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Home My WebLink About71828D - Armistead-. \RCAMA /. ❑DREDGE & FILL No r 1028 ". A B C D GENERAL PERMIT Previous permit# eW ❑Modification ❑Complete Reissue El 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 ' Grp. ❑ Rules attached. Project Location: County V" 'ell Applicant Name AjV (i . i Yr i t / 11 tlf . . Address .:., PO 1.° Street Address/ State Road/ Lot #(s) lam! �} ( _ City 1 State 1! kZIP /7� i� _ ►Y' �Ara_,O, Phone # ( ) E-Mail r Subdivision City(� ' {� E' ? ZIP g! Authorized Agent A,. 1 1. U c.. `X CW e EW I \W PTA ❑ ES PTS Phone # ( ) d d River B in (�,..�NJ/ PY, �p Affected - ❑ OEA ❑ HHF QIH ❑ UBA ❑ N/A _ -AEC(s): , . Adj. Wtr. Body �_ Ih y , D, r r�M1 at✓man /unkn ' -❑ PWS: ORW: ' yes / no PNA yes (�no Closest Maj. Wtr. 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Oc■E ME.■ Agent or Applicant Printed Name , Sig,�gl!!se7tomplianbdnatstatement on back of ApplicationFee(s)-,_ ermit fX Check #: h AGENT AUTHORIZATION FOR CAVIA PERMIT APPLICATION Name of Property Owner Requesting Permit: ao—rto A1'Y11S Mailing Address: CJ • Iw—� Jd ( ) 1 �a� L L46rD2 Phone Number: _ I Email Address: X Iy�l S�tC �1n1 IssyssI _ " I certify that I have authorized Agent I Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: 'X k UV) 4�n �A -Q-tl� a7)" YIC' nL—Cl ('-"Iel ?30r� II-C4 at my property located at in _�1C•tLCounty. / furthermore certify that / am authorized to grant, and do in fact grant permission to Division of Coastal Management stab, 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 r Print or Type Name Title )dte This certification is valid through lc� /_/6—/ -4— CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Own Address of Property: (Lot or Street #, Street or Road, City & County) Agent's Name #: Agent's phone #: Mailing Address: las VU/ -4 hereby certify that own property adjacent to the above r-ererenced property. The individual applying for this permit has described to me as shown on the attached drawing the development -theya------posing.--A description or drawing. uuith dime�tsians must be provided with this letter. I have no objections to this proposal. I have "objections to this proposal. If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writing within 90 days of receipt of this notice. Contact information for DCM offices is available at http://www.nccoastaimanggement.net/web/cm/staff-fistina orby calling 9-888-4RCOAST. No response is considered the same as no objection if you have been notified by Certified Mail. WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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 re quirement. I do not wish to waive the 15' setback requirement. (Property Owner I rm tion) Signa ure Print or Type Name /,D: —64ZK sao Mailing Address ball `ov1�s City/State/Zip (Riparian Pr erty Owner Information) ., Sig e Print or Type Name 5/"Gl Mailing Address A le(y4 4( City/State2ip leG) hsS S %w i/iGr��rr� �� `� ~(5�� '.�� G�i`II •''fir �� C� Telephone Number/Email Address Telephone Number/Email Address vLth l Date Date (Revised Aug. 2014) x", UhK-t II MU MAIL * Kc I Umim ME-1dr-If- 1 315"Aug"I I RU DIVISION OF COASTAL MANAGEMENT' A ADJACENT RIPARIAN PROPER TN"19,PWNER NOTIFICgT10NNVAIVER FORM Name of Property Own Address of Property:, (Lot.or.Stree.t Street or Road, City & County), Agent's Name orb Art, Mailing Address: Agent's phone applying theiy'are j x I have no objections to this proposal. i have- objections to this proposal. - If you have,obj!actions.to what is beingproposed, Oft the.Divislon of Coastal Management (DCU) in writing within 10'days of receipt of this notice. Contact Inforniation.for .DCM dffices is available . athtto.,Ilwww.nccoastair�an6-qemet - tt.neVWeb1cm1siaff-ns orby calling 1-888.4RCOASr 5 described, to mesas shown on, the attached WAIVER SECTION I understand that a pier, dock, mooring.pilings boat ramp breakwater, boathouse, or lift must be set back a minimum distance of 15' froih f My..area. o npanan access uriless 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. jProperty Owne.] rin tion) (Riparian Property. Owner1riformaijon) Si gna, rel, Signature Adarn M Easley Print or Type Name Print or Type Name ox Sao, 708 Davidson Street Mailing Address Mailing Address t1all Pi9sr . iA Raleigh, NC 27609. citylState,op citylwatelzip 11pe-, t-,W% 919-622-7119. 0 rM 6p- X lv� 2Tti Teleph.o—ne Number/Email Address Tdiephone Number/ Email Address 05/29/2019 Date Date (Revised Aqg.-2014). Dafo Received Dafe De os/ted Cheek Fmm Name Name of Permit Holder Vendor Check Number Check amount I Permit NumberXommenfs Recel for RefundWc&IfO afed Columns Column2 I Column3 Co/umn4 Columns Column6 Column7 Column9 Column9 e/5120f9 ATied Marine C-t'.dors C Chades Armistead F Ci�ens Bank a 00.00 GP a7 a2a T ae rd 6467