HomeMy WebLinkAbout69189D - MansfieldeCAMA / ❑ DREDGE & FILL
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NERAL PERMIT Previous permit#
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Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued_
)rized by the State of North Carolina, Department of Environment and Natural Resources �O
Coastal Resources Commission in an area of a vironmental concern pursuant to 15A NCAC .
El Rules attached.
it Name Project Location: County �I Sv�
.� �0041 Gar 11t ( r n Street Address/ State Road/ Lot #(s)
State A ZIP o� 7�� 1 � Lq V1(� y� -
( E-Mail Subdivissiion
ted Agent ' J (wsbv(116VI City ( i(CA✓1 lk\C I&A ZIP !?1
❑ CW )�EW >fTA ❑ ES ❑ PTS Phone # (ILO ) P—�t $ I River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body (nat I
ElPWS:
yes / ono) PNA yes / rid) Closest Maj. Wtr. Body Al w14J
f Project/ Activity
'- �D rwi W "' f11
)ck) length
latform(s)
;Platform(s) ;5 X10
)ier(s)
!ngth
tuber
d/ Riprap length
g distance offshc
ix distance offsh
hannel
bic
np.
ise/
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ham, A n r K aVJJ
(Scale:
❑ See note on back regarding River Basin r
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Rloiwk
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue Braxton C. Davis
Governor Director
AGENT AUTHORIZATION FORM
Date: 1L 7 /
a of Propert=Pr�;
Applying for Permit:
rrP,e
Nner's Mailing Address:
one Number( 1:�
Dee Freeman
Secretary
Name of Authorized Agent for this project:
Agent's Mailing Address:
ff H5 = 2798 Sea Vista Dr.
COUTAMON Supply, NC 28462
Phone Number 64/0 7CJ o O — 4,
3rtify that f have authorized the agent listed above to act on my behalf, for the purpose of applying
and obtaining all LAMA Permits necessary to install or construct the following (activity):
r mY PrOPwty boated at _ _a2 (�—
S certification Is valid thru (date) 6' /l Z
-'117117
Pro Owner Signature Date
AD, MENTT RIPARIAN PI&QPERRTTY OWNER STATEMEN
I hereby certify that I own property adjacent to - I/ a VKet- I ► aA-SA id
property located at f7 4&tri n h u ame of Property Owner)
on a� (Address, L lock, Ro etc
,In
(Waterbody) (City/Town and/or County)
N.
The applicant has described to me, as shown below, the development proposed at the abc
location.
I have no objection to this proposal.
I have objections to this proposal
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DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(individual prOPOSIng development Must lift 'ln description below or attach a s/te 'drawir
c-4-tv"\C-) "PY, I
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or gn
must be set back a minimum distance of 16' from my area of riparian access unless waived
me. Of you wish to waive the setback, you must Initial the appropriate blank below.)
_ I I do wish to waive the 1 V setback requirement.
I do not wish to waive the 15' setback requirement.
r.r� ���I ■ I�r��P�l 6r �� rr�lY�r�lwrr•�1
(Property Oww Informati (Adjjweent Property Owner Information)
S. i Stgnatur * d
P nt or Type Name Print orrjim Name
`'�C" C a,4�..f-%cam 3 5�.��yC�eet< L,hje
ADMgENT RIPARIAN PROPERTY OWNER STATE ENT
1 hereby certify that i own property adjacent to 0a V ✓e�- , I ` S'f 1 L�G�
�7 I property located at . -aL , o n �L ame of Property Owner)
I �
(Address, L lock, Ro d etc
on ��C.� , in _
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the
• io 'o
I have no objection to this proposal.
l have objections to this proposal.
DESCRIPTION AND/OR DFU 0WNG OF PROPOSED DEVELOPMENT
(Individual proposing development must fill In desc►#ptlon below or attach a site di
PLEA V- e )c
d8 rck- m- P 4-
x 1-j- kv-n py, I ni
W& R SECTION
i understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift,
must be set back a minimum distance of 16' from my area of riparian access unless wE
me. (if you wish to waive the setback, you roust Initial the appropriate blank below.)
I do wish to waive the 15` setback requirement.
I do not wish to waive the 9 5' setback requirement.
(Property OWM Infolmati (Adjacent Property Owner orma
B Q'fr r Igna e*
p nt or Type Name )prinor 7ype AWnw
Mellt Addrew MaDina Address