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Home My WebLink AboutLynch, Bruce 77356C®.�A CAMA / ❑ DREDGE & FILL N9 77356 a B D J QEKIERAL PERMIT Previous permit# eew ❑Modification []Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality 71111o6, and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ❑ Ru es attached. Applicant Name (� �t ( ( / it, -f Project Location: County 6 ` ✓ el`" ZIP rn �i S-7/ Phone E-Mail Authorized Agent /Nt,t Affected 0cw L1EW El PTA ❑ES ❑PTS AEC(s): OFA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: ORW: yes / no PNA yes / no Street Address/ State Road/ Lot #(s) Subdivision City ----A ZIP C" J Phone # (_) River Basin Adj. Wtr. Body ((nnat an unkn Closest Mal. Wt.. Body — Type MIN ■■■■ ■■■A■■N■■� ■■■■■■■■■■■■MOVE■■ ....:....■,�..��:...� ■IN .,..I..■. ME EM _ .. - . . - ■■■■■■■■■■�■■eM!IEM■ ■ wl■ ■■■ ■,�M/�'MpCt'.!!E■■0■■■G rill■■■■M■�l.ili_::ii■■ :. V�■::� EM= �■■■■Ir�O� illl/■■■■■ ■■■�■...■■.. ■�■M■..SIEMENS ■■■AME SIMMONS IN ME SIMMONS IS . ..■ ■q ■■IS so ■■i■w■ ■■MMM■■ ■■■ a :.:. ■M■■■:wow w(IM■A■■■ ■M■■■■ :::C:.: ■:::I■':: ■■M■■I■ w■w ..■ ■■■ 1 ■■ ■M■ ..�■■ j.IVL"L■I■.■■:.MONO■■ 1 1EI1■:■■1■■M■■N■■■■■■■■■■■■■I■MM■■. 'M:::1:::0:aa::■'■: ■.■ :::�:::;�:::::IN : IN MT Agent or Applicant Printed Name Sign et Please read compliance statement on back of permit* A06licatiionFee(s) Check # Permit Officer's Printed Name - --� ""-- - Signature t: / Issuing Date 1 f xpiratio Date Agent or Applicant Printed Name Sign et Please read compliance statement on back of permit* A06licatiionFee(s) Check # Permit Officer's Printed Name - --� ""-- - Signature t: / Issuing Date 1 f xpiratio Date N.C. DIVISION OF COASTAL MANAGEMENT AGENT AUTHORIZATION FORM Date qI,IlaWb_ Name of Property Owner Applying for Permit: Mailing Address: 1 certify that I have authorized (agent)`�� tt`tiJ�.c t M(-RAo act on my o ',fol behalf, for the purpose of applying for and obtaining sill CAMA Permits necessary to install or construct (activity) at (my property located at) cix i Lt a—mcraig-p-,r-ox--t l& L R CS This certification is valid thru (date) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to [')flvv� L b vlkhh110 C�_ .._ (��"� -. "s (Name of Prope y O nor) property located at _ i _ !"' _ .t. j (Address, Lb , Block 13cad, e on. Y (Watertiady) (City/ Pown and/or County) The applicant has described to me, as shown below, the development proposed at the above I o ation. I have no objection to this proposal. M I have objections to this proposal. DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must till in description below or attach a site drawing) WAIVER ,.SEGTION 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 most 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) (Adjacent Property Owner Information) 6 _5 0,1e, rtty�srat�r�Er, 7"Clelrhorae= +� unsi�rjr (Rovfsed 611812012) I hereby certify that I own property adjacent to {Name of Prop property located at TY (Address, LoC, Block 13 on (Cityrrown andlor County) The applicant has described to me, Wshown below, the development proposed at the above loua I have no objection to this Proposal. I have objections to this proposal DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development mast fill in description below or attach a site drawhig) M99M I UnrlOr-ItAnd that a Pier, dOGk, mooring pilings, breakwater, boathouse, lift, or groin must bflset back a minimum distance of 15'from (Y1Y area Of riparian aCGe$-, unless waived by me (if you wish to waive lho setback, you 00900" the appropriate blank below) -.- Ar— I do wish to waive the 15 setback requirement. --------- I do riot wish to waive the 15' qotback requirement, (Property Oyne I 'A _�Jqtfbrpation) (Acl}a;71�ropqrty Owner Information) Print or r Q Nar'"(11 Pis P 11 1 Ty M rm WiR A Mairis $0 fetoprion [1`6' dC) fRovo;(-.1d 6178/2012) zu ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to {3r'k(2 LbDCL Is (Name of Property Owner) property located at alit{ property b r (Address, Lat, Block Road, etc.) on inN.C. ( rbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above locatiytri V 1 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) WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a minimum distance of 16' from my area of riparian access unless waived by me. (If you wish to waive the setback, you trust initial the appropriate blank below.) I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. Date Owner Information) (Revised 611812012)