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Home My WebLink About76271D - Jeffs,CAMA / 1 DREDGE & FILL No. 76271 A B C GENERAL PERMIT Previous permit # Xew [--'Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality 11 ,' and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC t�n . (BCD 1 L ❑ Rules attached. '_,'Project � Applicant Name �r S . v � � ` � i .�� Location: County � I., n )�.+h, L Address q2.`j l.�ci� '�; c p� , Street Address/ State Road/ Lot #(s) b (gq CityPAC,- ng ►( k State VA ZIP 231 0 3 �- t.c. u WN L Phone # O)Y)'V3 70S(v E-Mail Subdivision Authorized Agent fA CA ko r- City TAQ\ a n 3 C_C_ZIP 2 (O2- Affected ❑ Cw ❑ EW PTA [XS ❑ PTS Phone # ( ) River Basin ��... b-�- AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body Akww man unkn ❑ PWS: k ORW: yes PNA yes /n Closest Maj. Wtr. Body Type of Project/ Activity S �1-A C A t—J V % ^ \ 11l, (Scale: 0 A S ) Pier Fixe< Float Fingi Groi Bulkl Basir Boat Boat Beac Othf Shor SAV Mon Phot Wain ■�■■■■■■��.■ill�'I�'�i■■�11�■■■■■■■■■■■■■■lair 3 r pier(s) length ■■■■■■■■■u�►a�■■■��• •r11■■■■■■■■■■�■■■■■■■ number ■■■■■■■■! -, J w�!'*.�■■tr'�t■��:_� WOMEN avg distance offshore ' ■■■■■■■■��l�UI■II■■I■■\1■��■■■■■■■■■■■ max distance offshon ■■■■■■■!■■i!!/■■.I/■■■■A�1■■E�■■■■■■■■■■ ■■■■■■■■■11■■■■■■G■■■,�■CE.\i�►1■■■■■■■■■■■ ME cubic yards ■■■■■■■■11■1119■■■1�!��A■■r!►�■■l\■■■■■■■■■■ ■■■■■®■■■11■■■■■■■■�il�■■■!!�■■��■■■■■■ IN mom III ■■■w■■■w�11■■■�■■■■■■■■■■■� r A■■■�■:�■■■MO wm_ .-No 71 MENEN=m notsure yes ,f+ ,.. ni4'r-4-r:�P4- vp� "41MENNE ■C..�t._■■■■�1■■■■■■■■■■■■■N ■■■1l►L�t1�OE!INTLOt■ ■■■m■■■ ■■■■■■■■■11■■■■■■■■■■■■■■o ■11■■■■ ■■■■■■■■■ Emma won ■IR��HIlm■s ■■■■■■■■■11■■■■■■■■■■■■■■■■ 0 M�Imlm A building permit maybe required by: a l Hu 1 �c.� Qe.4.�c ❑ See note on back regarding River Basin rules. ( Note Local Planning jurisdiction)/I Notes/ Special Conditions ) LAO q� \ /-IvA f ^c ✓c"C M litA T fi 0 ') /✓ Agent or Applicant Printed Name Signatur Please read compliance'statement on back of permit *e Applicatio Fee(s) Check# Name _-T7 r L_� Signatur P 3 ,A zGZV Issui Dat6 Expirati n Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Mailing Address: Phone Number: Email Address: I certify that I have authorized Agent f Contractor to act on my behalf. for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: at my property located at in County. i furthermore certify that J 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 Print or Type Name Title / I Date This certification is valid through I I I hereby certify thh (Name of Property Owner) property located at (Address, t_ot, BWA_ Road, etc.) on , in N.C. (Waberbody) (C#WFown andior County) The applicant has described to me, as shown below, the development proposed at the above to _ ca 1 have no objection to this proposal. I I have objections to this proposal. DESCRIPTION ANWOR DRAWING OF PROPOSED DEVELOPMENT proposing development must fill in description below or attach a site drawing) Yl 54-v� V b UC t o VV 7CU WAIVER SECTION AN 1 understand that a pier, dock, m9oring pilings, boat ramp, breakwater, boathouse, Uft, 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 Infarmation) (Adjacent Property Owner information) D J 1*# or Type Name Print or Type Name 1-tu.�:',\. _ �7327Z �o41c—,,�� Lam/ r9 Address Marling Ad&ess Telephone Number/ email address Telephone Numbfi?r1emio address Date Date" (Revised Aug. 2014) *Valid for one calendar year after signature* ADJACENT RiPARiAm PRoPLRTY OWNER STATEMENT t hweby cer*- that 3 own property to -- ..^ � � r 1 �. s� V C i CAL-U,0_1- 'S of Pn3perty flrwbri Property Notated at i M kA (Rddt LX*, Mock. Road. str.', on �i l- V�tC CO CLS in _ - t< , -- N.C. iWaterbody) (C*yffown andloor Comfy) fir !•-�.M ! a ! � • s - - .:x • #c - .f• !s ter 3 do Wish to WarFft tte 4, 6 Sete& ?e:#YPPxi7P. Al.. 1 do tact wish to ware the 15' sic €eq*'em. wtw Mdo"na�ion) _ ___(Ad# .:_ . Ohrrne rsfcarrrsa Pv*# or Type Name %-94- or Type A#arrae 1L'a vk&)6, n _ _ 3 TeMphow Attm r/eaud address fek-� Nrimber/email address ZOO.-> — Dare Dr�e • !PRvise A"g 20474) *M d for one caiw 4a; year after ;ire` HS CONSTRUCTION 864 HERON tANDWG - 866 HLW — Striddand HLW - McNM Data Roc~ Data DP,,Hd Check F— NameafMnVNo/dr Wedoi Chock Number Ch-k amount Permit N—b—IComments Revd torR f ndIR-0—te0 Cohmml C111umm2 Cdumn7 CoeereM c bow C.e C.0-7 CdumrM C*kN"" 3/10I2020 3/102020 H5 Construction, LLC.___. _ Custom Buift Homes of the Carolinas LLC Jeffs Living Trust/Gavin JeM BUT 2477 $ 400.00 GP#762710 BB rot. 1003 _ JD rcL 0383 3/102020 311 020 Donnie Pritt First Cifizens Bank 1099 200.00 _ GP#76250D