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HomeMy WebLinkAbout72808D - Camerontr CAMA / DREDGE & FILL No. 72808 A B C GENERAL PERMIT Previous permit # INew []Modification El Complete Reissue El Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality O L�•-} O O and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ` 0 ❑ Rules attached. Applicant Name `q Project Location: County/(... Address 1 e O / n Street Address/ State Road/ Lot # City " State N� ZIP-0 Phone # � Z ' 550 E- ail Subdivision_ Authorized Agent �� �%C� CityfflfAZIP 2 EW1 PTA ❑ ES ElPTS ❑ HHF El IH El UBA ❑ N/A ❑ CW Affected AEC(s): ElOEA ❑ PWS: ORW: yes no PNA yes / no Phone # ( --��' River Basis• ' .11� �'! � - Adj. Wtr. Body � w C nat unkn Closest Maj. Wtr. Body �� type of Prollec.-T.1, 11 rR ■■C■■■■:i■■i :�iL%If■in�l.�� i�i■■■ ■I'i� :��s.�%'•7,:Ti:[,■■ ■■■■■■■■■■■■■■II Nit 111■■■ ■■■■■■■■■■�!f■■■IA■�i■ M. ■■■■■■■■■■■■■11■■■1111■�■■■■■■■■■■■■■■■■■ M. ■■■■■■■■ mom !,!■ �1111■■■■■■■■■■■■ul IWEE ■■■■■IiE7i1■■■■■l�111■1111■�'liiMi�'3►?III�!11�1■■■■■■■■■ ONE �■■■�■MORE' :�■■li■i■■■■■■■■■■��.:■■■■■ ■■ ■■■■■<i//,aJ■■■■!a�!�■1■I■�/ILA'/!■■■■■f7%JI!■■■■�■■■ ,,2+ ■■■■■■■■■■■i�i.�i <�iL�J[1Jii■■■r1Y■■■■■■ ■■■ .■■■■■■■■■■/■/!7fZ��i1■■■■■■■■®■■■■■■ Ag nt or rinted Name Signature ** Please read compliance statement on back of permit ** Application Fee(s) Check # VrI1 Printed Name Issuing Date Expiration Date N.C. DIVISION OF COASTAL MANAGEMENT AGENT AUTHORIZATION FORM Date Name of Properry Owner ApplOng for Permit_ V iw) C, -z;4 Mailing Address- fj I certifv that I ha%e authorized (agent) to act on ntv r' behalf, for the purpose of applying for and ah/tainin all CAMA Permits necessar'. to install or construct (actisity) t�� 'l(// Aer :it 4niN propem located at) �J� •� /�f r//i 17L Z 0e,/ /ed1 / l This certificatinn is valid thru (date) Date ADJACENT RIPARIAN PROPERTY OWNER STATEMENT hereby certify that I own property adjacent to _�1/ Cj�Cty°Cl f s jf pme of Property Owner) property located at _ (Address. on __ in (Waterbody) :k, Road tc.) (CityITown 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) 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. (it 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_ Prim cr f y'x N,,mt, M•�r! Address Cr±y zin TElBF?fiOrl�rRbEi', errati' ad'rESS -Valid for one calendar year after signature' (Acl�acettt Propa+rty Owner ��brrs,>N OnC,me4 Pnnt,)r.i ,ve NarnA . 14far . drkess z.a z9 Telephone Number /t-mail address (Revised Aug. 2014) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT a I hereby certify that 1 own property adjacent to 1 G'11 s Name of Property Owner) property located at (Address, Lot, lock. Road�tc.) on %3/l4L�; _ in �f �Tl-u . N.G (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location, / y I have no objection to this proposal. I have objections to this proposal DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must rill 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 TeiWorte Num¢er ernad address �r Type .14 r rd:y� Address Tereat--mv Jurlss (Re vised Aug. 20141i ,Va♦id :or one calendar year after signature' r 6umnW.'ail 3�rz loor �r 6)9c &fn)avf4 C - dUr Date Received Date Deposited Check From (Name) Name of Permit Holder Vendor Check Number Check amount Permit Number/Comments Receipt or Refund/Reallocated Columnf Column Column3 Column4 Co1umn5 Column6 Column7 Column6 Column9 /11 r2019 � Pi in Man- Construction LLC Ga C.— n I WOFaro Bank 5003 00 00 GP #7260 7766