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Home My WebLink About71877D - Kozel LCAMA/ ❑DREDGE & FILL 0 pp - 71 077 A B 3ENERAL PERMIT Previous permit# ),New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued ' rized by the State of North Carolina,Department of Environmental Quality 0 t 1 ( ( :oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC tt `�,' r ^ ❑Rul s attached. t Name t\J U.. I K OZ L-" Project Location: County /- , ( b 1 C , Q 31L-- . Street Address/State Road/Lot#(s) U � C'lt \Sat ZIP �� \ C)-1 6". ()ail_ { /,' al)5 5- ( E-Mail Subdivision ;ed Agent E' 4-- ✓it l.6L.1. —. City '7 L1 cA-rti ZIP Zef-S - L ❑CW ❑EW 0 PTA S OPTS Phone# River Basin ❑OEA ❑HHF ❑IH ❑USA ❑WA Adj.Wtr. Body `T0,SA I.L SO r)A).1> ❑PWS: yes ,gin PNA yes / Closest Maj.Wtr. Body 1 b/54iL .575& 'Project/Activity 54 Lt 1 i o CtAi t 11 VVG I( / L c)t (t- (Scale: I IL• ck)length atforlri(s) L L `� Platform(s) , ` ier(s) J T�—_.._ ngth I•` Tiber prap len h IINAN , i � N distance offshore .--.6,1- • i Lc distance offshore cannel . r- I �J_Loa 0i np \ I j ,` j — se/BoatlIt \ +I F St.' pS \ 9 f� if ulldozing i i� kfi?it/ I C c vf . , i e Length 'A"fr 5 O , it , not sure yes ii, 1 ium: n/a yes _.. yes I 4ttached: yes g rig permit may be required by: T'( t k . Li See note on back regarding River Basin r Local Planning Jurisdiction) AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: al/l/ 7`0 l Mailing Address: /05* 04-// 2i �e Phone Number: — 53- S / // Email Address: F /e'L I certify that I have authorized Agent/Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: Tt i>972 / �/le�PC i 717( €'J at my property located at in A — County. 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: "t46.7X7 Signature 14 KOZ6-Z. Print or Type Name Title ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to a",/,0,1 /I Z6 L s (Name of Property Owner) property located at 769/ 5 t1L 91 _Wig.e (Address, Lot, Block, Road, etc.) on /0/5¢it , in C<7 r , N.C. (Waterbody) (City/Town and/6r County) The applicant has described to me, as shown below, the development proposed at the above location. I have no objection to this proposal. 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) LA.-„‹ RiZci Agit tvE- A, c.7 Ckv A P -PP U '1A1--Ki‘ 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 Inform ion) (Adjacent Property Owner Information) ignature Si ature-* Gam'//' 12 ' i Mr S�jA Print or Type Name Print or Type Name 785' e<GP %// cii4A Guest✓ e Pe AA,ilinn drlr/ro cc u..:r..... A.a.a- ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to �'i�l r z e/ 's (Name of Property Owner) property located at /c7/ I` S��r C.r77 ACC 2 y r S. (Address, Lot, Block, Road, etc.) • on /5.N/ in $ C2/t , N.C. (Waterbody) (City/Town and/o(County) The applic t has described to me, as shown below, the development proposed at the above catio I have no objection to this proposal. 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) A T 4"-"Li �, w.y T, ra f r k J WAIVER SECTION I understand that a pier, dock, moonng 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 lnfprmation) (Adjacent Property Owner Information) !/ Z5 i/ " )% H ryt Signat ire Sid `011r Print or Type Name dr'or T pe Name Mailing Address Miiligg Address") c. City/State/Zip Ci tiat ip eer /I/G Telephone Number/email address a hon u b er� real address Dab Received Dab Deposited Chock From(Name) Name of Permit Holder Vendor Cheek Number amount Permit Number/Commenb Columni Column2 Colima Column/ Columns ColuneM Column? Column$ 9/15/2020 McPherson Marine Service,LLC Marguerite Grimm FCB 3314 $400.00 GP#76434D • 9/15/2020 Anthony Carr Money Order Chad Hock United Bank 543577 $200.00 'GP#71896D 9/15/2020 Emily Pace and Mary Starcher same Cadence Bank 836 $400.00 GP#71882D 9/15/2020 Donald and Melissa McVickers same State Employees CU 1870 $200.00 GP#77620D 9/15/2020 [David Bilotti Carroll Noone Bank of America 580 $400.00 GP#77828D 9/15/2020 Enchantment East LLC same TD Bank 1242 $200.00 GP#77830D 9/15/2020 William Kozel same Bank of America 7103 $400.00 GP#71877D 9/15/2020' 'Robert Kronengold same PNC Bank 1233 $200.00 GP#76480D 9/15/20201 Thomas Cruz same Wells Fargo 129 $200.00 GP#76460D