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Home My WebLink About72761D - Carrollf.'CAMA/ DREDGE & FILL GENERAL PERMIT �levv ❑Modification []Complete Reissue ❑Partial Reissue 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 No. 72761 A B C Previous permit # Date previous permit issued Applicant Name U U V e, O 11 Project Location: County pfL 7oattached. AddressA041 Street A��ddreess/ Stat ad/ Lot (s City2State NL ZIPS A� 4 s ` v Phone #b E!!-Mail Subdivision C.- n Authorized Agent n " t *'k ❑ CW PQEW 9PTA ❑ ES ❑ PTS Affected AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ URA ❑ WA ❑ PWS: ORW: yes PNA yes /''no� Type of Project/ Activity f 4 01 O Pier Fixed Floati Fingei Groin Bulkh Basin, Boat i Boath Beach Othei Shore SAV: Moral Photc Waive City GZt! ZIP Phone # ('- j--" River Basin(v k 041 Adj. Wtr. Body l ✓� Un C14AA Q S nat an unkn Closest Maj. Wtr. Body �J t4 (Scale: ( r �'6 ) ■■ ■■■■■■■■■■w■■■■■■■■ ■■■■■■■■�■■�� ■■■ ■■■■■■■■■■■■■■■■■■■ ■■■ME■EVARS■■ ■■■■■■■■■■■■■■■�■■■■■■■■■■■■■■w■w■r�■■■ length :ber -ad%/ rap length ■■■■■'■_■■■■.�a��s:■■■■■■■■■■■■■■■■■■■■■■■i ■■■■■Obi■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■channel ■■■■■■■■■■ ■■■■■■■■■■■�■ r%��■■ ■■■■■■■■■■ zubic yards • •�'�' iiii■iiiii■iii■■ii':�■■i■i�■�ii��i��w�i■■i' �Miii MEN i■■i■i i�iii.► O. WN ■`��i0 M siiiii■ i■■iiiii�ie�i■iwii%:`� iiiiiii■iiii■■■■■i■i■i' line Length ■■■■■■■iiiii�i■L'S►a■■■■■■■■■■■■■■■■■■■■■ notsure yes ... ` .. I r"L�J■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■w■ A building permit may be required by: ( Note Local Planning jurisdiction) Notes/ Special Conditions G or A akfant Printed Name ❑ See note on back regarding River Basin rules. Signature ** Please4C-ffcompliance statement on back of permit ** Si atur 9 / Z ;4 a� Application Fee(s) Check # Issuing Date M -)—/ / -/C, Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: -Tow C-a-e c) I Mailing Address: Phone Number: Email Address: I certify that I have authorized L�C Li W c IQ g (-I L-I to act on my behalf, for the purpose of applying for and obtaining all CAMA permits n-Y'All 1 • C(X necessary for the following proposed development: rn4a l I �?� Al u w i(1uw l r 41 at my property located at LiDq q- CAto S+I 5Lkr' in b OSI OW 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 Signature Print or Type Name a"Ara a U a. I ao Date This certification is valid through ! ! KI U LAI I hereby certify that I own property adjacent to TLC 4C Propertyof . t 's property kxated at � 0 Cg �� (Address, Lot, Block, Road, etc,) on 1 C V- In c-,u r-T c t+ 14 , N.C. (Waterbody) (City own and/or County) The applicant has described to me, as shown below, the development proposed at the above loVon. I have no objection to this proposal. 0`{� I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill M description below or attach a site diewing) 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 i I do wish to waive the 16 setback requirement. 1 do not wish to waive the 15' setback requirement. (Prop",Ov ner Information) (Adjacent Property Owner information) PnW or Type N RIQ•HC�d •Ot2S�CGt''rO))CU(1S'IVUC'fkXl� Te/epi�one iw, /etnaA aridn3.ss iu CL 03.05 . ;;019 Date 'Valid for one calendar year after signature• *-w,9wcq 4D(- ctd')ctcP,M-- oB ►� DaAe* A (Revised Aug. 2014) ToC4 v�.S I hereby certify that I awn property rrt to J:L-X v••A (CA----, e of Property Owned} property locked aty g Lot, B Ros4 OW-) on I i' W . In r N•C- (Waterbody) (City own andfor County) The applicant has described to me, as shown below, the development proposed at the about vn. I have no objection to this proposal. I have obodions to this proposal. DESCRiPTfON ANDIOR DRAWING OF PROPOSED DEVELOPMENT, &NjiViduai prioposbtg 4.ev+e%pment mirst f1w ie'deseripdon below or attach a site draww WAVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin must be set back a mir*mffn distance of 16 from my area of riparian access untess waived by me. (If you wish to wa m the setback, You must initial the appropriate blank below.) I do wish to waive the 15' setback requirement.. 1 do not wish to waive the 15' setback requirement. D infomratlOn) (Adj w d Property Owner Information) q IQ• �a - o hs ice frolic on2wo2whWeLc Telephone � email adds �` � • `�'r 0�-oS- au19 Date \ 'Naid for one calendar year aver signelcW *-w,9vn,(q n.ed 4c)r Qd ja cv-A-- (SAW M4) rnfei 1Y)\WP-'S vn rC - -VY\Q vS . Project y $ qf�- S4- 5 LA C-C CA 4-Q By ru Subject /o rI d LA ✓rd I Page ! of CC Date )'-'X ,, _z o - /R Date Received Dafa Deposited Check From (Name) Name of Permit Holder Vendor Ct—k Number Check amount Permit NumbeNComments Receipt or Refund/Reallocated Columnf Column2 C.I.-3 C.1-4 Column5 Co1umn6 Column? Co.-8Column9 _ 3/18/2019 Jerry Ennett/Ennett Marine Construction Tony Carroll Coastal Bank & Trust 2162 $ 200.00 GP 72761D JD rct. 7906D