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Home My WebLink About72800D - Zadellr XCAMA / ❑ DREDGE & FILL GENERAL PERMIT XNew ❑Modification ❑Complete Reissue ❑Partial Reissue A B C Previous permit # Date previous permit issued No. 72800 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 r7 H , 12 00 ❑ Rules attached. Applicant Name F12 AA K. AOV—t.t_ Address 1I00 MAPtr-- -Ayr- city--A PEX. State_1jlr, ZIP -Ll 502 Phone # (----''j E-Mail mg Mai I - corn Authorized Agent iAc tL ►.JA-re r&-- AA rz iiJ i= C-i 5-T Affected ❑ CW UW XPTA ❑ eS ❑ PTS AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ URA ❑ N/A ❑ PWS: ORW: yes / D PNA yes / no Project Location: County I�RLAA[s-&ii cr— Street Address/ State Road/ Lot #(s) 144 L-10AlS PAW Subdivision City —9EAC- ZIP 2r4&2- ,Ac,rAfT Phone # (°I1e )443-4898 River Basin L c KSr-Gt Adj. Wtr. Body CAX.At,- (na�ani/unkn) Closest Maj. Wtr. 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Mailing Address: i o MA P ue A U RPeX NQ_1 Z' _' Cbz Phone Number: Email Address: F ZAD F, LL. ® 0 m (� i✓ . C a M I certify that I have authorized �/ACJcWA T CQ- /v1A (tiN'E C.O/Js i Fu(_._Yo&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: 12��t.CC- F LuRTT1VCr �)oC,k aND 9'AMs' at my property located at \A k in UO3 V40C County. 1 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 permit application. Property Owner Information: Signature /�_ Z+oc� Z-�- Print or Type Name Title l 1 �_'I / asi� Date This certification is valid through I l ■ Complete items 1, 2, and 3. ■ Print your name and address on the reverse so that we cpn return the card to you. ■ Attach this cjrd to the back of the mailpiece, or on the fro4tt if space permits. 1. Article Addressed to: ,« �- i eve . A. reGu.c.f ❑ Agent X ❑ Addre R eived by (Printed e) t I C. Date of DqI1 "µ / D. Is delivery address dilferent from item 1? Yed If YES, enter delivery address below: *No III�III�I Service Type 0 Priority III�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIII3. ❑Adu@Sgnature ❑ Adult Signature Restricted Dellvery ❑RegiseredMail apMessO ❑ Registered Mail Restricted 9590 9402 3518 7275 5833 78 livery 0 Certified Mail Restricted Delivery ❑ Retu n Receipt for 2. Article Number (Transfer from service /abe- ❑ Collect on Delivery Merchandise ❑ Collect on Delivery Restricted Delivery 0 Signature ConfirmatlonTM 7 017 0190 0001 1319 118 Mall Delivery Mail Restricted Delfv ❑ Signature Delivery Restricted IJelive i00 Ps Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt ADJACENT RIPARIAN PROPERTY OWNER STATEMENT hereby certify that I own property adjacent to *}IA PJ t 2A PELL 's (Name of Property Owner) property located at i yu � SUNS ��W D(� (Address, Lot, Block, Road, etc.) on (I.At1 L in k COLO1E/'J \3ep�-LN+ , 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. 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) SCC - �AWT�AJG- WAIVER SECTION 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.) L I do wish to waive the 15' setback requirement. 1 do not wish to waive the 15' setback requirement. (Property Owner Information) Sinatzire -7 �EG�lS Print or Type Name Z-L4Z kI�2L /70 Mailing dress Semis Z `i A16 4? "? Cit S te/Zip Telephone Number/email address %- Z9 /9 Date (Adjacent Property Owner Information) , /J .41 luk t o T1 � blame i Aj!iling Address Ci�ty/�Sja �ip Teleph ne Nt4mber / e/mail address 4//V119 Dar 'Valid for one calendar year after signature' (Revised Aug. 2014) ADJACENT RIPARIAN PROPERTY OWNEI STATEMENT hereby certify that I own property adjacent to r �-ANK P� property located at L-�-yN �^ s (Narr a of Property Owner) � ��y �7��c �`� _ (Address, Lot, Block, Roe;,i, etc.) on L' N aL in LpC N V�J�CA) (Waterbody) (City/Town and/or County) I N.C. The applicant has described to me, as shown below, the development proposed at the above location. 1 have no objection to this proposal. .V I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT OS; i"�I O l?t #t5s #� # E.'S t %31EtII iQ IC tN' a#.ac 1_ sitie drawing) SEE DAA4,JJ_jJ CT - WAIVER SECTION 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. I do not wish to waive the 15' setback requirement. (Property Owner Information) Signature /4GrM 2 Print or Type Name 1907 /�ZpgP / fp Mailing Address _S UP?/- Y /yL Cit State/Zip Telephone Number / email address /-ZS ::-� Date (Adjacent Property Owner Information) Signature (_ � ty S/u S it Print or Typ9 Came Mailing Address l�J- a: kl \e m) a I --�q3 City/State/Zip a 01 --(--Iis oc--) Telephone Number / email address Date * "Valid for one calendar year after signature' (Revised Aug. 2014) LA LA LLI O-N 5�a� -Fr&, 6°C'r- 'e-o5fig Date Received Date De sited Check From (Name Name of Permit Holder Vendor Check Number Check unf .11 Numbe �ommants Receipt or Refund/Reallocated Columnt Column) Col-3 Column) Column6 Column6 Column? Column6 _ _ Column9 172019 kw ter Ma— C—lxV b- Inc Frank ZadeH SB&T 1134 00 00 GP k]7800D TV, rc1 —7