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Home My WebLink About69421D - Kor_'C,AMA;/ F-! DREDGE & FILL �Al) 60 GENERAL PERMIT % Previous permit# A B r New - Modification ❑ Complete Reissue ❑ Partial Reissue Date previous permit issued rized 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 7 ❑ Rules attached. it Name - ♦ I Cc.c , OJ& Project Location: County I)nnn&'_,;Lk� D Z &r' A - C i, a State ZIP ! v Si 6 O E-Mail ted Agent j! I /1rt,,\e ❑ CW L<EW V PTA XES XPTS ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: yes ( 1 no PNA r -Ye-V no f Project//Activity ` � ck) length & X Sy atform(s) r X I , Platform(s) , X , ier(s) ngth tuber J/ RipJoffshore distx discanne )ic yards ip se/ Boatlift illdozing 2-%6 S.1+ 832 St 4- a Length OV not sure yes nd um: 7 n/a yes n yes no ached: yes no attached: ig permit may be required by: -ocal Planning jurisdiction) Street Address/ State Road/ Lot #(s) 2:-154 81A �* chr'�� Subdivision �. I r CityS Sarv1(,i ZIP z8`f(o Phone # ( ) River Basin CF1R Adj. Wtr. Body ►.Tt,.)�j (n" Closest Maj. Wtr. Body 4Z f,jLJ (Scale: j ❑ See note on back regarding River Basin r� AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: km JI 4 1Z1r Mailing Address: '5 . � Phone Number: Email Address: [CAPC4, `6r I certify that I have authorized Agent / Contractor to act on my behalf, for the purpose of applying for and obtainingallCAMA permits necessary for the following proposed development: �L G' dzt at my property located at _75I ��NL in Arv►-s w 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: Signature Print or Type Name 1_:.�� Title CERTIFIED MAIL - RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Own Address of Property: (Lot or Street #f, 5treet or Road, city & county) Agent's Name #: f'I�1e�J rl r_ �r1f g Mailing Address: l-.7S �/�t/ dPrj% 5= A A Agent's phone #: L;- o?3 2-.R.5.rode �� zlc hereby certify that I own property adjacent to the abov—e--r-eTerenced property. The individual' ap . I ing for this permit has described to me as shown on the attached drawing the development th a e 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. J 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.nccoastalmanagement.net/weblcmistaff-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. I do not wish to waive the 15' setback requi (Property Owner Information) Signature Li'le, ,�wY Print or Type Name ..... .5&'y& P (Riparian Pkpe Owner Information) i Signature L U' -� cr��S G U✓='S Print or Type Name //,, 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 #, Street or Road, City & County) Agent's Name #:�rl�W M°rl z- �CrV Mailing Address: h Agent's phone#: hereby certify that I own property adjacent to the above referenced property. The inclivid,a 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 availableathttp://www.nccoastaimana_qement.netlweblcmistaff-listinq 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. I do not wish to waive the 15' setback requirement. (Property Owner Information) Signature Print or Type Name .. - ... 1 iaa P64 (Riparian Property Owner Information) Signature Print or 7-ype{�1 Name ITNI y "� 61 `fwff✓ L,�- ol -,-)I a • ■ 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: aa " -761 N6- �)��jj IIIIIIIIIII 111111111111111111111111111111111 9590 9402 3097 7124 9621 58 a. Artirfe Number (Transfer from service label) 7015 3010 0000 7848 8822 PS Form 3811, July 2015 PSN 7530-02-000-9053 ■ 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: A. Signature ❑ Agent B. Received by (Printed'Name) I G Dade of D. Is delivery address different from item I? H ym If YES, enter delivery address below: El No 3. Service Type M Priority Mail Express® ❑ Adult Signature ❑ Registered MaiITM ❑ Adult Signature Restricted Delivery ❑ Registered Mail Restricted rtified MailO Delivery f] certified Mail Restricted Delivery ❑ Return Receipt for ❑ Collect on Delivery Merchandise Q Collect on Delivery Restricted Delivery ❑ Signature ConfirmationTIA n I —vred Mail ❑ Signature Confirmation red Mail Restricted Delivery Restricted Delivery r $500) _ Domestic Return Receipt A. Sig ❑ natu� I I �y I�f yr Agent X ❑ Addm B. eceived y (Printed Name) C. Date Del D. Is delivery address different from item 1? Ll Y8! If YES, enter delivery address below: ❑ No jWS w,I 5 1101 1 mryid ,JA Id �tPPf�f 5 � t.:✓, .'U � �� 3. Service Type o Priority Mail Express® IIII III II I IIII II I II I II III II I III I I ❑ Adult Signature Q Registered MailTM Q Adult Signature Restricted Delivery Q Registered Mail Restricted 9590 9402 3097 7124 9621 65 11 ❑ Certified Mai, Certified Mail Restricted Delivery ❑ Delivery Return Receipt for Q Collect on Delivery RCollect on Delivery Restricted Delivery ,______ , ..ail Merchandise ❑ Signature Confirmation o Signature Confirmation 2. Article Number (rransfer from service label) 7015 3010 0000 7848 8 81, 5oil Restricted Delivery Restricted Delivery PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt C 8 T