HomeMy WebLinkAbout69365D - Keen,K CAMA / tJ DREDGE & FILL
N? 69365
GENERAL PERMIT
5 A B
Previous permit #
'New ❑Modification DComplete Reissue .]Partial Reissue Date previous permit issued
thorize l by the State of North Carolina, Department of Environment and Natural Resources
he Coastal Resources Commission in an area of environmental concern
pursuant to 15A NCAC Q — �t ,
cant NameCi_4 _ r
❑ Rules attached.
Project Location: County ,�gw► C.
ess. 2��.y �w� v _ ',
Street Address/ State Road/ Lot #(s)
_ ._inter State IJ L ZIP 3
--1 �— Sr•>� �,.----
e # (4t.9 ) -7O -(03 z YE -Mail _ __
Subdivision
rued Agent V
'48 - b1 111�1�R11'1
f
City _ZIP_. —
led CW )(EW J PTA ES n PTS
Phone # (-__) River Basin - _C{ P
oEA U HHF p IH � USA L7 WA
(s)
/�
Adj. Wtr. Body L�ct n.9
�J PWS:
yes / no PNA yes no
.-- -.__ --1- - ------�natJ
Closest Maj. Wtr. Body----T(-Lam_-----_.
of Project/ Activity
r (dock) length
ed Platform(s) 9X
adngPlatform(s) --___--- --
ger pier(s)
Din length — - --
number
Ikhead/ Riprap length ._
avg distance offshore
max distance offshore
,in, channel—
x13
-- _ —�_
11
(Scale:
Lai
r
t I
--- -- - I 1
cubic yards -- — I
i
kt ramp
Ich Bulldozing
per (C►,- ,, 4k� tKan .
I I
reline Length
not sure yes-
ratorium: n/a yesw �{
Cos: yes Fno)
uer Attached:Cno ye -
uilding permit may be required by:� f�GCL
ote Local Planning Jurisdiction) /
,w/Special Condns itio?.l�. .e afy, //au
`'^ 1s�"l�l.r
S
❑ Sege note on back regarding River Basin r
�CAMA / ❑ DREDGE & FILL
3ENERAL PERMIT Previous permit# A B
New 'Modification ❑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 U 7 N . 1206
❑ R I ttached
t Name _� Gt w4-
Z 4" 4r I
StateA)( ZIP �73
(fiq ) 440-02 YE -Mail
ed Agent s q L" p"'4
UG�YN d ri^
❑ CW YEW ❑ PTA
❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH
❑ UBA ❑ N/A
❑ PWS:
yes / no PNA yes
Project/ Activity �
:k)length
ttform(s) JC ( X
Platform(s)
igth
nber
i/ Riprap length_
distance offshore
x distance offshore
annel
iic yards
ip
1 1
�e/ oath i 3 x t3
dldozing
Length
not sure yes no
um: n/a yes n
yes no j
,ttached: yes no
ig permit may be required by:
_ocal Planning lurisdiction)
uesa
Project Location: County llYyo Sw CA�
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # (
River Basin CFK
Adj. Wtr. Body 0 Cle6.A I (nat
Closest Maj. Wtr. Body 4St, 11, )
V'Ak"k'J
(Scale: { 4%z
❑ See note on back regarding River Basin r
McCrory
wemor
� A-64 IA
NCDENR
North Carolina Department of Environment and Natural Resources
N.C. Division of Coastal Management
John E. Skvarla,
Secretary
AGENT AUTHORIZATION FORM
Date: t 30' r
ie of Property Owner Applying for Permit: Name of Authorized Agent for this project:
IA &t-v1
ier's Mailing Address:
ail
ne ( W )'7V & P Y__
.. H ?i h14 �. "t,v ►l
Agent's Mailing Address:
is-
�! r
N y C 191 41r)_
Email:
Phone (110
!rtify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
and obtaining all CAMA Permits necessary to install or construct the following (activity):
my property located at
is certification is valid 1 year from (date) In--36—I
c
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 4:;wn /L 4.
Property located at �_Z 571A., �s4 D(Name of Property Owner)
on 6"1 O Ap- Address, Lot, Block3 Road, etc.)
(Waterbody) N.C.
(CitylTown and/or County)
Th
,,e applicant has described to me, as shown below, the development proposed at the above
i
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
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.
(Property Owner Inf rmation) (Adjacent Property Owner Information)
Agnte
Print or Ty rn Na/l �-
�p+a/ �i/
X a !✓A'dra" // Prin orO Name
Mailing
r4Ad,re Mail A ress L 9 A/C- zZ9 ,?Y50 7�zi
Envelope ID: F38DB095-C27B-4588-BE1C-F2C79E3CB84D
n Envelope ID: 276BC3EC-0914-4A4C-AF52-A7106196BEEA
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to Scott C. Gi l l i e
's
property located at 133 Starfish Drive
(Name of Property Owner.)
(Aaaress, Lot, Block, Road, etc.)
on canal off Intracoastal waterway in Holden Beach
(Waterbody) N.C.
(CityiTown an or County)
The applicant has described to me, as shown below, the development proposed at the above
ILI have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
0`740i ual �roposir�g, development must'fitt ut.d pScciri belowar i1 ch a a�te;drarr�ngj
Owner can build a pier/dock/boatlift up to 5' of the property line.
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.
Co�Y,3iQ,�y Owner Info
,�a�►+t,S ll,t, � icy-t�.t-t-1�c, �,�.k,
t�rlature
James Lee Keen / Renee Bond Keen
Print or Type Name
(Adjacent Property Owner information)
_ Srdf• Ir �.
Scott C. Gillie
Print or Type Name
ailing Add ss
Mailing Address
i
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