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Home My WebLink About73509D - HertensteinXCAMA / [-] DREDGE & FILL GENERAL PERMIT XNew ❑Modification ❑Complete Reissue ❑Partial Reissue No. 73509 A B C 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 ❑ Rules attached. Applicant Name S'TCV" 1 VIAGIWIA �iER. .✓�rctwi Address 113) S Sce owric LD C-r City J ND IAn/A Po S State zip 44- 2 59 Project Location: County S f2u.15 I.JI CK Street Address/ State Road/ Lot #(s) 1214 91'V15.1RVIF W _Dgwr '5 W M Phone # Q"I ) 9(0 5 - 37g5,, E-Mail Subdivision X1A Authorized Agent MA1T•r 14o.*J City Si -IA" oT-rE zip 2 8'4'70 Affected ❑Cw )(Ew KPTA El ES ❑PTS 46gdT- Phone# (910)T80-4381 River Basin LHMsr-g AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body 514_4wOTy%_ RIVE (nat man /unkn� ❑ PWS: ORW: yes / no PNA yes / no Closest Maj. Wtr. Body A I W W NEC-7�17!'!�!!I.1■■■■■ =1=7■■■EN■■■EE■■OE■■■ • • - • ■■■ ■■■■■■ICE■�1■■■■riF1■■i■(■■■■■■■■■■■■■■ NiiN■■■■■■nL't�l■■■ ■ NOON■ ■IN■� ■■■■■■■■■■■■■■ ■■iNi■i■■■l e! 1■■■ ■ NOON■ ■t ■I ■■■■■■■■■■■■■■ M. ■Ei■■NiiiiEi■■■■iiiii■iiii■i■■iiiiii ■NiiiiN■■NI�Nt l■■■ ■ NOON■ ■�i1■ii■!■■iiiiiii ■ NON■NMINE■■E■Ili ■■iiN■NON■■r!■■■ifs: on ME■EN■I■■■■N■■■ENONE /iii■OtiD9■■■■N■iiiiii■N■ iO■EEA■M■MEL ■i/1J■■■H�■I I■®i■E' ■■i,A■EME■EV `3■..'Ngm■an TMN 3 ! ■ ■i■■ �JJ■I ■i■■■1!l■l1/.■NONE . 7!T'r.7rl11■■1IEEE � , � NEENENN7�lONLI�'i3iiil�iii��ii1■�■�E■!T!�'�f�:�l■N■ON RPIMM I■11■■■■■I ■■■■W:PFR fM■■■Nr 'rA'An u4„ Agent or Applicant Printed Name Signature ** Please read compliance statement on back of permit ** $200 --* 22(04 Application Fee(s) Check # Permit Officer's Printed Narpe • Signature /lor 3/27/2019 Ib'I/1011 Issuing Date Expiration Date WA AZ,VAIV on& North Carolina Department of Environment and Natural Resources Division of Coastal Management Beverly Eaves Perdue Braxton C. Davis Dee Freeman Governor Director Secretary AGENT AUTHORIZATION FORM Date: 2 2 ( C( Name of Property Owner Applying for Permit: Name of Authorized Agent for this project: 4 I H5 Construction Owner's Mailing Address: 1l31 O(Dorn� C irAo�,- no pooh / N �&2s 1 Phone Number (3(7 0662W 5 3r7 3-7 11 Agent's Mailing Address: 2164 Holden Beach Rd. Supply, NC 28462 Phone Number(910 )880-4381 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): Remove decking and install new thru-flow decking and hand rails For my property located at jl 1 i VC.-V1-r_t.y 1>. 5 VV . S:h�2 i`oAL �L c'� VI 7d This certification is valid thru (date) J, Il4 - Pro wner Si nature Dqte zl2-1 I �,� 127 Cardmal Onve Ext.. Wilmington, NC 28405 Phone' 910-796-7215! FAX 910-395-3964 Internet: www.nccoaslalmareagemertz vi M Eawi Oppor" t AAA NU" Achon Employer One N�otthCarofina 444MMI ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to !� �A `r. \�t LG i m6 4-k 4 &j< property located at 1 (Name of Property Owner) ! Y1� 21 !• t�r�.ryrrk•�r. 5 r�"�.-� (Address, Lot, B16ck, Road, etc.) on �ai�tyor- in 1C;4k NC �"/-7r� N.C. (Waterbody) (Cityfrown and/or County) The applicant has described to me, as shown below, the development proposed at the above iQCati.^ . I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT ~i^� (Individual proposing development must fill in description below or attach a site drawing) Remove decking and install new thru-flow dock decking and hand rails 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 wish to waive the setback, you must initial the appropriate blank below.) I do wish to waive the 15' setback requirement. d 210 1 do not wish to waive the 15' setback requirement. Owner Information) J ; r Print or Type Name Mailing Address .kfyA rik� f ty � Z Cih1lS te/Zip n1-7 7)-7n-2D 1 Telephone Number/email address 1n Nic 'Valid for one calendar year after signature' (Adjacent Property Owner Infonnation) !Q Sigma re /t 6_N/j a t7 I YEuI<Ort/ Print or Type Name o. &K .3 60 S' Mad g Address Jj 9.-4 L P!) E MC Citylstat ip Telephole N mberlemail address �17�19 Quips (Revised Aug 2014) �T-.Mm6s V_qvlw I ml r�.19 VPJIP-IW-WWlmFArA� Omme NNE ■r■O■■■■M■■■�iiEN■rME■ ■■N ■■�■ NOON■ ■►��s�■r�■■■■■■■■■ ■■■ NOON■ ■■�■■■■■■■NE■■■■■■ ■ ■i■I■■ ■■■■■■■■■■�■m NO ■■ INSIMEREMININEEN NO MEN _,_. _ �, . .�1N ■ ■NISI■■■■ ■ NMEN■■■■■ ■■ 'rrrmImin 1 ■■1MOS■■■■■■NE ■■■!'l..�■■■' l�it�■■■■■■■■■■■ ■■ IN�■M■EN■ ■E■■■■■n ■ NEON 11s!�111!.'M■ ■��■■■■■■ ■■ NNE ONES NOR■SN ON ■NOOMINN ■■ N■■1■ ■■■ ON ■■■■►1l■IN No ON ■■ ■■■ NNE+ ■OIMMNN■MOON■■ ■■■■■■■■ ■ ■ ■■■■■■■■■■■■■ NOON■■■ ■■ ■ ■■ NOON■ ■■■ ■ OENESOEi ■NON■ ii■■E■■i ■ ■ ■■ No EN ■■� ■OSOSi■L�i■S■SOi■i■E NEE ■■� ■■■■■■■■n■■■■n■■■NOON■■■ f■■■ Si■■■S No ■■ ■ ■■■NOON ■■N ONE NMM■iM■NE■ M■■N■■■■■■MMv ■NNE■ 1 ■■NEE■ENN■■N ■ ONE■ ■ ■■■■■■■■ .�■ MOON ■■ ■ ■�i■ �■■E ■E■ Date Received Date De sited Check From (Name Name of Permit Holder Vendor Check Number Check amount Pennit Number/Comments Receipt or RelundiReallocated Columnl Columnl Column3 C.1-4 Column5 Colu 1 Column? Column8 Col-9 4 H Stev n a.rw N ' B &T 0 00 " P *73509