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Home My WebLink About74260D - Chamblee'CANNA/ ❑ DREDGE & FILL ,�,� GO$ERAL PERMIT .Sly. Zew ❑Modification []Complete Reissue El Partial Reissue No. 74260 A Previous permit # Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality � 7 Z J I2 �Q and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ❑ Rules attached Applicant Name gilt(, Qam 6G e Address-J2 / 9 Sf City Aot o State ZIP `1;7 V 07 Phone # ( ).2JO- 92 E-Mail Authorized Agent ', e v.✓ �Or✓ L✓fL ❑ CW PTA ❑ ES ❑ PTS Affected ❑ OEA ❑ HHF Ll IH ❑ UBA ❑ WA AEC(s): PWS: ORW: 9/e PNA yes Type of Project/ Activity e e Project Location: County G/ /y9i✓a116;.e C Street Address/ State Road/ Lot #(s) Subdivision City LVJ140216!�6 �OAI ZIP 2ryii Phone # ( ) River Basin VA7e Ok Adj. Wtr. BodC,4,4, ,-'eL (�iat /man /unkn) Closest Maj. Wtr. Body A9I 4AI U/ v- ti3Od .✓ew (Scale: / 11S 70 / ) Pier (dock) length Fixed Platform(s) Floating Platform(s) Finger pier(s) Groin length number Bulkhead/ Riprap length avg distance offshore max distance offshore Basin, channel cubic yards Boat ramp i Boathouse/ atli Beach Bulldozing Other Shoreline Length 1210, SAV: not sure yes �, Moratorium: n/a yes Photos: yes Waiver Attached: yes A building permit may be required by: ( Note Local Planning jurisdiction Notes/ Special Conditions Ae% v Ag„ /a f/4R 67g N "f ❑ See note on back regarding River Basin rules. N CRORc/I i,414 Ad , A 0"7 R) ZY/%i Ad', I If AgenI or Applicant Printed Name Y-� —**Please Signature ** Please read compliances on back of permit Application Fee(s) Check # Dt4e,,� t L1,L s Permit Officer's Printed Name Signature y Is4inibate xpiration Date �� NC ENR North Carolina Department of Environment and Natural Resources Pat McCrory Donald R. van der Vaart Governor Secretary AGENT AUTHORIZATION FORM Name of Property Owner Applying for Permit: Owner's Mailing Address: 0 - lee Phone R30 — 2 t Name of Authorized Agent for this project: Agent's Mailing Address: ca?r.►: SC w ec rr . cow-, Phone fff7401 nr q? 3. I certify that I have authorized the agent listed above to ad on my behalf, for the purpose of applying for, and obtaining all LAMA Permits necessary to install or construct the following (activity): Project Site Address: N , G 4�2 3 a� a, CL PropertyOwner Signature Date "This certification is valid ? year from date signed by property owner. N.C. DlVWOo d Coastal Management 127 Ca chW Drive Ext., WWVgton, NC 2M Phone: 916-7W72151 FAX: 910.395-3964 lnkiwt www.ncwqsWmwaqgmew.ne1 An EMS OPPO+MlY 4Mkma ft AMW E.OoM RECEIVED UR 2 12019 DCM WILMINGTON, N ■ 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. Article Addressed to: LL C 0.1 f' It. S+e , 2c z R; t.>�r•� ►1d , V A 2 3 2-'3 A. ❑ Agent �r✓ ❑ Addressee B. Rec&vod by f5rinted Name) C. Date of Delivery D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No .. 41; II I III it IIII II I III III IIII II II I I I I I I I I 3. Service Type ❑ priority Mail Express® ❑ Adult Signature ❑Registered Mail*^^ 9590 9402 4922 9032 9505 66 ❑ Adult Signature Restricted Delivery ❑ Certified WHO ❑ Registered Mail Restricted Delivery ❑ Certified Mail Restricted Delivery ❑ Return Receipt for ❑ Collect on Delivery Merchandise ❑ Collect on Delivery Restricted Delivery 0 Signature ConfirmationT 7018 1130 111102 0001 8084 d Mail d Mail Restricted ❑ Signature Confirmation Restricted Delivery Delivery 3500) PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt 0909 `IOOO 2000 OETT 9TOc' ■ Complete items 1, 2, and 3. A. Signature ■ Print your name and address on the reverse X L( Agent so that we can return the card to you., ❑ Addressee ■ Attach this card to the back of the mailpiece, B. Received by (Printed Name) C. Date of De liv or on the front if space permits. ' L S i -- 1. Article Addressed to: gtG C u, Club Dr CefWOS&V,, , N C a7go IK D. Is delivery address different from item 14 u Ye` If YES, enter delivery address below: JYNo IIII 3. Service Type o Priority Mail Express II I III II III II I III II I IIII II I III ❑ Adult Signature ❑Registered MaiIT"' ❑ Adult Signature Restricted Delivery ❑ Registered Mail Restricted 9590 9402 4922 9032 9505 73 ❑ Certified Mail® pelivery 0 Certified Mail Restricted Delivery �C]' Return Receipt for ❑ Collect on Delivery Merchandise -- ^ ^'Ilect on Delivery Restricted Delivery 0 Signature Confirmation T"' 7018 11300002 0001 8060 sured Mail ❑ Signature Confirmation sured Mail Restricted Delivery Restricted Delivery ---r- fover $500) PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt h909 TOOO 2000 OETT 9TOz Fk ,sS h� b.CK, q� F-tk6(t 3Ca) e 1 ZL aOt U Z o rn Z W ' U W N Q n cr G C� rC' V 1�0� Date Received Date Deposited Check From Name Name of Permit Holder Vendor Check Number the * amount Permit NumbenComments Receipt or Refund/Reallocated Column? Column2 Column3 COW-4 Columns Columns Column? Columns Columns d 1 nd it Ch mblee — State Bank 11218 P #74260D 'DTP, t 7798