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Home My WebLink About72752D - HerringLJ -. ❑I CAMA / D DREDGE & FILL GENERAL PERMIT New ❑Modification ❑Complete Reissue ❑Partial Reissue No. 72752 A B C Previous permit # Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality ' l and the Coastal Resources 1Commission in an area of environmental concern pursuant to 15A NCAC �� I � C)Rules attached. b Applicant Name � R Project Location: County PC Address „C d v v Street Address/ State Road/ Lot #(s) p City N (O✓Ci State . ZIP 3r'o� (V 1 D6� 12L {y C Phone # (�C?) �t � 0 ` 5Z4'?- E- ails� oo '' Subdivision Authorized Agent M F-�-' City Jul-P I L �� ZIP z�2 Affected Cw ?4EW ,»PTA )WES ❑ PTS Phone # ( ~}-- River Basin' WY AEC(s): ❑ OEA ❑ HHF [IIH ❑ URA ElN/A Adj. Wtr. Body FZ,A NJ (L5 G9111UNFLI ( ) ❑ PWS. nat Ar4�ryunkn ORW: yes PNA yes Closest Maj. Wtr. Body �O(SA fit' �D Type of Project/ Activity LN54 KfAJ--W0 Pier (dock) le h Fixed Platform(s ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■E■■■■■■■■■■■■ ■■■■■■■p■■■■■■■WAIF J■ ■■ Mill■G■■■■■■■■■■%r1■■■■■■■w!■Ir■!!►l7�■■ ■■■■1<<===========---------------�.��- _ ■■lava■■■■■■■■■■■■■r�■■111■■■■■■1�1■■■■■■■■■ ■■ii■■■■■■■■■■■■rii�ii■■■■■aim■■i■■■■■■ �■■■■■■■■■■■Maw■ ,. ■�■■■■■■■■■■■■■■■■■■■■■ ent or �picant/Prrinted Name 1 Signatur Please read compliance statement on back of pert Yoo 1 `rJ(p( Application Fee(s) Check# Pe icer's Printed Name i ture Issuing Date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Will; Mailing Address: Ron Phone Number: C11 ' q Q 0 Email Address: �tL11�(I<btl CIDM I certify that I have authorized i7c ro j " Agent_ / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: FM at my property located at \D T in �Ma bz _County. l furthermore certify that l 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: Signature Print or Type Name Title 1 l�'i l A _ Date This certification is valid through 1 I j� I % V CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM 1 " It - Name of Property Owner: Address of Property: (Lot or Street #, Agent's Name #: Agent's phone #: or Road, City & ount Mailing Address:1) Eo m), T RA )fie tv +uxo Creme P. C - I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit has described to me as shown on the attached drawing_the development they are proposing. A description or drawing, with dimensions must be Provided with this letter. I have no objections to this proposal. I have objections to this proposal. If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845 DCM representatives can also be contacted at (910) 796-7215. No response is considered the same as no objection if you have been notified by Certified Mail. 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.) 1 do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) � Signature Print or Type Name 1)x Ih Mailing Address City/ ttS ip 91D - �-)9 Ll - I L Telephone Number )-I,;,� -l9 Dare (Adjacent Property Ownev Information) -/2e4, ignaa�ture 1 Print or Type Name Z/ -our-10 L.0e Mailing Address n IVL Z 7 td 05 City/stat Telephone Number /'--�7 Z Dale Revised 611812012 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT . - - I hereby certify that I own property adjacent to _(Name of Pro rty Owner property located at �O 10 dl 1 n06V44I I �� Cam, nL (Addr s, Lot Block, Road etc.) on in i l C_ _ N.C. (Waterbody) (City/Town and/of 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) --f � q t° a T; c� �Xl 61 � 13 t, ALL 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) (Adjacent Property Owner Information) Signature ignature Print or Type Name Print or Type Name Mailing Address Mal ing Address � City/State/Zip CJ tate/Zi Telephone Number 7TW16 hone Number Date (Revised 611812012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to 116) 1 QT-- ,� c,'s (Name of Prope , Owner~r,• �C property located at Tr�lt��/x,�� ";;ems, , j jke�=h � G.- Lc} '��35 -. on L v (Address, Lot, 13lock, Road, etc.) in I l�ri 1 i?�em1 h l E'�?, N.C. (Waterbody) (t City%Town and�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) '�Ki6�'b►a�, � ��iOr+1 EsT,6t'+ /JQ VIn1jC,i1�� , ►�u�I1�ytC.r;t� c� �r�Lpcc b 0,8 vo2,af Sea"X1-L- 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.) 74� I do wish to waive the 15' setback requirement. i do not wish to waive the 15' setback requirement. (Property Owner Information) (Adjacent PropertylOwjnerinformationl 1 Signature ` Print or Ty a Name Malting ddress C i ty /State2i iZ- Telep one Number Dale TPAWITIM or Type Name V GZl- fflartto"e__ Majtjng dress, City/S�ta-t Telephone Number Dale (Revised 611812012) Cr�n1�� C,V-Lnc-e- RU I I<-h(--r4a Daft Hecwwd Daft fad Chwk Fmm Name Name o/PWndt Holder Vendor Cheek NunMar puck amount Pwnit Nunsborr fs /hew or Rd w,&Vt* ao"ftd cw/ l Cwumn2 Cwumn9 Co/ufmfr Column6 cwunma Cwwnnr CohmxM cokm o