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Home My WebLink About72754D - Chancy1CAMA / -]DREDGE & FILL NO. 72754 A B c j GENERAL PERMIT Previous permit# New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality 14 and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC / � ❑Rules attached. Applicant Name (`'"1 �2-1 Project Location: County pe -""J %c Address ) Y1n 07 lTLl City UN N State ZIP 2g334 Phone #4i�LP 590-6Z tl$kMail Authorized Agent Affected ❑ CW :J!ZW ❑ PTA � ❑ PTS AEC(s): ElOEA ElHHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: ORW: yes / no PNA yes no Street Address/ State Road/ Lot #(s) Subdivision City -5`� l (mil ZIP Phone # ( River Basin' Adj. Wtr. Body �an kn Closest Maj. Wtr. Body ,/s ■■■ ■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■��i4tlli!!J • '�93�frii�G■ - ■■■■■■■■�e:sic.■■■■■■■I■■r�■■■■■�■v■■■■■■■■■■■■ '■ A■■!■�■■■ ■■1��1■■■■■■ill■■■■w■■■■■■■■■■ ■■■■■■■■■■■■■■■■/ :t;: ��I'/'iiil/�iLill�!'151"i�iT/■rills■■■■ Ag nt o '77' ited Name Signature ** Please read co ce statement on back of permit Printed Name Application Fee(s) Check # /..Z — ie Date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: ri r' Mailing Address: l / ? / T) r ),)c I (A L; �- K i Phone Number: Email Address: I certify that I have authorized Agent / C *actor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: at my property located at in-v1;� �� County. 1 furthermore certify that / 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: �c�nc Signature Print or Type Name Tale Date This certification is valid through I I ADJACENT RIPARIAN PROPERTY OWNER ST I hereby certify that I own property adjacent to S-rc .�, �aj4i LZku—r7cB-eAA,,c�) A (Name of Property Owner) property located at 4ir1 � s , Lot, Block Road, etc.)n /� on ,�In1iC,s Channel�Ta* 1 ^� I in /"�/ der CCU N.C. T (Waterbody) (City/To n andlor 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. (Property Owner Information) __ .. (Adjacent Property Owner Information) X& C a cAa _ atur �re�cr► kti� L.LC l/R/E • � nlc Sib ature Pr'nt or Name J�IJ Print o y ,�jlCC Mail- iJing Addres-7 UW /f.,ll OA 111S4tate�'ID-' Cf�� rp / "C (O`3 / Tel �p�h ne7 umber/email address Telephmber ^d Date Date (Revised Aug. 2014) "Valid for one calendar year after signature" RIPARIAN PROPERTY OWNER STAT I hereby certify that I own property adjacent to Sr-een l"Q�~ i�lv4iil-ie a'ge)C J) property located at Q / (Name of Property Owner) � �l- / Aa A, Lot, Block Road, etc.j //�� or , 11�S 00rAeJLT� l � in 4u N.C. (Waterbody) —� (CitylTovan andlor County) J! The applicant has described to me, as shown below, the development proposed at the above location, V I have no objection to this proposal. I have objections to this proposal. DESCRIPTION ANDIOR 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 wash 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. (Property Owner Information) (Adjacent Property Owner Information, tJ/ -� ,� atur #h 1Ac�,e� .CN � Sib ature �, cam, l,�s�,� �, 7 F c 77" Print ,W Namey �• Print or Type Name fling Ad dre G � Mailing SAd�N c/tat �D- 6a �G 15,�te/Zt 7�� Teleph ne umber/email address Telephone Number/email address Date Date * e 0 3 / (Revised Aug. 2014) `Valid for one calendar year after signature' Date Received O=Check From ame Name of Permit Ndder Vendor Check Number Check amounf Permit Number/Comments Recei t or Refund/Reallocated Coke ! Coka 2 CdtamJ Cdumne Cokannb Cofutn8 C., C_olumne Cdumn9 1/30/2019 Lighthouse Marine Construction/Darryl Emy Laurie Chancy Coastal Bank & Trust _ 2533 $ 200.00 GP #72754D JD rct. 6975D