HomeMy WebLinkAbout73535D - BeckhamCAMA / ❑ DREDGE & FILL
GENERAL PERMIT
(XIN�w ❑Modification El Complete Reissue ❑Partial Reissue
No. 73535
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 011 N . 12 CIO
s ❑ Rules attached.
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Applicant Name AV W, gsc K+WA
Address Irl CIAQ%N CIRCLE
City MVATL4L- 15C ACA State CSC ZIP 2-A S 72
Phone # (,9*5) 449 - 741IT E-Mail NIA
Project Location: County $Tz�1J5WtCK
Street Address/ State Road/ Lot #(s) 24
RAC:fcy-y 5-N-MI :T
Subdivision HJ&
C Q
Authorized Agent WAAVA 604CF- _ City (ktAfJ SSLX BeALR ZIP -2-2 (f 9
Affected ❑ CW 'gPTA ❑ ES ❑ PTS � Phone # (9116 ) 511 -gM 5 River Basin (- k,, qr�
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
Agent or Applicant Printed Name
Signature* Please read compliance statement on back of permit
02Uo 13073
Application Fee(s) Check #
Adj. Wtr. Body CA)VAI-- (nat /man /unkn)
ri .tee.. M-; W., Q-A., A Ian/ bpi
rY I'MC-
Permit Officer's Printed Name
Sig
2o1 to 7 Zo19
Issui g Date Expiration Date
A��
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis
Governor Director
John E. Skvaria, III
Secretary
AGENT AUTHORIZATION FORM AGENT i ON FORM
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis
Governor Director
John E. Skvarla, III
Secretary
Date: (/ _ 29 -)(�
Name of Property Owner Applying for Permit:
I'�1A 14 Ct1_k)J0A7
Owner's Mailing Address:
� i eii C i/i1 cp
IATIE 6-tI01-41 C Lr)S7L
Name of Authorized Agent for this project:
61?1a- Coluou,47;6,A-1
Agent's Mailing Address:
Phone Number { aIL 3y b ~ 74 .� Phone Number L_
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
lib_ 0,04C !n <_t)tr/;L, ` ;.Y 241EFei/tl) S� pt&-/)r-. 1�t y
127 C3rdmal Dnve ExL, Wkr*VW, W: 28405
Phor* 910-798-7215'' Fix 91N395-3964 Internet: www.mcoa-wimarw4 mew.rw
Ad: -ou4 ,-=a Lnq , A Auliur Enarc-
For my property located at
qk�W
ft .
a 6? emc.11
This certification is valid thru (date) . 9 YW
Property Owner Signature Date
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CERTIFIED MAID, • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: �C�w' ' ! ISL'Cky� on
Address of Property: 2L� 4Q(
(Lot or Street #, Street orlRoad, City & County)
Agent's Name #: Gr ICE �hS�ruC�ly�
Agent's phone
Mailing Address:"+� 1QQCh Dc
&g-Ar):�Q �NC 2-,64�U
I hereby certify that I own property 9djacent to the above referenced property. The individual applying for
this permit has described to me as shown on the attached orawing0he development they are proposing.
A descrintion. o ,with dimensions, m4t.ktebrovld6 with this letter.
I have no objections to this proposal. _ _ I have objections to this proposal.
K you have objections to what is being proposed, you must notify the Divislpn of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspo"Aiae should be
mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM represent can also be
contacted at (910) 796-7215. No response is considered the same as no objection lfyryld'Jt" been
notified by Certified Mail.
WAIVER SECTION
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.
(Property Owner Information)
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Si Ynature
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Print or Type Name
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Mailing Addreis
City/S te2ip
SL�3 LH9 -1 �1 S
Telephone Number
Date -- ------
(Adjacent Property Owner Information)
Signature
l 11C1 _ �^
Print or Type Name
P o �> 6;,,- �-, ( (
Mailing Address
City/State ip
F S-tl) - u
Telephone Number
Date
Revised 611812012
CERTIFIED MAID, RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: Cckr-O
�+ �eCk�qm
Address of Property: ' G �� �� 5 C co-n5�(
(Lot or Street #, Street orlRoad, City & County)- -
Agent's Name X— r ict �'R �uC��ly(�
Agent's phone #: %U + 57- Ci O95
Mailing Address:WD &QC\IA D—
kxt� N( 2,6%q
I hereby certify that I own property Eidjacent to the above referenced property. The individual applying for
th permit has described to me as shown on the attached Irawing�the development they are proposing.
I have no objections to this proposal. _ I have objections to this proposal.
�. if you live objections to what is being proposed, you must notify the Divisfpn of Coastal
Manage�`1,ent (DCM) in writing within 10 days of receipt of this notice. Correspo taw" ce should be
mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM representAdVAM can also be
C contacted at (910) 796-7215. No response is considered the same as no objection ffydillis +s been
notified by Certified Mail.
WAIVER SECTION
I derstand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a
i 'm m distance of 15' from my area of riparian access unless waived by me. (if you wish to waive the
tb 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.
n
(Property Owner Information)
,�An MRL'd LgCrA>
,Sinature
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Print or Type Name
n C�)qp�C�rc
Mailing Addreis
City/S te2ip
Telephone Number
Date
Property Owner Information)
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ture C- 1
Print or Type Name
-F6X 66L-t
Mai 'ng Address
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City/State2ip
L9(6- 3�'�--�,22'5
Telephone Number
U-�O-1�
Date
Revised 6/18a012
■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
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❑ RegisteredMail-
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❑ Registered Mail Restricted
�2elivery
❑ Certified Mail Restricted Delivery
�+ieturn Receipt for
❑ Collect on Delivery
Merchandise
2. P nu,- — rr,—f r fr— — i— r.tion
❑ Collect on Delivery Restricted Delivery
❑ Signature ConfrmationTM
❑ Signature Confirmation
7 017 013130 0000 7487
0184 estricted Delivery
Restricted Delivery
PS Form 3811, July 2015 PSN 7530-02-000-9053
Domestic Return Receipt
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■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
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so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
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or on the front if space permits.
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Article Addressed to: \
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❑ Addressee
B. Received by (Printed Name) C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
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❑ Adult Signature
a Registered MaiITM
❑ Adult Signature Restricted Delivery
❑ Registered Mail Restricted
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jCrCertified Mail®
❑ Certified Mail Restricted Delivery
Delivery
a94aeturn Receipt for
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❑ Collect on Delivery
- elivery Restricted Delivery
Merchandise TM
III Signature Confirmation
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❑ Signature Confirmation
Restricted Delivery
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PS Form 3811, July 2015 PSN 7530-02-000-9053
Domestic - curn eipt
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Date
sited
Check From Name
NameofPermifHolder
Vendor
Check Number
Cbeck
ount Permit Numb—r—rnanfa
Recei t or Refund/Reall-ated
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Column? ColumnB
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Grk:e Constnxbon of wick County Im
Carol Beckham
IBBBT
13073
200 00 'GP #735350