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Home My WebLink About74361D - GolobNCAMA / ❑ DREDGE & FILL No. 74361 A B C GENERAL PERMIT Previous permit# ,New '—Modification El Complete Reissue El 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 . (, r%� /,, El Rules attached. �j Applicant Name V A k V C 1 V l o b f/ Project Location: County W wfl c i`ly-e r Address f h K r Street Address/ State-�Road/ Lot #(s) �l� j� h City I b A, (v v State zl Pq-(64 I( {�, e -OL j Z'd Phone # () 1 E-Mail N Ilk Subdivision l� Authorized Agent V1 01 ❑ CW 'SkEW Y] PTA Es i PrS AJ0 h Affected ❑ OEA ❑ HHF ❑ IH ❑ UIBA ❑ N/A AEC(s): ❑ PWs: ORW: yes / no PNA es / no City l V t 1 Ky vtg1 "-1 zip 2 4?+f Phone # OLO ) yam��-MARiver Blasi J41A f P V� Adj. Wtr. Body 1 C `'L_6f na man unkn Closest Maj. Wtr. Body BONN ■�iile�Wr■ri■■Illi�i:�riM#!!�Il■■■ri�i'J'�'li''i►�!111�[�►1'�I■ -.. ,• ... ► . ■�■■■■■■■■■fir �'�liSAiri7G�i1�lei■■ffvll�!.�i7iIR,iJi■■ ' ■�■■■ ■■I�J�:%mil■■■■/.il■�■■■■■■I�If■1■■■■■ MEN C��!��■■■�i�l■I ■1 ■1�■[I■■■■1r1J\i!�?'i'1i1fi■!�■■■■■■ ■11�/■11,RL ■Uip/L�'1�7ir■►�J1�►`�V;■_■I�! �;�!■■■■1;,il■■I ■1®■�! .�i�l►.■■■■�i■!�■lir■M■■■■■ i:�■i%►.L' Iirlf �G � ►,ia■■■■■■ ■�NONIIRx /,Jmrla■WW-NOI J1cd I. m ■ ■ \\ ■ a■aNLI!/■■■■1■■■■ ■■■i�■■■■■■■n!��■■ten.►■■■�■■■■■c��y��■►■■■ ■MLIEi%■■■m■■■■� la'�ni�MEN auamommm■■�\ 10 X/gent or li t N intPrJ \ J A( - Signature ` "Please read compliance s'atement on back of permit ** lot � A- � 2 Application Fee(s) Check # Permit Office Signature Issuing Date k I/ 1 /1 Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: M5 MA"Z 7 (AD V) Mailing Address: j_q 7 t C�Z � R:Q� W✓ `i �� Phone Number: qjZ Email Address: I certify that I have authorized�� Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits /\ I necessary for the following proposed development: CA --),uIL1� at my property located at - — GY , in & OM C)Vfi�County. It / 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: I' Si ature Print 6r Type Name 4? 5 Title a �-1 / S / 201,7 Date J ` / � RECEIVED This certification is valid through L[ / ' ( / i0AY 0 1 2019 DCM WILMINGTON, NC ADJACENT RIPARIAN PROPERTY OWNER STATEMENT hereby certify that I own property adjacent to >'r �� 's ,► , i , A r . . , r — , , (n9 pf P_ Opener) property located at r��`'� (Address, LotBI c Road, tc. on C.Y4i.�=1 in , N.C. (Waterbody) (City/Town 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 rill in description below or attach a site drawing) CP(�Avw;r -Mw-- n 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. (Property Owner Information) Signa o � r. Print or Tie Name W-%t \Alo Address O+f NC ��Qll C1ttyy/State/2 qlo _ 91—o5'38 Telephone Number .Z///G /?0/4 Date (Adjacent Property Owner Information) Signature — Print or Type Na ) Mai/14d ress City/ ate/Zip Telephone Number Date RECEIVED (Revised 61182012) MAY 01 2019 DCM WILMINGTON, NC ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to ) r A �� 's A , 1 e -I- _ . I A, � f.< < , W.-Kno Qf Pope#y..X*ner) property located at onJ f �P- n ( ) 171--/ flan-i CY� (Address, LotBI c Road, tc.)N.C. (Waterbody) (City/Town and/or County) The ap/plicant 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) DRAV0('15r ATAX-�n) 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. (Property Owner Information) i Print or Type Nam (qy I t=JTC4 cuv(- f2� Mailing Address WILIr^k0N.4 Nt- Ci State/Zip WIjo QOG -"7(.3 Telephon Nu ber y7,s 7,3 Date djacent Property Owner Information) V lib<d Print /�y� / a�/_! & M-ding Address City atelZiZen LZ 7 r Z, 7` Telephone Number -- 20/ Date Z`E IVED (Reviseq#1 'Ag DCM WILMINGTON, NC bAtX 9f 6-t-1 .0 , DOCK Lulu--- A-FW� aC2 ANVE Atvj - y - - - AJI i A f 5 �4 1 \/AR�V�---PY44 RECEIVED �L 6,1 _ DCM WILMINGTO'N, NC Date Racolwd DataDI,.Iftd Check From Name Name o/ Penm/t Nokler I Vendor Check Number amoCheckunt Pamlt Numbx lComments Recel t or Re/und/Realkrcated Columnl CoIU MY Column3 Column{ Columns Column6 Column? Column Column 5114/2019 M &T ° e 1-800-BANK BBT TRANSACTION RECEIPT 1-800-226-5228 All items are credited subject to payment. nBBT.com Learn more about Online Statements and Mobile Banking at BBT.com Location/Date/Transaction # Amount 5Uc350C I09513 089 00410 15:04 L41�.11'i' #XXXXXXXXXXXX990-0 DUPLICATE Ft1T 100 . 01D Member FDIC DEPOSITS SUBJECT TO VERIFICATION AND MAY NOT BE AVAILABLE FOR IMMEDIATE WITHDRAWAL.