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Home My WebLink About69422D - Kor(CAMA / - DREDGE & FILL 50 SENePAL PERMIT '/ Previous permit# A B KNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued irized by the State of North Carolina, Department of Environment and Natural Resources / coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC ( / /� l f'r . 1 Zm /� El Rules attached. it Name L s' I/_�f S�� + �i�Cl�'r� Project Location: County V'I (.J; ck �I�{ �nri, nQ,. r)OA (e(CC Street Address/ State Road/ Lot #(s) It s,lcz StateZIP 4 3 E( ) E-Mail /� J - / :ed Agent 4,1 � i�('r of Co_oTCL1( 4srS L-,—( ❑ cW C-m(Ew jXrm 9O(,Es y rs ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: yes / 'nod PNA (yes no f Project/ Activity Subdivision j+ 7G n $ City �j�J J�c'�" ZIP 23g4 Phone # ( ) River Basin Cr"C Adj. Wtr. Body AT (.')l ) (nat / Closest Maj. Wtr. Body 1 T (Scams: I' ` 4 • _ �`■.,,".1vo:: No ■■�i�72JUJ MEN 11 MM■■ H■E■11�Ili ■ NONE M■■■ ME■E■111MV,M,■"!Ml■I■ z11 M■l NMI i-mil ngth■■ ■��■ 1 ri ■oi ■ rnber 1■■E■1 �� Ia�iR�11 ■MI ■■■■l�rrlr■■■EI I■■EI111' �1��0■■ IM0=1111111 ■■■E■■■■■■E11■■ ■1111 1N■■ ■■■MEMO ■■■!�■■■■■■■11■■ 1 11low. ME ■■■■■■■■1 iannel ■I■■u■11!1■l� ! p [wpm ■EEM■■■1 11■■la■ ':,1 1■E EEINM ■■MM�■■■1 MIEEEE11 ■ ■ �q ■■ LJ■ ■■■ E11■■IE a,,■■■■■■■■■ ■■■■■�■ ; ■■■■■■■■■■E11■■I ■■1 Ag 1■■■■■■■■ ■■■■■■■■1 OMEN ■_■N■11■ kil no ON 11■■ ■■■■■■■■1 I I ■■■HI■■r■Q�1■■��■■■ N■�■�■�■�! ■■■■■■lo�lM1IEE■■ 1_.1■■■■■■■■ Gr■■■■■C; ■■■■■■■■REEN 11111 E:�1■■■■■■■■■■■■■■ MOM • ■■■■■■■■■■■11■sum 1► l �■■�■oo MM ■■■■MEMO ■E•■■■■E■■11M■E■s=1■■■M1■■■■■■M■E1 INOUE yes E■EM■■E■■■11E■ ■■ OI I■■�E■O I■M ■■■ME■■O ■�■■AE■■■■11■i■i��lllrlil�ii■EEM■ ■E■■■■■1 yes n��■i■ It� moo1i■■■�IMPM i �. ■notsure �m �., I.ttached: yeE■�r�Fr E■■■OI■■■MEWgv ■■■■■i1 .m ig permit may be required by: C.i• ❑ See note on back regarding River Basin n Local Planning Jurisdiction) CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Own Address of Property: (Lot or Street ;F, street or Koau, city at county) Agent's Name #: l /n� ,-c, r^ d(,�or5 Mailing Address: Agent's phone #: Vhereby certi tha�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 drawing, with dimensions, must be provided with this letter. cl/I have no objections to this proposal. I have objections to this proposal. 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 notice. Contact information for DCM offices is available at http://www.nccoastalmanagement.netlweb/cm/staff-listing orby calling 1-888-4RCOAST. No response is considered the same as no objection if you have been notified by Certified Mail. 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 must initial the appropriate blank below.) I do wish to waive the 15' setback requirement. U" I do not wish to waive the 15' setback requirement. (Properly Ow er Information) Signature --� Print or Type Name &N 1w,&uwJ Alozi?, Pe Cog 1 CERTIFIED MAIL - RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONfWAIVER FORM Name of Property Own Address of Property: (LUl UI JUCCI1*, JUCCI UI MUdU, lIty 6t krUUIRy) Agent's Name #: �I�JCJ /ilr,�;,{� C,0,"drz, Mailing Address: Agent's phone #: ere y certi y t at I own property adjacent to the above referenced property. The in ivi ua applying for this permit has described to me as shown on the attached drawing the development they are proposing. A description or drawing, with dimensions, must be provided with this letter. I have no objections to this proposal. I have objections to this proposal. 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 notice. Contact information for DCM offices is available athttp://www.nccoastaimanagement.netlweblcmistaff-listing orby calling 1-888-4RCOAST. No response is considered the same as no objection if you have been notified by Certified Mail. 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 must initial the appropriate blank below.) I do wish to waive the 15' setback requirement. 7 4 1 1 do not wish to waive the 15' setback requirement. (Property Ow er Information) v1' Signature �� Print or Type ypetName f EJ-41t (Riparian Property Owner Information) Signature C, �e, a, A, M Print or Type Name a�rol p, jLe� �- AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Z�Sa / Mailing Address: Phone Number: Email Address: I certify that I have authorized Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: i�- at my property located at in &UrS kQ, IC County. 1 furthermore certify that I 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: l Signature �=Y Print or Type Name Title T ■ Complete items 1, 2, and 3. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: �P�--�-- L/4 I A. ❑ Agent ❑ Addressee Name) C. Date of Delivery D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No Service Type ❑ Priority Mail E 9 I I illlll IIII III I IIII III I II II I I III IIII I I ( El ❑ Adult Signature 1TM El Registered Ma1ITM 2ult Signature Restricted Delivery ❑ Registered Nail Restricted 9590 9402 3097 7124 9621 89 rtified Mail(5 Delivery ❑ Certified Mail Restricted Delivery ❑ Return Re%Uiptfor ❑ Collect on Delivery Mercharx*,e P Artie -.It -Number (Transfer from service label) ElCollect on Delivery Restricted Delivery D SignaturriCnfirmatiod^A III 7 015 3 010 0 0 0 0 7848 n r., —H neap 8792 )Iil Restricted Delivery D Signat,:4 Confirmation Restgfed Delivery �s Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt 0 ■ Complete items 1, 2, and 3. ■ Print your name and address on the reverse so that we can return the card to you. • Attach this card to the back of the mailpiece, or on the front if space permits. Article Addressed to: lee A �. VU A. Signature X ❑ Agent _t �✓ ❑ Addressee B. Received by (Printed Name) Date of Delivery D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No Service Type ❑ Priority Mail Expresso I I I II I I I (I II I I I I I I I I I I I I I I El ❑ Adult Signature ❑Registered MaiITM D Adult Signature Restricted Delivery ❑ Registered Mail Restricted 9590 9402 3097 7124 9621 72 13 ertified Mail® ❑ Certified Mail Restricted Delivery Delivery ❑Return Receipt for ❑ Collect on Delivery Merchandise 2. Article Number (Transfer from service label) ❑ Collect on Delivery Restricted Delivery ,d Mail ❑ Signature ConfirmationTM ❑ Signature Confirmation 7 015 3 010 0000 7 8 4 8 8808 d Mail Restricted DYlivery Restricted Delivery 6500) PS Form 3811, July2015 PSN 7530-02-000-9053 Domestic Return Receipt