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Home My WebLink About74616D - Caps�-ICAMA / DREDGE & FILL No. 74616 GENERAL PERMIT Previous permit# A �� ° )(New --Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued._ As authorized by the State of North Carolina, Department of Environmental Quality 07 / / / Z— and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC / rr // ❑ Rul�iattached. Applicant Name C Y�-- Project Location: County ECG` Address Z60 Gy1 E /I f �'"�^ OG Street Address/ State Road/Loft #(s) City v �—� A� State14:�ZIP �� 1 �E' yj4 C Phone # f[1Q E-Mail Subdivision Authorized Agent �{�j h % ' City L. ZIP�� Affected ❑ CW PTA El ❑ PTS Phone # ( River Basin AEC(s): ❑ OEA lb HHF /❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body If '� � � at man unkn ❑ PWS: Closest Maj. Wtr. Body ORW: yes PNA yes - ■■■■■■■■r::.:■�i■lilLis�■Sirfiil�Lr`■■�■■■■■■LI��■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ��••••� `i■�ii 1■ritiir�fif/■■ R -Y' 1 1 r, or ADblicant Pri lance statement on back of permit ** Application Fee(s) Check # Issuing Date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: ---.JC �ays Mailing Address: Phone Number: - 10 " MT (01 Email Address: LW V-d reAI , u I certify that I have authorized jnaA Mcir ne: N 'S4rntc on , Agent 1 Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: 46' X 4" f I e r a nd 16' x IV dock at my property located at tl1115 11 NC in----Pej1jfY County. I furthermore certify that I 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: )a WMA6 Print or T} pe Name Title 8 ,00 , Date This certification is valid through I I ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to S 's (Name of P Owner) property tooted at a6 L1 4T1 l -e � /'"a IZ , (Address, Lot, Block, Road, ) .. on _ 'W _ , in ``,, , N.C. (Waterbody) (CitylTownland/or County) The applicant has described to me, as shown below, the development proposed at the above I I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must Hit fn descripfion below or afia+ch a site drawing) See A$Chd D661Win9 4, 1 l +a'I �1- " 1 do wish to waive the 15 setback requirement. MW i do not wish to waive the 15' setback requirement. 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.) (Pro Owner Information) (Adjacent Property ) Slfg6tw Sig»a/ure*�K, Me � VY7-" -c le, Vvsl--U (26 P��ro� T-IT L• ifle- L; nJDn 5i+fe-e-� =A T r) Number/email address rrn� Tokphone,f"e 1eqW address C, i 2 in 1 GI Doe* (Revised Aug 2014) "Valid for one calendar year arm sigrmibW ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to Jack CADS 's (Na Pro perty Owner) property located at ��o � l✓� e i/� I�l lil y n Ed on _ 1� G OQ (Address, Lot, BI Rgad, etc.) in r-F G(T-u N.C. (Waterbody) (CityR 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. li 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) See A+�nc-AeJ Drawln9 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.) 1 do wish to waive the 16 setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) (Adjacent Property Owner Information) Date Si to g* Z Z161 7- Prkrt or Type me Rd e Type ke, Mace Mqfflng Addresp �►lll 1 le , MC a 7Y6? C�� pu' 1- 744 Z Telephone Nwnbpr/email address Date* (Revised Aug. 2014) *Valid for one calendar year after signature• Project M Subject cc Page of Date —4- 1-7 M0iv i A A' 1-4 lb k 14 J L/l Date Received Date Dp,,itd Check Flom !Name Neme of Permit Hokbr Vendor Check Number Chock amount Permit Number/Comments Recel t or Retund/R"lloceted Column! Column? Co/umn7 CW-4 Column5 Co/umn5 Column7 Column8 Colu-9 8/29/2019 Jerry Ennett Jack Caps Coastal Bank and Trust 2430 ###### GP #74616D JD rct. 8534