HomeMy WebLinkAbout53172D - Norman CAMA / DREDGE & FILL
3ENERAL PERMIT Previous permit# - `
_New Modification ❑Complete Reissue I 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 _-+ t'1 Rules attached.
it Name 3 KtI NayMan Project Location: County 4el,,, n0v✓ C.4
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(�Grr(/3 Street Address/State Road/Lot#(s)
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yes no PNA yes no Crit.Hab. yes
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bags: not sure yes no r` INION
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itorium: n/a yes no —■ �—
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,er Attached: yes no
iilding permit may be required by: NQ1ST h��r c I See note on back regarding River BasiCp Q )I a4):--1-1) 10 (x.la 0eA. r, mees/Special Conditions - Q �V`� N � 1 t/�p� V, q1 _ n ,, _ 1 1 _ . . c A I111. 1n nA -I J)A5h !A .nL
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAVER FORM
e purpose of this form is to provide proper notice to you as an adjacent riparian property owner to the individual or
ividuals listed below. The CAMA General Permit application procedures require that applicants provide the Division of
astal Management confirmation that a written statement has been obtained signed by the adjacent riparian property owners
ficating that they have no objection to the proposed work or that the adjacent riparian property owners have been notified
certified mail of the proposed work. Often these forms are submitted to the adjacent riparian property owners by a marine
irractor or other individuals acting as an authorized agent on behalf of the applicant.
ris form was sent to you by the following individual or company designated by the applicant as an
ithorized agent: L i �r
YI a►'-K Cif M e ('/r'2;)ey;i �i,72- 6C/'5/1/-flct/mil iLl�
CI lt— dfi-g/
u horized Agent's Signature ( Date
ame of Individual Applying. For Permit: AZ AC /70712/42:lLi
ddress of Property: ‘'' L'g `/
(Lot or Street m, Street or Road)
(City and County)
hereby certify that I own property adjacent to the above-referenced property. The individual applying for this permit
as described to me as shown on the attached drawing the development they are proposing. A description or drawing
iith dimensions. should be provided with this letter.
l have no objections to this proposal.
f you have objections to what is being proposed, please write the Division of Coastal Management, 12'
:ardinal Drive Extension,Wilmington,NC 28405 or call 910-796-7215 within 10 days of receipt of this notice
qo response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
l understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be set back
minimum distance of 15' from my area of riparian access - unless waived by me. (If you wish to waive th
setback, you must initial the appropriate blank below.)
C do wish to waive the 15'setback requirement.
I do not wish to waive the 15'setback requirement AT: ci
•
67-e, / 67, ,
sib�.IAutiNl rurjutllt7tf 11%VALi•-+ ... - - _
Name of Individual Applying For Permit: E, 1\)rir(71Q►r1
Address of Property: 25.5 (' 1€ r
(Lot or Street#, Street or Road)
1"91 S 09 i),l 1\1t+k i oo_oveC
(Cit}I and Co ty)
I hereby certify that I own property adjacent to the-above-refced_property- The ind
applying for ilus permit has described to me as shown on the attached drawing the deveIopmt
are proposing. A description or drawing,with dimensions, should be provided with this Ic
>/ I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-39
within 10 days of receipt of this notice. No response is considered the same as no obje
you have been notified by Certified Mail.
�`�" WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift
set bck a minimum distance of 15' from my area of riparian access-unless waived by
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
Q � � ►> jc-,
Sim.Name Date
uti
y
Print Name vim..1 1A . A • • ��
�� rm.
Clements Marine Construction
NCDENR Letter of authorization of Agent
This letter is to grant permission for Mark Clements, DBA, Clements Marine
Construction to apply for, and obtain permits, and all information needed on my behalf
for projects, building permits, NCDENR permits, or any permits required from the State
or Counties in which work will be performed for me.
t/ I do understand that by allowing Mr. Clements to obtain such permits that this will in
no way release me of any responsibilities to codes, or environmental required permits.
,7-e-//f4C/22a1rt-‘2 date //.27f/- 01
Print name
date
Signature
7
Contact numbers
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New Hanover Co., NC
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CLEMENTS MARINE CONSTRUCTION INC 1501
112 CIRCLE DRIVE 910-270-9110
IiAMPSTEAD,NC 28443 /,2J 66-301
Date 36 365
Pay to the A/CDe/17� I $ live—
z. rder er r-- A7�nG o �.t o.7�o
{ s Dollars 8
First Citizens
Bank 41 a.
firstcitizens.com w
For ne/^%eMatn/
1:053 L00300400353 208 L458ii' 0 L50 L ( P531 r 1 a._
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