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Home My WebLink About72362D - Lewisr YCAMA / ❑ DREDGE & FILL No 72362 A B C D GENERAL PERMIT Previous permit# ❑ flew —]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 I SA NCAC eA QQ� , C, (� ElRu s attached. Applicant Name K(`nl� �jVy.' ✓, Project Location: County Address 1 ` ! "'G Vf'tf41 Street Address/ State Road/ Lot,#(s) City e- -Q S Q:il/ State � ZIP o �;l.A 6)" a 01VA' Phone Authorized Agent ❑ Cw Affected AEC(s): ❑ OIiEA ❑ PWS: ORW: yes Pno EW A PTA �S ❑ PTS ❑ HHF ❑ IH ❑ URA ❑ N/A PNA yes / no Type of Project/ Activity Pier Fixes Float Finge Groii Build Basi? Boat Boat Beac Othe Shor SAV Mon Phot Wain Subdivision City t ZIP H Phone # I ) "'""� River asiin� �i P. On /1; Adj. Wtr. Body nat man unkn Closest Maj. Wtr. Body 4 i/n - 1.4 (Scale: 1 rf= Z6 / ) i length ■i■■■i��i■■■■■■■■■■■�i■■■ii■■■�■'',■,�i■■�■}w ber J.- 7 avg distance offshore max distance offshore ■■■■■■■■■■■�■■■■■■■■■■■■�■I �■■■■■■■■ ■■®ii_____ ■■■a:��..•■�_■_ ■i.■■■■i ■■■■■■■■■■■ ■■■■■■■■ �■■■ lll,llll,1111,11111111�%'lll,llllllllll�■■■■ ■■■■■■■■■■■ ■■■■■■■■i i.:��■ i■■■■■1■■■■®■■■�7J1 ■■■■■■■■■■■ ■■■■■■■■ � a;�■ ■■■■■■°�i�An■■■■■mot ■■■■■■■■■■■ MEN -not MIMIJine ■n�■■■■a■■■■■■■■■■■■�■�w■■■■■■■■■�■■■■ Length sure -1 ■■■■■■■■■■■■■■■■■■■■�:i,L��!�■■■■■■■■■■■■■ yes wm■■■■■■ - ONE ■�ii■■iM■i�ii■i■■■■■■■■■■■ A building permit may be required by: ( Note Local Planning jurisdiction) Notes/ Special Conditions or ApplicanttPrinted Name LIM Please read compliance statement on back of it ** Fee(s) Check # ❑ See note on back regarding River Basin rules. ADJACENT RIPARIAN PROPERTY OWNER STATEMENT Lpw� I hereby certify that !own property adjacent to /�� k '1 j— � / S Is (Name of Property Owner) property located at 2 L a L e� i n G 6n / VA. LAP S a l 119e g c h: Y �l `I"( on g S'r? it h pj (Address, Lot, Bloc, ad, etc.) 0 in ��G 1 e c i h %��hdl' ✓ N.C. pS 1 (Waterbody) (City/Town and/or County) apgli has described to me, as shown below, the development proposed at the above location. !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) Pal Oki ScW i P S r- S HO wil on PPC J'Ak S NtW 'CA WAIVER SECTION I u derstand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a mini LM distance of 15' from my area of riparian access unless waived by me. (If you wish to waive t s r, 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) Au� � , li", Signature , &� h 1, . L e w�}i Print or Type Name I i 1 MC'v';c4t- STkee7 Mailing Address 5nD';4S �z ,,'V C#ry/ tatelZip 9/ 0 S)-o 9Y Telephone Number / 1r I I i Ig Date Information) M ' Addre /: City atelZip Telephone Number Date (Revised 611812012.) Blvd - Google Maps rage i of i ZI SLv � V./1 J 90 J� Maps 822 Carolina Blvd m 11 ?°n��% nt�,►� ��b7 a 2 (, old a� c J % � X 1` ,,,.� �:dam � � C ,�,,,;.._•� •,4� I I AWACEN RIPARIAN' PROPEL '" OWNER STATEMENT w l hereby certify that I own property adjacent to /�� ,�L + 's {� (Name of Property Owner) property located at 2 �. a ]' C 1 h c, C� f d "L� I-Irp S a) 1 Ye � c /1 Z' 9 `/' (Address, Lot, Biotic, Road, etc.) on 1 G PSG l S Gt i1 d{ in (Waterbody) (City/Town and/or County) The applicant has described to me. as shown below, the development proposed at the above iocatic ' have no objection to this proposal. i have objections to this proposal. DESCRIPTION- ANDIOR DRAT INO OF PROPOSED DEVELOPMENT (individual proposing develolp-me r; must, 1711 in descriptior, below or attach a site drag: la, co a,4as I? rP�1 Gil SCIW 1 j f--tt67 g6kJ'-K W'd 110E`1 I i WAIVER SECTION I understand that a pier, dock. mooring pilings, breakwater, boathouse, lift, or groin must be set bac minimum distance of 15' from my area of riparian access unless waived by me. (if you wish to `vvc 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 Infonnatior" (Adgacer- "I"oLert-vOwner information) Sig nature , Signature Q Print or Type Name _ Print or T e Name J!�M;y,cai^ STk'?i Po box 323� Mailing Address M ' og Addresq �� G cil) l atelzip cit}� j ip Telephone Number Telephone Numbe Date Date (Revised 6/1812012) ; Blvd - (joogle Maps Maps 822 Carolina Blvd Ai rage i of i SL� � N, %ZI, L. i � Wl r rL 0� J LOT 6 c SOT 4 I rz,� FT2� � 4 \ � L ' 31190 � .i_ i� /14��t�A�� cvr �.�f! �2 o® Cap®l'�4 �1vd ��11H� p 50, 00, i 5 49`' 29 0'W. ��i'� SF-0 � �TUO, NC r i 0AROLINA BOULEVARD_____ E E-r r ^ DA-1-t+G f i` Date Received Date Dvhw Check From Name Name of Permit Holder Vendor Check Number Check amount Permit Number/Commenfs Receipt or Refund/Reallocated Columnl Cokmw2 Co1umn3 _ Column) COIUM115 Column8 Column? Column8 COlumn9 1/2/2019 1 Mark Lewis same PNC Bank 2617 $ 400.00 GP #72362D JD rct. 7048D