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Home My WebLink About73518D - BallardL;Z CAMA / '-1 DREDGE & FILL GENERAL PERMIT )(New ❑Modification —]Complete Reissue Partial Reissue No. 73518 A B C Previous permit # 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 07k. U 2 OO ❑ Rules attached. Applicant Name GRr_6o1Zy c VAr_V*% 5A14LAraV Address KA City State ZIP Phone # (33G) 2 SC - 7178 E-Mail 141A Authorized Agent MAT-r AO/V ❑ CW XEW XPTA ❑ ES ❑ PTS Affected AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: ORW: yes / f-) PNA yes / no Project Location: County 13 Runl.s ►.i ► CK Street Address/ VStat`e'Road/ Lot #(s) 2 7 9 4 SE.4 ISTA �RL Sly ►V 0 Subdivision N1A City _`3tAppw ZIP 2 g 4 G 2 Acir,sT Phone # (�910) A80 - 4 3b'1 River Basin L t4 mottz Adj. Wtr. Body A I W W 65t /man /unkn) Closest Maj. Wtr. Body A I W W • r ► ♦ c. ■■■■■■■■■■■ ■�'� 1 1 �111111 �1 �■■■■■■■■■■■■■ M■ ■■■■■■■■■■■■■■■1'1■■■IiIYYI�■■■■■■■■■■■■■■ Moffsh ■■■■■■■■■■ ■■■■■ ■■A��ILiii■IiiiZi�l■r■■■■■■■■ - ■�■■■■■■■■ ■■■�a■■■■■■�■■■■■ ■■■■■■■■■ ■■ MINE ■■■!■NEON ■■ • ■■■■■■■■■■MEMO ■■■��1�■■■■■■_■__■■_■_■_■_■_■__■■■�.1. EEO - �r wrw■■■■■i■■�n��a■■■�■■■■■wry■■■■■■■■ -W 4I- H 0 Agent or Applicant Printed Name -^ Signature ** Please read compliance statement on back of permit 200 42-258 Application Fee(s) Check # 14 e,l:ri K c Gu ►IXW- Permit Officer's Printed Na e 4 C' a. Signature kr 3/27 201q 27 12-019 Issuing Date Expiration Date NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Beverly Eaves Perdue Braxton C. Davis Governor Director AGENT AUTHORIZATION FORM Date: Name of Property Owner Applying for Permit: Gregory Ballard Owner's Mailing Address: 2794 Sea Vista Dr. SW Supply, NC 28462 Dee Freeman Secretary Name of Authorized Agent for this project: H5 Construction Agent's Mailing Address: 2164 Holden Beach Rd. Supply, NC 28462 Phone Number (336) a-50 - 7 / % !k' Phone Number (910 )880-4381 I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct the following (activity): For my property located at 2794 Sea Vista Dr. SW, Supply, NC 28462 This certification is valid thru (date) /,/.T Property Owner Signature O / �0 Da 127 Cardinal Drive Ext., 1Mlmington, NC 28405 Phone: 910-796-7215 \ FAX 910.395.3964 Intemel: www.nccoaslalmanagemeni net N� hCarotina An Equal Oppo" t ANumatwe Action Employer ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to Gregory Ballard (Name of Property Owner) property located at on ICW 2794 Sea Vista Dr. SW (Address, Lot, Block, Road, etc.) ,in Supply, NC I 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) Please see attached drawing WAIVER SECTION I 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. (Pr pert/y /Owner I formation) i ture eglory Ballard Print or Type Name 2794 Sea Vista Dr. SW Mailing Address Supply, NC 28462 City/State/Zip 33ro-2Sd—-7)I Telephone umber/email address at acent Qroperty Owner Information) i Kp= e A o� bv .Sm) M " g Ad ress Ingr�r1vA , NC a $4 b Telep one Number/email address e✓r cn1 vricuQ Low -- Date ` (Revised Aug. 2014) *Valid for one calendar year after signature* ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to Gregory Ballard s (Name of Property Owner) property located at 2794 Sea Vista Dr. SW (Address, Lot, Block, Road, etc.) on ICW in Supply, NC N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. V - 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) Please see attached drawing WAIVER SECTION I 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.) �('-S� 4, 1 do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) 11'A /1 /. q�t& Signi&re Gregory Ballard Print or Type Name 2794 Sea Vista Dr. SW Mailing Address Supply, NC 28462 C,r IState/Zi S7L ` � ` -7 Teleph e N ber/email address o a7n�l%g Date (Adjacent Property Owner Information) Print or Type Name t -Jq0 S Yh J v i.; Mailinq,Address s-"OLIQr City/State2ip Ct t6,Z4'> „3`� s� Telephone Number/email address z iz� ►�� Date* (Revised Aug. 2014) *Valid for one calendar year after signature* PROJECT I I I 10 FT 2794 SEA VISTA DR. SW/BALLARD • 8X16 FLOATER 3X16 RAMP —o 4X4 DOCK 19 FEET Y U x 13'6"X16 FIXED DOCK ------------------------------------------------ 4 FT. BALLARD fi 150 , H5 CONSTRUCTION, LLC • 13" u 13' 50ATt-i Fr-, • 8X16 GAZEBO 27 FEET 0 z Z7 0 a m r_ z m NOT TO SCALE =,� - _ _ ,a ,_ �� _.. _; ,,. � - - __ __ � _. - Date Retelved Date Devoaltod Chet* Fm N,me Name of PVMt Nokkr Vendor Check Number Ch.w amount PermN mung ok'OIMNnta RecN t er ROMMYRedocated Column~ Column2 Column3 Column{ Columns ColumnQ Column? Columns Column➢ P