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Home My WebLink About75885D - GrouseqVAMA / - i DREDGE & FILL NO. 75885 GPENERAL PERMIT Previous permit# A B C Ls New DModification ❑Complete Reissue ❑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 I SA NCAC H • -� ❑ Rules attached. Applicant Name �- �' 0 u.Sl2 _ Project Location: County 1? , � K Address ln U Street Address/ State Road/ Lot #(s) City /" Dt X State_XZIP 2--539 Phone # (�le�) ��c)2, 2Z�"� E-Mail '9�UL a� we S ( ) r16AA(6ubdivision Authorized Agent �<<<- �,-k S cu City Ca , S ZIP -2-6`i(, �( Affected ❑ CW �PEW CA[PTA ❑ ES ❑ PTS Phone # ( ) River Basin 1.,-6. ElOEA ElHHF ElIH ElUBA ❑ N/A AEC(s): Adj. Wtr. Body (nat art /unkn) E. PWS: ORW: yes / PNA yps no Closest Maj. Wtr. Body Qk k,Kij Type of Project/ Activity ��, " `d i - (Scale: T S ) Pier Fixed Floati Finge Groin BulU Basin Boat Boatl Beac Othe Shore SAV: Mora Phot, Waiv length -tumber ■■■■■■■■■s■■ ■■s■e m■■■■■■■■ ■ ■■■■■■■■■■ ■■■■■■ V■■■■■■■■�■_ ■M■MOM■■■■■■■■■■■■■■■ ■ ■■■■■■■■rIl>�i��.i ■■ram■■■■■■■■■■■■■■■■■ ■ ■■■■■■NMee■■e■■■■■■■■■■■■■■■■■■■e■ Mill -ad/ Riprap length ■■e■■■■■■■■■■■®■■■■■■■■■■■■■■■■e■■■■■ channel ubic yards ■■■■■■■■■■■■■ i�11N1��r■■■■■■■■■■■■■■■■■■■ �. ■■■■■■■■■sue;■i��■�rl�e■■%je■■■■■■■■■■■■■■■■■ ouse ikil mE■■■iii Bulldozing ■�i■■i■■■■ ' I �■■ ul ONE ■■■■e■■eee■■■■ems! fie t�i�7i■■■■■■■■e■■■■■■■■e■ ■■■■■■■era!■■■■�■�� _■■■■■■■■■■■■■■■■■■■ ■■�■ �■■■■■ ■ ■■■■e■eeee■■R:r►�■■■ee■eee' ■■ ■N '■■■■i■notsure �■■■■■■■■■■■■frl►>i17■■■■■■■■■ line Length C�-O - yes '9 ■■■!■■■■■■■■!!��■■!Ne■■■■■■ ■■■■■■■■■■ immomom ■� �i ■ ■ ■■ 0 ■ ri .►,�e Misr/' . ►■■ os: yes m■■■■■■■■■i■■■■■ ■ A building permit may bl-riquired by: OceA✓, (-'At ( Note Local Planning jurisdiction) e- Notes/ Special Conditions or Awficant Printed Name Permit ❑ See note on back regarding River Basin rules. Name .-c A- ru L "� * Please read compliance statement on back of permit Signature J Fee(s) Check# Issuing Date ti ?d Date Nerve of Property Owner RequemkV Permit Mating Address: e7, For -74xa, T4P-j-" Phone Number. -1.91q jo z 2-2 Email Address: =-- LJ6 1 M* that I have WOMMed -Agnid AwkS\ Agent / Con actor W act on my behalf, for the purpose of applying for aril obtaining all LAMA permits IV -f- at my property k=W at -/ 7 in Qx rity. I furtfmvmom certify that I am authorized to grant, and do in fact grant permission to - Division of Coastal Management staff the Local PwTrNt Officer and thew agents to araer an the afore"wnboned lands in conrwhion with evWtAwng ffdbrnokw - rekded to #w perry* apphdobbri- plop ty Oww ftivinift: z SbIMM" P" or Too Ahvw Me cob aawzu,eu a t as n / 000a000i Ud r o.Jpg V. mvmm or COASTAL OAK- "—so-owwwwomma rw rw,.,w �wv.q ow�rt M MM "..II�� i«* NM k MM'1OtiM M ills, M!nA � v��hftdm ft"0*.soM�wMiMM I No powMINa piv. omdt. ov M t� b� SIN Sw iv IyYtr1111 I* woo M s Ya fir ON 1 M rM wAM b wM+. 00 ,4ouA4(- !f f— P/ At f LIl N i. Mon.•IITall N 6 4h CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Owner: Address of Property: 1 Agent's Name #: "X g,- -Z..J,-b�,- Agent's phone #: .0 17t4b y (Lot or Street #, Street or Road, City & County) / Mailing Address: A � �-�fi�- CaO.) I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit has described to me as shown on the attached drawing the development _ they are proposing. A description or drawings with dimensions must be provided with this letter. O have no objections to this proposal. ____ I have objections to this proposal, -i If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writing within 10 days of receipt of this norm Contact information for DCM offices is available at i tii /ti vv eflw(. -:F.�ir orbycalling 1-888-aRCOAST. No response is conskbred lire some as no objee[!M dyrou bam bM noUlfed by CertWed Mell. WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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 the appropriate blank below.) / "Wiy I do wish to waive the 15' setback requirement. 0,4 ,� 1 do not wish to waive the 15' setback requirement. (Pypwner Information) Signature Print or Type AlAme Malting Address City/statelzip Telephone Number / Email Address Bate (Riparian Property Owner Information) Signature I �0 Lk 1a�� Chi �% J %4 C-P Print or Tyhe3Name 91IS a 0 1 � - OL05e- Mading Address 7 City/state/z* Telephone Moog r/ Email YC�►e[`, _5 /-9 Dale (Revised Aug. 2014) 1 r � �Cl jIkf �b 5� iro SCLii.AG -SC'i} C �4 IWQ% lite r tV L•� (� der �Sdn�