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Home My WebLink About74230D - StephensCAMA / ❑ DREDGE & FILL NO. 74230 A B c WENERAL PERMIT Previous permit # Nev; ElModification 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 `� N • (ZOC) I-1 Rules attached. Applicant Name L l A IDA .5Tr- P N E NS Address 5 32 oLyF-A: RCG.1i Z'D cW City 45VU ►.,-,Vr '_ State \/ C ZIP Phone # (gluj 2L1 'QVy¢E-Mail'd�A Authorized Agent W I u, 9%cjAAR'Dao,-J Affected CW XEW ;&TA )(1ES *TS AEC(s): `l OEA ❑ HHF ❑ IH ❑ USA ❑ N/A ❑ PWS: ORW: yes G PNA yes rf� Project Location: County 15? ►Als" ►cK Street Address/ State Road/ Lot #(s) Z5C 0 TN ti-r P-10 51.E Subdivision ^( /A City SNA AZM16- ZIP 2g 4-7c�, Acnr-,rr Phone # (q 10) 34 7 -0 33SRiver Basin Lamµµ MCjL Adj. Wtr. Body 67 8 JZ%Vw-¢ nat man unkn Closest Maj. Wtr. Body SA Nlf Type of OAw - ■�::■■■G: �■■� illil:r�:�=� �i1�■ii■il�i■■G■il��■I�i■.rii _ ■■S■■ll■■t■■W■N WWA 0 ■■J■■i■■■■■■■■!■■■■■■ ■fi■■■■■■■■■/I■� III' ■ ■■■■■■■■■■■■■■■!�i■■■■■ ■■■ ■NNIMEN�■ rails ■ �MnO■ON■■■■N GM■■■EN ■■■■■■Il■■■!■■■EWOM ■ ■■■■■i■■■■■■■®■■■■■■■ ■■■■■■11■■■'■■■■■■■ ■ ■■1■■■■■■■■■■®■■■■■■ ■■■■■■I1■■■■■■■■■■ ■ ■■�■■�■■■■■■■■■■■■■■■ ■■■®■w■■■■■■■■■■ ■ ■■a■■■■w■■■■■■■��M 1.1ZERIE110 NINE iic ■ENEIN. /'nI( f?gencOrAp licant Printed Name Signature Please read compliance statement on back of permit ** Application Fee(s) Check # Permit Officer's Prin Name L • Signature s}�Z A /Ok L14tici Issuing Date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Lind Stephens Mailing Address: Phone Number: Email Address: 53gHolden Beach Rd SW Shallotte NC 28470 910-261-0604 certify i la► I f,ave auU for i,-4eG Will Richardson/ Ric hardsou Construction Agent i Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: Construction of docking facility at my property located at 3603 Shell Point RD SW in Brunswick _County. i furthermore certify that I 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: IoA Signature Print or Type Name Title Date This certification is valid through 06 1 01 1 19 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to Linda Stephens ,s property located at 3603 Shell Point Rd Sw (Name of Property Owner) t Address, YBloc Road, etc.) on Shallotte , in Brdnswic 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 fill in description below or attach a site drawing) Construction of docking facility 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) Signature Will Richardson/Authorized Agent Print or Type Name �y3235 S,egaccrrest Ave SW Supp�y N/(e462 CSuppr3y Ne28462 Telephone Number 4-8-19 Date cent Property Owner Inform 'on) Signa e - Thr 7M G Plf L i'c lose n Print or Type Name 13 5Z) S : ► n c Mailing Address City/State/Zip ffl)3-1D.R6 s� Telephone Number Date (Revised 611812012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to Linda Stephens I property located at 3603 Shell Point Rd Sw (Name of Property Owner) (Address, Lot, Block, Road, etc.) on Shallotte in BrunswickN.C. (Waterbody) (City/Town and/or County) The applicant 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) Construction of docking facility 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. vs� I do not wish to waive the 15' setback requirement. (Property Owner Information) Gf'1�9 AP J�rL Signature Will Richardson/Authorized Agent Print or Type Name 3235 Seacrest Ave SW Maitin Add e Suppgy N( 59462 SupplfyVi!28462 Telephone Number 4-8-19 Date (Adjacent Property Owner Information) . NMI 11-�� ature Print or Type Name � 09 _5 h-e1/ �o►�t0�d. Mailin Addre s \Z1rv-14e.AlC 28470 citylstatelzip Telephone Nurn r 4- M M Date (Revised 6/18/2012) CREEK INING AREA 4a9 90 Fr Check Date Received Date Depoeited Check From Name Name o/ Permit Holder Vendor Check Number amount Permit NumbenCommenta Receipt or ReiundiReallocated Column! ColumnY Column3 ColumM Columns ColumnQ Column? CeiumnB Ceiumn9 47