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Home My WebLink About67971D - CreeksideCAMA / ❑ DREDGE & FILL YL, " 79 j 1 A B iENERAL PERMIT Previous permit# New ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued ized by the State of North Carolina, Department of Environment and Natural Resources oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC o4 �. o UQ %'v'L- S,4 L Ll� GIv61 (,._ l County /\Je-A�j❑R44Qy1-UVf� ules attached. Name t u Tr Project Location: l(: 3L� lade i 4 &'e_ Street Address/ State Road/ Lot #(s) ►'r ; . �A i n� State EK ZIP Z�� ! 'tea •,•� e (q 10) 3 �z3E-Mail Subdivision :d Agent VOA ❑ CW )<EW \--O(PTf ❑ OEA ❑ HHF ❑�F� ❑ PWS: e ies Lo PNA yes Project/ Activity LJp1c LA lo.. k City ZIP Ms ,kpTs Phone # ( ) River Basin ❑ UBA ❑ N/A Adj. Wtr. Body lca Cry k (na/n Closest Maj. Wtr. Body? (Scale: 1 s V ■■■gth ■n■■■■■■r�■■■■�■■■r.�■■■■■■■■■■■■ iber ■�lrliililr■■■■/��■■■■■■■■/1■►■■■■■■■■■■■■■ ■■■■■■■■■■�I/I■■■■�..■■/1!■■■■■�■■■■■■■ Riprap length distance offshore ■■■■■■■■■■ I■®■■■■■■■■'�/1■ ■■■■■■■■■■■■ , distance offshore ■■■■■■■■■■I■ ■�■■■■■■■■■1/■■■■■■■■■■■■ ■■■■■■■■■■I■ ��■■�■■■■�l■'!■■■■N■■■■■■■ ■ ■E! M■■■I■ � ONO NE1 EMENE■■■■■A* :c yards ■■■■■■■■■■i■■■■■...... ■■...�.■■■■■■■■■rr - _ not sure yes 81! ��■■■■■■i■■�■■■■�■■■■■c�■sue■■■►�■■■■ ig permit maybe required by: ; de 1_) 4aVA (iV`Qr( x ❑ See note on back regarding River Basin rL nrnl Pinnnino hiricdirtinnl s Payment Proccessing Confirmation Date Received 12/19/2016 Check From (Name) D. Evans Contracting Inc Name of Permit Holder Creekside Yacht Club, Inc Vendor BB&T Check Number 3699 Check amount $400.00 Multiple Permits No Major/Minor Permit Number/Comments GP 67971D Receipt or Refund/Reallocated BS3429D N.C. DIVISION OF COASTAL MANAGEMENT AGENT AUTHORIZATION FORM Date / /-- ? —1,/P Name of Property Owner Applying for Permit: Mailing Addr( ss: I certify that I have authorized (agent) 0A)JJ --VAOt) to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or consi ruct (activity) SZi,+?i at (my properly located at) cj This certificaton is valid thru (date) 5 - 1._ A 017 Property Owner Sig6ature ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to 6�� I (Name o Prop rty Owner) property located at A33�f OA dd�.r ` (Address, Lot, Block, Roa , etc.) one /e >u in2,m N.C. ( aterbody) ( '(y/Tow and/or County) The applicant has described to me, as shown below, the development proposed at the above cation. I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual p;•oposing development must fill in description below or attach a site 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.) do wish to waive the 15' setback requirement. l L� 1 do not wish to waive the 15' setback requirement. (Property Owner Information)u / (Adjacent Prope Owner Information) C�'�^eLe.lFsi44 t1' Sin re SAtup r tA Print or Type Nanle / Prip� or'Type am A r� ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to ��eP��QI�� '�i�'s (Name of P operty Owner) property located at 6 J (Address, Lot, Block, Road, etc.) on lJ t ?� , in ,'/ N.C. ( aterbody) (Ci(Y/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above loca 'on. 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) 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. t/ ✓ 1<- _I do not wish to waive the 15' setback requirement. (Property Owner Information) Sig re Pnnt}��, �7ype Na ESL _ _ / ,l Y / • � AL (Adjacent Property Owner Information) ��ignature w. Print or Type Name,, � �, LA UDMPPNLQ"-,m W, 0 WIF A4 017 LA ca 4§ ft lmmmmmw� SHOW Jot r G � fou�yll n �� f? — W j 100J I �j f 4zt Is oos > S-4 z�> P NNI J O � S O ,MISOo2 7 • V;Ujd ?JVZV)t %Awzr)(:) VON 4"Mm� `0s S 44%0140 rwnio I. •,*.91-P •� Adm� MONO St �r MAIM -� s 40moo 4&00 qWH W 1124 9%AC IV4%VD*l