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HomeMy WebLinkAbout68597D - RobertsonIC,1,4, �CAMA / ElI DREDGE & FILL 1� �}1/ �1/ 8597 A B GENERAL PERMIT Previous permit# 'New —Modification ❑Complete Reissue —'Partial Reissue Date previous permit issued_ orized by the State of North Carolina, Department of Environment and Natural Resources — ' 1 /-� 11 Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC O 1 (!"' oV R I hed .nt Name ) p Y1 R s �' (), an C �U U State C ZIP_2 # ( k- ) ` ' 60'( E-Mail --- ized Agent OAti A3 d ❑ CWEW �TA ❑ ES ❑ PTS ❑ OEA � ❑ HHF ❑ IH ❑ UBA ❑ N/A ElPWS: yes / -no) PNA yes / )if Project/ Activity ❑ u es attar Project Location: County 9A'O�(Aenl K Street Address/ State Road/ Lot #(s) Subdivision (,City 4> t x(^C V' ZIP ZD, Ci A Phone # 0 �;1 r Basin L- Adj. Wtr. Body C�Riv1 � (nat Closest Maj. Wtr. Body Al (/U 1 U ding permit may be required by: a I nr 1 Pinnnina hiricrlirtinn fi(i M Q ( S('*o gA� % ❑ See note on back regarding River Basin i AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: �Q/JA `t�- �C" P-C4t4k' Mailing Address:P,©cla3 ZS)- Phone Number: cn YZ Email Address: I certify that I have authorized e Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: wc_'_- at my property located at _5yi_5el ✓0t°ac�( /U inAk%A_A1_ A1r _kCounty. I 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: [�IL Signature go L:e a& ^ Print or Type Name Title CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner: _ -J�`,� C�� p, a —&I Address of Property: 11-1 1D iL✓ -lD,e°; PA, ( (Lot or Street #, Street or Road, City & County) /- Agent's Name #: ! )Ccl/i C//C p-Ri C e Mailing Address: _ / V Agent's phone #: �/O MY" I hereby certify that I 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. 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. Correspondence should be mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM representatives can also be contacted at (910) 796-7215. 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, 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 Inforn)ation) Sigdhture Print or Type Name �DX Mailing Address (Adjacent Property Owner Information) Signature Print or Type Name �2_3��,�� Mailing Address J CERTIFIED MAIL - RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner: --i 0A- Q/v,/ D-e Address of Property: /A c9 /,! s� 'o p �� � cx t [.ci�S �' /(Lot or Street #, Street or Road, City & County) Agent's Name #: per. ✓. c�1 akfc-,- Mailing Address: %fY 1 2 i 'r- �� 17� Agent's phone #: //G? �j� S'—� lf-� 21- I hereby certify that I 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. 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. Correspondence should be mailed to 127 Cardinal Drive Ext., Wilmington, NC, 28405-3845. DCM representatives can also be contacted at (910) 796-7215. 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, 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 Information) Sig ture Print or Type Name E, 0180V 6?1 � Mailing Address 2f2�e> (Adj ent Prr Zer Information) Signature L� tP�m _,'� — Print or Type Name Mailing Address [ ;�o,5- N- SI,�Re 0A, l� 'book-�� I, �v I61I 10 t 7 5 fY'�f