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Home My WebLink About74600D - SpiersAJCAMA / DREDGE & FILL NO. 74600 A B C GENERAL PERMIT Previous permit# -'New ❑Modification LComplete Reissue []Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality n ^7 P c)U and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC V I I Rules a Applicant Name ,- p04w l vii E7g/ Y Project Location: County'_�^r�,_ Address -! O UoZI-p [, At Street Address/ State Road/ Lot #(s) City State rv� zIPl-Xl ?_3 �jGl' / (/l G�•!� Phone # Authoriz E-Mail Affected ❑ CW EW - "A jH] ES ❑ PTS AEC(s): ❑ 0EA HHF I '�I UBA ❑ N/A ❑ PWS: ORW: / no PNA yes / no Type of Project/ Activity 1 1 A /- tJ Pier Fixe Floa Fing Gro B-T Basi Boa Boa Beal Oth Shoi SAS Mor Pho, Wai, Subdivision I City zip Phone # ( / River Basin"�0 Adj. Wtr. Body A l V/,y /man /unkn) Closest Maj. Wtr. Body r h IJ WA) /;. /_ // . J- /.- / i!t (clock) 11Wh ■®■�■■■!■■■■■!■■■■■■■■■■!■■■71� ■■■ !■■■■■■■ ■ ■■■ !■■ly MENOMINEE■ ■■■■■■ !■■■■■■■■ ■■■MMI■M■■M n length NONE ■■■■■PPMMIAW SOME& Own 321LLG:N NONE ►RKF FAMORK),,T� A■■■!!■■�I�iill'®■■■■(/J■■■ll�l■■■!!1%6il�fNil�Ir/■ rap length■■ avg distance offshore ■■\ ■■■■p■■■w��illz� ■f�i�NisENE ■®■■ii►'—=�:=a=====--___ =ate _ �c===-=="■■■■■■. max distance offshore■■■■■■■�■■!■�n ■!■i■ii■��ii■■�-711 ■■n■�nni ■a■■■■■■n1012AN■■M1■■■■MW1M—M■u_ e_L, !!MUP'"UNllILF1 ■■■�■■■■■■■■� w!■■■wa■■r!■w■n■■■■ cubic yards ramp ■®■■■■■■w■!■■■�■!■ww■■■■■■ww■w■!■■■■I ■®■■■w■■■� ■■�!■■��■■■■��■■■■■■■■I -louse/ Bo A •� •zing !w■■■N■!■■■!■■!■■■■■U■■■■■■■■■■■■■■■ zline Length not sure yes ME MONOMER is: yes ■■■■�■!■■■■■■■■m■■■wm■■mlNONE 'er Attached: Yes A building permit may be required by: ( Note Local Planning jurisdiction) Notes/ Special Conditions % r '7� ZA Agent or Ap i ant Printed Name Signature, * le a re d mplianci statement on back of permit ** Application Fee(s) ICheck # ❑ See note on back regarding River Basin rules. 4 PermitOffic is Printed Name Signatur Issuing Date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION c� n r1 c- Name of Property Owner Requesting Permit: C d h Mailing Address: Phone Number: 9 l C—) a- 5 4 el 1-9 Email Address: c. S �2 t �-' rl- @ b �L� S' c�w��l•� - ✓��'� I certify that I have authorized ld'L✓ 13 Agent4i Ctgntraotor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: &-4L&Z '& 6C_FIea6 at my property located at 3 ''i in C-1 r-1 a <5� Y'- County. I furthermore certify that 1 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 pen -nit application. Property 0 ner Information: Signature L-T Y-s Print 4 Type Name Title ZZ-) 1Ot Date This certification is valid through I I ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to ►dam"sl (Name of Property wner) property located at 3 O 03 � 1-0 dd 1—YL j—fcz. � � S � 6 $ /A-1 � L (Address, Lot, Block, Road, etc.)'yy1 on , 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. 4(J 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��kI7 .R v LK, %kgA-h 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. (Propert ne ormation) 5. Signature e (-n n t,SC-rn n C to i G r-S Print or Type Name 34 5 :o nr, c� - z L Mailing Address City/State2ip 8 y,i3 Telephone Number Date Io-l1P � (Adjacent Prope Owner Information) Signature 10 nrl -i k� ► s C.- Cie = �^ Print or Type Name Mailing Address J 9 'rl -0 City/StatelZip � �i rv. 42 Telephone Number ,30/ - `7��-s �i ►� Date (Revised 611812012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to .' _ ��' ro 's (Name ol Prdperty Owner) X property located at 6 1 'D D L N Yi--. (Address, Lot, Block, Road, etc.) on Y in k' C:__, , N.C. (Waterbody) (City/Town and/or County) .1_.ecle_? :=as 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) r 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. y Owner Information) (Adj C w -Z) A. I e r S Print or Type Na e Mailing Address City/State/Zip 93 Telephone Number I tq v - to c- 4 (�\ Date <j to-- S i d- y y pq on) Signature / s'c-vv\ i L Print or Ty e Name ,S• f :D t, o �- L C—V%. c Mailing Address City/State/Zip y sr3 Telephone Number Io^yS3--;Ia1 Date 413 (Revised 611812012) Date Date Check From Name of Vendor Check Check Permit Received Deposited Permit Holder Number amount Number/Comme Conway H Spiers and Donna E $ 10/14/2019 S iers same PNCBank 1356 400.00 GP 74600D nts Rct. # J D rct. 9055D