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Home My WebLink About74534D - FloydV XCAMA / ❑ DREDGE & FILL �. GENERAL PERMIT Xlew ❑Modification ❑Complete Reissue El Partial Reissue No. 74534 A B C 0 Previous permit # Date previous permit issued 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 I SA NCAC 0 714 , 120 0 ❑ Rules attached. Applicant Name Address 1751 �-'BOSS DR SW City State_ALC ZIP 214-7D (�$ ao& c h �B -F'o 1 IOw •the Phone # — ,2 740 E-Mail Authorized Agent A WINE Affected XCW XEW )(PTA ❑ ES ❑ PTS AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ,! ❑ PWS: ORW: yes / o PNA es / no Fp s Project Location: County IggLkw Tw 1 cle- Street Address/ State Road/ Lot #(s) Subdivision City ZIP _)V Phone # O River Basin LuMaFii Adj. Wtr. Body at man unkn ClosestMaj. Wtr. 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BE CAIVTILXVEREfl ¢ROK PIoR/ Agent or Appl' t Prin e 0 C VIL S ` e it icer s rimed Name y LZ:Q Lj- Signatu lease compliance statement on back of permit* Signature S 5TS 9 /10 IAO 14 1 A o /Z?— A, pIication Fee(s) Check # Issuing Date Expiration Date .� 01 �Z2 vass) (IKo13 ��L1yM H9►N -Wyo 1 4 AA HSW/V J.12 � 0) Xor IDSAO ' DocuSign Envelope ID: DD5E8883-AADA4B90-B45C-E6BFB2CD4A3A ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to _ �+ N 1'J . (—to y C/ _ _ 's of property located at S /- Lf- Al. <- w6rayJ S st (tom( amProperty Owner) z z J 4-Qc) a 5 on �� t�r-c �l� (Address, Lot, Block, Road, etc.) �Q�r,�W 1C lC t✓' o . N.G. (Waterbody) (CityiTown and/or ounty) T applicant has described to me, as shown below, the development proposed at the above location. P 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, 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. S� I do not wish to waive the 15' setback requirement. (Pr Owner n o at (Adjacen p@�,.Qwwner Information) Swam, Piv" Signature o W. � o �; Y♦ o r ��2z u�yJ Print or Typee Name r Print or ,Type Nam Mailing Addr�ess f u Mailing Address J r /r . 2� 7� G L 0-1V U t S( city/State/Zip �� 0 Qly/Statelzip f Telephon Mumber Telephone Number 8/19/2019 Dale Date (Revised 611812012) ve 1 00 F, N IV O r 0 0 0 c ch E, m m 0 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that 1 own property adjacent to Id, %boy Is ,' CI-0 O(Name of Pr perry Owner) property located at lR z L/oA2 (Address, Lot, Block, Road, etc.) on � � 4�a.- CK Lk e/ u<< Co . (Waterbody) , in �,�Q'l(a�- NrC. , N.C. (City/Town ap&or County) The ap cant has described to me, as shown below, the development proposed at the above location. 1 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) -444 otck;j WAIVER SECTION I understand that a pier, dock, mooring pilings, 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. n) U, Print or Type Name 17V 3 - / Cr6JS P le - Mailing Address 151 A I 1 0 4 N,C ity/State2ip 7110- �7y- ;010 Telephone Number Date (Adjacent operty Owner Information) I c K. '39/,�, Si nu ure Print or Type Name 1J7�; 7�`J'�iY/GV(75S Mai a (r City/State/Zip q Telephone Number L� Date (Revised 611812012) 2-0 MAk5A i I I ia"1, g f� Z dye- 0;AWsH of Pi Z2� � Date Received Date De osited Check From Nama Name of Permit Holder Vendor Check Number Chack amount Permit Numbar/Comments Racal for Rarund(Rwl/ocetad Columnf Column2 ColumO ColumrW column3 Columntl Columal Column8 Column9 9/11/2019 9/11/2019 9111120191 Clements Marine Construction Carolyn and John Flo d 1 H5 Construction LLC Jam Properties / Dan Smith First Citizens Bank BB&T IBB&T 5230 $ 400.00 GP #74372D GP #74534D IGP #74505D PA rct 9168 TMc rct 9146 ITP rct 8749 John Floyd 8585 $ 200.00 I Mary Travers 1 23451 $ 200.00