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Home My WebLink AboutBlake, Bradr CAMA / EJ DREDGE & FILL NO. 75992 A B C D GENERAL PERMIT Previous permit# 7New ❑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 Commission in an area of environmental concern pursuant to 15A NCAC [Z Rules attached. Applicant Name Project Location: County Address j l / ' Street Address/ State Road/ Lot #(s)_ City_. _ State ZIP, Phone # (_ ) - E-Mail Authorized Agent 0, n Affected ElCW LJEW , bPTA ❑ES ❑PTS AEC(s): ElOEA ❑HHF ❑IH ❑UBA ❑N/A ❑ PWS: ORW: yes / no PNA yes / no CityZIP Phone # O River Basin Adj. Wtr. Body I %t ' at /man unkn Closest Maj. Wtr. Body—. ■■■■��■■■■■■ ME MEN ■■■■■■ EEO■■■■■■■■■■■■■■■ .■■�.■■■■■■�� M■■INN■■■■:■■■�CO■■ ■■■■ ■■■M■■M■N ■■■■■■ ONE ■■■■■■■ ■■■■■■■■ ■■■■FiE■■■■■■■■■■■■■■■ MEN ■■e■■■■e■■■■■■■■ ■■■■ ■■Nfl■■■■■■■■■■ MEMO ■■■■■■■■■■■■■■■■ ■■■■1A■■■■■■■■■■■R■■E■MRMEN ME IN ■■■■ 0 CMEN NONE :::::::m ORION :::MEN No MEMO R■IN■■■■■■■■ MEN M■®O■■0■■■ ■■ MEMO MEN ■■■■■■■■■NINM■■■EIN■■■■■INe■■■■e■■■e■■■■ ■■■■M■■MOM■■■■■M■N■M■■■■■■■■■■■■■■■■■■MIN ■■■■■■■■■■■■■■■ MEMO ■�■■■E■■■■■■■■■■MEMO ■■■■■■■■■■■■■■■■■ENR ■■■■■■■MEIN■■■■MEMO ■■■■■■■MOM■■■■■ MEMO M■■■MIN■■■■■■■■■■■INNER ■ONE ■■■IN■■■■■■■■■■■■■ ■■E C■■E■E■M■M■■■■ ■■E■■ ■■■MINE ■R■NM■■ I■■■■■.■..■... ■■■ ■■.■■1��■■M■NINE■■��■■■E■�■■®...�MEN ■■MINE■ EN■■■■■■■■■■■■■■e■N■■■■1■■■■■MININN■■■■■M■■ ■■E■ ■■■■ ■■■E■ ■■■■■■■ ■E■ • ..■■■■■ . E■■E■■ OEM ■■■1�■■■MM■li■MEN �■■■�CE■■MEN ■■■■■■ ■■■a M■M■■ .■. .■...■ :':::::: Elm :::C::::�B�C::N::C�IN MSCEE to IN ■■ ��C�IC C.�.. ..C�..�..�IC�C■No ■■■ ■■■■■MIN ■■EME■■■■0■ MEE■■ 0 ■■MIN■■ :iiiiiIUMMEN MEiiS IMEiiiiiiiiiii t 'I Agent. rA,plicant Printed Name Signa r •* Please read compliance staement on back of permit •'�` orb , - Application Fee(s) Check # Permit Officer's Printed Name / Signature / /r_ (- AX Issuing Date Expiration Date AGENT AUTHORIZATION FOR CAM1IA PERMIT APPLICATION Name of Property Owner Requesting Permit: Mailing Address: 1 O Phone Number: Z-5 Z Email Address: I certify that I have authorized / Contractor to act on my behalf, for the purpose of applying for and obtaining all_CAMA permits necessary for the following proposed development: Ql �� X, at my property located at I o I Pe \j JDAl n in.- County. 1 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: Signature Print or Type Name Title I I Date This certification is valid through I hereby certify that I own property adjacent to \)`+U�JV-A \,,r i_ s I n t r\ ,. r, r 3- . - . I n& me of Property Owner) property located at JU k VC—', \ Ni L W1 (Address, on 1��5 U �� \� , in _ (Waterbody) and/or County) N.C. The applicant has described to me, as shown below, the development proposed at the above locatiyq. _(�Ky I have no objection to this proposal. wF' 1 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) c;1Fq{ ar 'z(p t— Telep on mberl emai address (Adjacent Propert Owner Information) or Tvpe Name (/ rviciiir�,y nu �� (Revised Aug. 2014) "Valid for one calendar year after signature" ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to' _9=1 ,E ame of Property Owner) property located at �� ) `C)�O kD (A�dress, LQt, Clock, qWd, etc. on 21 CE s 2 in N£ t 1`�26.2N.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 description below or attach a site drawing) rs 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. trrvperry owner intormation) re" is r Print or Tyyy} e Name /) �CJI IJrrr./ irxv),, l.. Ma' in GAW res Ci a! 'Zip L—1�FI-�` — vl Telep on tuber/ email address n„rr- 'Valid for one calendar year after signature' Si nunn'e* Property Owner Information) / email addrrlss (Revised Aug. 2014) r