Ve /? (Name of Property Owner) property located at 1 17- IY I, pp 4 n C "A/C, (Address, Lot, Block, Road, etc.) on lee] Aey ezteelf- in ("MeJfAl N.C. aterbody) (Cityrrown 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 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.) I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) Signalure y Print or Type Name 99(� L/ 4)1-- Mailing Addr ss 4-/4ue, 10 NC. 2�J32 City/State/Zip "�J�-6ls'_a�v� Telephone Number/email address 0-_ -/9 Date (Adjacent Property Owner Information) Telephone Number/email address /bt I-- / � Date" (Revised Aug. 2014)