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Home My WebLink About74204D - CannonY CAMA % DREDGE & FILL ` NO. 74204 A B C 6 OD GEN E"L PERMIT Previous permit# CJNew ❑Modification ❑Complete Reissue El Partial Reissue Date previous, ermit issued As authorized by the State of North Carolina, Department of Environmental Quality �1 ��' } and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC (' ` " ❑ Rules attac Applicant Name , Project Location: County c Address 1 City State_ ZIP�F�U Phone # () E- ail Authorized Agent Affected ❑ CW ❑ EW ❑ PTA 4ES *TS AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: ORW: yes no j PNA yes /; no 1 Type of Project/ Activity Street Address/ State Road/ Lot #(s) Le 1 �J Subdivision City ZIP Phone # ( ) River Basin Adj. Wtr. BodyAIA\Anat 4 a unkn Closest Maj. Wtr. Body (Scale: Fixed Platform(s) "A Floating Platform(s)■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■�■■■■■■ Finger pier(s) ■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■III■■■■■■ Groin length number ----'gv�g distance offshore max distance offshore4DL Basin, channel ■■■w1■■■■■■■■■■■■■■■■■■■■■■■■■■w�i�l■■■■ r ��:� Iii11■■■■■■■■■■■■■■■■■■■■■■■■■■t■� I■■■■ ■■■■■■■[I[il/Li■■itL�[/III®li,Pr�■■■■■■■■■■■■■■■■■■' cubic yards Boat ramp ■■■■■■■■H■■■�■■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■Cy■■!!�1■■■■■%%■l1■■■■■■■■■W Boathouse/ Boatlift Beach BL.. Other I / �'T� ►'��!�i�1r,�j1��'i W • ,. SAV: not sure yes Moratorium: n/a yes yes .. _,...■■■■■■I■■■■�■■■■■■■■■■�i■■■■■■■■■■■■■■� ■■■■■■%■■■■■Il■■��a%■■■■�%■■:I■■■■■■■■ %RNM■■■ ■ ■w ■■■■■ .%■■■■■■■■■ ■■ ■■■■■■�Il�,�i��ir��1� _'! ■I��In�l�ir�iri �■■■■■■■■■■■■■I ■■■■■■■1II ■II ■I,%■I/■■ICI ■■I/■%%C'!/ll ■■■■■■■■■■■■■I ■■■■■■■i�■%■I/■I,%■■�/l,L%■1/I/11 III ■■■■■■■■%■■■■ IN AMMAMP INIS 1. CHNI■I■I/■%%■w�■%Li1■■■M■%!:1%�I%■RI■ 9M1 %I/[!/!I►■I ■■" .%% Mai■■■■■■■Photos: '' A building permit may be required by: -b�N 1 \ 0 t I El See note on back regarding River Basin rules. ( Note Local Planning Jurisdiction) Notes/ Special Conditions d V � � I' \ v1h (1't 1 �GU') n \ ,I V Il "� t /A L"1i V� �A ,IA`i' Ul V W K d r e rs Agent or Applicant Printe4Name Signature Please read compliance statement on back of permit Printed Name Application Fee(s) Check AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Mailing Address: Phone Number: Email Address: I certify that I have authorized �. &/" � Agent / Contractor ` to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: 411r4't/ xk//L at my property located at 0 � j") 1,/� /� ,0' in County. / furthermore certify that l 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: L_ — Signature A Print or Type Name 6 w' 7 Title Date This certification is valid through �� / /—C;�0 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to ffA/-S C.,Q,d'✓,1Qo4 is (Namo of PrDoeity Owner) property located at d (Address, Lot, Block Roa , etc.) � on Z/ in L , N.C. (Wa rbody) (CitylTown and/or County) The applicant has described to me, as shown below, the development proposed at the above location., _�,`/'_ !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) 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. (PropArty Owner Information) ignature %r!� s /�►T•-fin Print or Type Name � c-`— �b� �� f Mailing Acpress . 1 w A City/State/,rip Telephone N mbe /email address Date (Adjacent Property Owner Information) Signature Print or Ty e Name nlfi LT N Mailing AS s City/State2ip Telephone Number/ema' address Date* (Revised Aug. 2014) *Valid for one calendar year after signature* ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to I �a✓'tS nli O/A 's (Name ofi Property Owner) property located at �� ib 1-e%-i'� ��l � (Address, � Lot, Block, Road, etc. on G� in w%-- 4i5l4rw , N.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) Gannar�Ma Tia3 a91v a qo g 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.) "r-- I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) Si nature Print or TypiName Mailing Apdress l_1i C� City/State ip Telephone Number/e ail address Dale 6Tfl 'Valid for one calendar year after signature* (Adjacen Property Owner information) or M fling Address I City/State ip Telephone NuTber/email address c2..� Date (Revised Aug. 2014) 7 ML ✓ rit,f ' a S tiLJJ It 7017 3380 0000 8627 6453 J � r a�� Guyon �✓e. 9,jr,/\1 161 afJ, ,N l PN NIXIE 076 DE 1 2603 f s3 ' l RETUPH TO SENDER l /P(- ( i %) !' l�'.I t`C L! Kph L} a?rE�'1fr�832 1384 C SC. 2846572ZE25 *0243- :!SS9-•'F--@3 (1t11111'11!1flit III it,�111'911t�'11`11tt11�1�111�lttit�il �i t f �j►' , I,1 � i I l tI � � I' � ! t, 1 i' .�t t �,l 1� �`' ail' ��[ t l ll' ' ,�,� '�islli j�� 'i, ��; �,• ,� R4' { I ' t '� t ��' {i � t i t- t _ ;�-:�-T' __ � . • % _ "ram _ _ _ • _errs— A. Sig V / Cl Agent - yk " ■ GomPlete items 1, 2, and 3• X p Addressee ■ print your name and address on the reverse _-- FCDt. of Delivery so that we can return the card to you. 13. R •i by {Printed Name)-r�-�.. -, +.+ „'.-.�.-•� ■ Attach this card to the back of the mailpiece, rx or on the front if space permits. -.--- D. Is dell address different horn Kean t? ❑ 1 Article Addressed to: if YES, enter delivery address below: p No •"-s-9",—.,�--:�'� t(/ T `� ...ram.-..•�A a-i-- ❑ Prt mity Mall Fxprasib - _ 3. Service TYPe -""-'""__ = . a"► ."'�-^Y�; ' _- II I IIIIII III II I II I IIII I II I I I II I I I II' III I II III ❑ p�uiged Maure llT ❑Adult Signature egd Ma Rstricted OfNepem,Z.MaII Restrictedv a, rtSly p Return Rfor trwad Delivery Merclwnclise542 7305 6318 85 ❑ Certified Mall Has 959094023 _ ❑ Collect on Delivery ❑ Signature Confirnatlon— _ Collect on Delivery Restricted Delivery p Signature confirmation p. Article rfrom service ._,' Restricted Delivery ice lebe0 __.. ...r...�.� " �- le Number (T ansfar Restricted Delivery- _ 7 017 3380 0000 8 6 2 7 Domestic Return . ecelpt ps Form 3811, JDIy 2015 PSN 7530 02-ODO-9053 �-� _ Data Received Dare eqnsited Check From Name Name of Permit Holdw Vendor tfieck -- aCh.cltmount I Pe It NumbenCommenta Racal t or Re/urmOV Mocated Col—1 Co1umn2 Co1umn3 Column4 Columns Column6 Column? I Coltanne CdunmD 1 P #74204D