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Home My WebLink AboutHeath, Cuyler III5 Epall AMA if DREDGE i FILL N4) 78969 A B i D RIERAL PERMIT Previous permit # ew OModificatm ❑Complete Reissue DPartial Reissue Date previous permit issued As authorized by the State of North Carolina. Department of Environmental Quality h J and the Coastal Resources Commission in an area of environmental concern pursuant to 1 SA NCAC (/ f p -C sC..)' }� attached. Applicant Name_. _ (�,¢ i-� 1-------- Project Location: County_.- Address �x Cap Street Address/ State Road/ Lot #(s) — State 1 Vl ZIP,tp / (OV Phone # �Q)_E-Mail Authorized Agents n dux P w2.v __-- [] CW A O ES OPTS Affected AEC(s): Q OEA 0 HHF 0 IH ❑ UBA O N/A 0 PWS: ORW: yes / 00- PNA /7' f no Type of Pro*V AcdWty Pier ( Fixed Fload Hoge Groir Buixt Basin Boat Boad Beat othe Shor SAY Mar Phot Wah A bu ( Note Local Planning Jurisdiction) Notes/ Special Conditions length vffnber ■ljl■■ ■ r ■■i�■■� ■■■ ■■■■ ■ ■ midctuuww - ■ 171EX distance offshore ■� ■E `ni�ih�..-.� j,� ■ wjbk yards ■■■ ■ ■■■ ■' ■■firTZ ■� ■�`r ►� ■ i ■(■■IVi:"7■■ ■�� -.....rrlow .��■� �� t�i�■ ■■ "�■r!� ■� ®�t.■■,■■. ■ /.� sir. ��■■■■■it•■■��M�� A'' C•7�tr• ■ felt Printed Name PerrnEtoffiicrrs Printed Elan. Piease read compliance statement onbackof permit * Signa re F � i i r clheckngDa a phi iration ate Name of Property Owner Requestir19 P00nit, ° Mailing Address: Phone Number: Email Address: t+ilftt' at_ -- ' I certify that I have authorized AUaiit l oontrNutnr to act on my behalf, for the purpose of applying for end obtaining all LAMA permits necessary for the following/proposed devnlopmont; at my property located at in 'S40W County. 1 furthermore certify that 1 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 infotynation related to this permit application. Property Owner Information: Signatute r Print or Type Nary -- Title C��i2.5►z�2(% Date This certification is valid through l , 1 AD A ENT IPARIAN PROPERTY WNER STATEMENT s I hereby Certify that I own property adjacent to 6� (Name of Property O,Nner) property located at /� l�f�r `�1N� (Address, Lot, Block, Road, etc.) N.C. , Infs on (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above . I have no objection to this proposal. 71 have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (10dividu8l proposing development must fill in description below or attach a site drawing) nd; ucr j bs 3K l $ I"/A' 6 0fwaV&15 /4N0 N6W fig to gaol IIx 1 /ti 745 ARJFA WAIVER SECTIQN 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 IS' setback requirement, (Pr rty Ow, r I formation) (Adjacent Pro perty Owner Information) Sirralure K X' Ile igrrature Hint or Type Nara iv o it&wfio 40j''r Print or TYAe Name Mailing Address t"w I°S•tsn✓ .... ors. i - lL�Allirfty drlrlti,..., *Valid for one calendar year after signature* (Revised Aug. 2014) ; AO�M11T f e6RM PRQPER11' OWNER STATEMENT I hereby ceftity that I cw►nt property acyaoWt to € c:ft t� ,�1 x� N Is {Name of Property Owner) pmperty located at � � � V sA � (Addt�ss, Lot, Block, Road, etc. 01) � ,°,c ,� tom,' K in t r � c 'r' _�__,�- N.C. (Watefbody) (City/Town and/or 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 ANWOR DRAWINGS OF PROPOSED DEVELOPMENT Ondivkhmi p► vos/ng devetmpment must tilt In dwcdfpftn below or Mach a sine drawing) diP4 r )Op xx rF1'"VVzrP pNz' /t'e%� (q) pol.�•G o- its At& I understand frrtat a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin must be set back a minimum distance of 1& 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 16 setback requirement. I do not wish to waive the 15' setback requirement. (Pr perty Owner Information) (Adjacent Property 0 iW Information) a4t, �' , , J. ,Siraatrire tahrre evytew. Lmaw �dq 401r'ir Rant or Type Nerve Print or 7ypa Neer* Mailing Address Naft Ad*ess Telephone Numbqr I e►nail amass T+rttsph a N / omall addVess2. "child for ona calendar year after signature` (Ravlsed Aug. 2014)