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Home My WebLink About77827D - LaFrance (CAMA/ ❑DREDGE & FILL NQ 77827 A B 3ENERAL PERMIT Previous permit# %Jew ❑Modification El Complete Reissue El Partial Reissue Date previous permit issued rized by the State of North Carolina,Department of Environmental Quality 1 ZOO :oastal Resources Commission in an area of environmental concern pursuant to I5A NCAC O� 1 A k.`'' 0 f n f o F,ules attached. t Name tl V ^ Project Location: County fj w tN-St C , \A VI '`5 k Street Address/State Rg4d/Lo # s) U State ZIP Z � (9 1 \L (P 'u aka $—�1 �4-d 1n� c lam) � L,�-Mail t�f "! � � subdivision ed Agent 1n �"�` 04 /C/ tom.City Li F bt7 ZIP 2-Y4e ❑CW W )' PTA ❑ES ❑PTS Phone# ( --)-"""". River Basin 1N ' ❑OEA ❑HHF ❑IH ❑UBA ❑WA Ca'S Gf �(� ElPWS. Adj.Wtr. Body (nate yes /G PNA yes /, no Closest Maj.Wtr. Body 5"�I SO`""'t0( Project/Activity i{ 0.-C.4-/ \,O (AL l -- (..-4 t f I ' (Scale: I :k)length '�/L4 1 i stform s 12 )( � i Platform(s) 1 ier(s) { 1 N I `,----ril t d i — J/l'iiiaki length f -j---I distance ffshore } aele. is x distance o hore { a „[ `-N �• • cannel )ic yards j I • • ? :) .IA/ktti/4 8 fi -� \s oat' — -- ,� -._. T . : ..:___—* - ......---- . .__.._.... t a..._. )Rldpzing - ; • f '''''''''.•, te 1 I A, 44-ii 1' ', -cl''^'•i'' _ �j I j -f-f-� i ' Length � not sure yes , , cum: n/a yes C[w�'..- ....... ; , 1 -- T._.._..... atached: Lry9 - Ig permit may be required by: 5 t'li P (4-1--1 ❑See note on back regarding River Basin ri _ocal Planning Jurisdiction) AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: ( (V 1 n La Cl r)C e- Mailing Address: CA 114 (J ,5-1-reef Surf Cif-y , nlC Psr 5 Phone Number: 61 19I- g'(c " 51 F64 Email Address: rernerI y hones le c.erritity1 nk. rid I certify that I have authorized e n n d1 1 rr i r 1 n e (t A S r ici- Agent/Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: /.11 x 4' D c c k) x 1,2 ' nJ er Pitr �i at my property located at 2 / 1 ` - (p+h 5fe.e+ in ell6ka) County. I furthermore certify that I am authorized to grant, and do in fact grant permissior Division of Coastal Management staff, the Local Permit Officer and their agents to ei on the aforementioned lands in connection with evaluating information related to permit application. Property Owner Information: Signature ()JO / V/r] LiFt-4 c Print or Type Name Cu L J t_.r Title ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to 04 f i//p L jF4)1 ce 's property located at C/) 114 (f1) 6 free f (Name of Property Owner) on C,c��}(� I (Address, Lot, Bloc , Roa , etc.) in 5 t_.Ir'- Ci , N.C. (Waterbody) (City/Todvn and/or County) The applicant has described to me, as shown below, the development proposed at the above localii U I have no objection to this proposal. e, I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) 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.) ✓iclZ I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) (Adjacent Property Owner Information) Signature Signature* PI ' g�UI L/1l� /.._.�LFdnLe, Ierry H Rivenbark Print or Type Name t Ca I I9 loth,5t� ter �''��r�`' het S y n✓1'MI:Winn dririrocc l� ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to i2 i 1 yin tx7F1--4 n Ct ,s property located at to 114-114- t S free f (Name of Property Owner) 1a�/' I (Address, Lot, Blocjc, Roa , etc.) � on ! x( , in 5 U t'f �.i aterbod , N.C. (Waterbody) (City/To n and/or County) The applicant has described to me, as shown below, the development proposed at the above iogtionr C1 crr I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must till in description below or attach a site drawing) 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 ✓. I do wish to waive the 15' setback requirement. et I do not wish to waive the 15' setback requirement. (Property Owner Information) (Adjacent Property Owner Information) Sig toe n ��L/In 1 t'_�nG SiJimtmy R Flowers ► � ' Print or Type me LT T r�t s) I /14 Omdlt"r°.�'�' PE�'1 ��T� le� re�t ci Mailing Aririmcc. . - -11 • ,, NI/ , --Ills Cheek - t(Name) Name of Permit Holder Vendor Cheek Number amount Permit Number/Comments Receipt or Refund/Reallocated +n3 Column4 Colomns Cofumne Column? Colonma Column9 same BB&T 4480 $200.00 GP#776180 Ben rct.10295 Calvin LaFrance Coastal Bank and Trust 3284 $200.00 OP#77827D JD rct.11632 Ryan Mattox BB&T 7098 $200.00 OP#77826D JD rct.11631