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Home My WebLink About72784D - GillisYCAMA / DREDGE & FILL NO. 72784 A B C GENERAL PERMIT Previous permit# JCeW -❑Modification ❑Complete Reissue ❑Partial Reissue 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 15A NCAC 1H . /a OO ❑ Rules attached. Applicant Name Jy (>I -ril 6. LL ► 5 _ Address i.Z W. A51^1CV %I-LF ST City UCE AJ KBE 3CA L k State_NL_ ZIP ;Z to9 Phone # (gjd nq f tIN E-Mail MIA Project Location: County ��v�:w►C►c Street Address/ State Road/ Lot #(s) /moo; w gv C V Iug !;I Subdivision Authorized Agent 6fMcf C0tJS ?vt loo►J WANurCity pGEAN \544 UALN ZIP AE)4iq ` Affected ElCw AW EWTA ❑ ES ❑ Fi A Phone # ( gIQ) 5 49 109 S River Basin LUAAZep AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A ❑ PWS: ORW: yes / � PNA yes / qQ Adj. Wtr. Body %A)JAL (nat / nkn) Closest Maj. Wtr. Body ULEFk •TA :111111Cc i • a y-M., r■■i■r■iii■■ili�:�ai�iilii■■■■■■ I■■■■■■■■■■■ Mi. ■■■■■■■■■■[■■■■ 1■■I■': ■■■l1■■■■■ I■■■■■■■■■■■■■ ME ■■�■■■111 ■■■■■■i!■■■ I■■■■■■■■■■■■ i■■�'�i.i..�i■1■■■■■■■■■■■■■ • ■■■■■■■■■I�'is'!■■■I■�1■■■■■■■■■lull■■■■■■■■■■ ■■■■■■■■■IAA■■■�■� i. �?�ee�4 C-lee_-e Agent or Appl t Printed Name i Signature ** Please read compliance statement on back of permit* Z00 *-►3015 Application Fee(s) Check # �Cr_ M C�u�� Permit Officer's Prin Name C Signature T! �zo i q to I % Zoi 9 Issuing Date Expiration Date NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Pat McCrory Braxton C. Davis Governor Director AGENT AUTHORIZATION FORM AGENT AUTHORIZATION FORM Date: May 17,2019 Name of Property Owner Applying for Permit: Judith A Gillis Owner's Mailing Address: 12 W. Asheville St Ocean Isle Beach, NC 28469 Phone Number (910)579-8484 John E. Skvarla, III Secretary Name of Authorized Agent for this project: Grice Construction Agent's Mailing Address: 6618 Beach Dr Ocean Isle Beach, NC 28469 Phone Number 9� 10) 579 - 9095 I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct the following (activity): _Boat Dock and Ramp For my property located at 12 W. Asheville St Ocean Isle Beach, NC 28469 This certification is valid thru (date) June 30, 2019 ju&tivA. GaU* Property Owner Signature Date 127 Cardinal Drive Ext., Wilmington, NC 28405 Phone: 910-796-72151 FAX: 910-395-3964 Internet: www.nccoastalmanagement.net May 17, 2019 An Equal Opportunity t Affirmative Action Employer CERTIFIED MAIL • RETURN RICEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT R IAN PR7Jh-� RTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner: 1 '�6 C Address of Property: 12 qs�e�� 11 5� oczq,-)T6i e (Lot or Street #, Street or Agent's Name #: Gr ict Ozsr)*gji�o Agent's phone #: ` W- S-N - q 5 City & County-) -- �cf(-' Mailing Address:66[b Bv-tch Dc- G1.Wr)T6[Q U6\ N( z" q I hereby certify that I own property 9djacent to the above referenced property. The individual applying for this pe rmit has described to me as shown on the attached 4rawin the development they are proposing. �1 I have no objections to this proposal. I have objections to this proposal, ff you have objections to what Is being proposed, you must notify the D of Coastal Management (DCM) In writing within 10 days of receipt of this notice. C e should bo - - - - mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM repress also be contacted at (910) 79&7215. No response Is considered the some as no objection been notified by Certh7ed Mall. q� WAIVER SECTION V1 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. (Property Owner Information) (Adjacent Property Owner Information) `` _ SWnature Signature Print or Type Name lllailing Address a�,nT-S� N C 040state2ip lu- S`?-1 - �-1-( R / o - 67 7 S- t, --� I -� Telephone Number Date Telephone Number L- -5- E Date ',ota � Aar -e--1 Print or Type Name Mailing Address citylstate .ip Revised 611812012 CIR TIFIED MAIL • RETURN RECEIPT REQUE,§ICD DIVISION OF COASTAL MANAGEMENT -- ADJACENT R IAN PRO LRTY OWNER NOTIFICATIONIWAIVER FORM I Name of Property Owner: Address of Property: t')- �She�i �11 J (a1,•��5` e )�Q�f� (� (Lot or Street #, Street or Agent's Name #: l3 r ict � r 5yr QJi �0 Agent's phone #: %0-- 5-N -geg5 City & County) — Mailing Address:Cptt3- BQuCh ►✓c— I hereby certify that I own property Mdjacent to the above referenced property. The individual applying for this permit has described to me as shown on the attached rawi the development they are proposing. C C1 have no objections to this proposal. 1 have objections to this proposal. you have objections to what is being proposed, you must notify the Dl. i of Coastal anagement (OCU) In writing within 10 days of receipt of this notice. Cor a should bQ mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM represe also be contacted at (910) 796-7215. No response Is considered the some as no objection been C notified by Certified Mall. qW WAIVER SECTION V1 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 i0ral the appropriate blank below.) I do wish to waive the 15' setback requirement. " 1 do not wish to waive the 15' setback requirement. (Property Owner Information) (Ad acent Pro a Owner Information) �A"- Sienalure Signature Print or type Name Print or Type Name \1 �� a5r�� `1� \,AJ /-c1, �, / , I (,e J 1146iling Address Mailing Address Z%Y 'DCe,cn ys le pi b 9 city/State/Zip city/state/Zip ` �l}- 5`7� -' LA'j`-t Telephone Number Dale -- 7 (0`-/ (p0'7 a as 7 Telephone Number Dare Revised 611812012 ■ Complete items 1, 2, and 3. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: �rrd�e �we�l C� csWtS�eC�1` rI VGC (O l (I�IIIII'IIIIIIII II IIIIIIII 9590 9402 2219 6193 1046 08 Addressee 10 D. Is delivery address different from item 1? ❑ Yes If YES, enter ivety address below: ❑ No <749 `.a 3. Service Type ❑ Priority Mail Express® ❑ Adult Signature ❑ Registered MailT"^ ❑ Adult Signature Restricted Delivery ❑ Registered Mail Restricted fled Mail® Delivery ❑ Certified Mail Restricted Delivery return Receipt for ❑ Collect on Delivery Merchandise �rricla Ni imher !Transfer from service label) _❑ Collect on Delivery Restricted Delivery El Signature Confirmation?^' - "ail ❑ Signature Confirmation 7 017 0660 0000 7487 0733 ail Restricted Delivery Restricted Delivery PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt EEI' 0 ZQhZ 0000 0990 2.'CH ■ Complete items 1, 2, and 3. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article to: Addre sed L � M � Tf -, k,6- OC4lc�YN Z1 9590 9402 2219 6193 1045 47 2 Ar -_ r,-,.,„-f , f nm service label) 7017 0660 0000 7487 PS Form 3811, July 2015 PSN 7530-02-000-9053 vur` o COID o i a 01 0 6U.0 0000 0990 zToz A. ❑ Agent Y ❑ Addressee by (Printed Name) I C. jftte yf Delivery D. Is delivery address different from item if' u Ye: If YES, enter delivery address below: ❑ No 3. Service Type El Priority Mail Express@ ❑ Adult Signature ❑ Registered MaiIT" ❑ Adult Signature Restricted Delivery ❑ Registered Mail Restricted Mail@ Delivery ❑ Certified Mail Restricted Delivery %<MRe4�Receipt for ❑ Collect on Delivery Merchandise ❑ Collect on Delivery Restricted Delivery O Signature ConfirmationTM n tr,cured Mail ❑ Signature Confirmation 0 719 tricted Delivery estricted Delivery Domestic Return Receipt wn i ,h\ )bX-Ab J Dab Received Date Deposited Check From (Name) Name o/ Permlf Holder Vendor Check Number Check amount I Permit Numbe lCommenfs Rece/ t or Refund/Reallocated Cal -I Column2 _ Column3 ColumM _ Column5 Column6 Column? Column8 Column9 3/2019 ton / Brunvkk CourtW Im! udRh G'II' _ _ _ a 8T 13075 P a7 T