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Home My WebLink AboutBogue Sound Yacht Club Marina, Adam Parchman (2)I CAMA / C1 DREDGE & FILL No. 75717 -� A B C D GENERAL PERMIT Previous permit# PNew ❑Modification ❑Complete Reissue ❑PartiakRelsstey Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ❑ Rules attached. Applicant Name 1 �I l 1,� r 1 (� V1/ /'� �( �Lr [ �.1, Project Location: County_ _ 4-_ I Phone # Authorized Agent O CW EJ EW iPTA ❑ ES ❑ PTS Affected AEC(s): ❑OEA ❑HHF j�IH El USA El N/A ❑ PWS: ORW: . yes / no PNA yes / no Type of Project/ Activity Pier Fixe Float Fing Groi Bulk Basi Boat Boat Beac Oth She SAV: Man Phot Waiv j t - Street Address/ State Road/ Lot #(s) ;r Subdivision City 1. ( l . ZIP Phone # (/ ) River Basin Adj. Wtr. Body _ '' (nat /roan /unkn) Closest Maj. Wtr. Body (Scale: ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ :::::::::NNNNNNNNNMENNNNNNNNN0 MENOMONEE ■■■■■■■■■■■■■■■■■■■■■■■■■L`!'r�■ ■■■■■■■■ lengthN■E■■■■..........■■■■■■■■■■■■..■_.■■■■■■■ ■■■■■■■■■E■■ MEMO ■■■■E■■■■■EE■OEEMEEE■■■■ number ENN MENE NNNNNNNNNNNNNONN �11NIEMEEMMOO avg distance offshore ■■■■■■■■■■EEO■■■■NMEE w■ lm■■■■■■EE■■■■■■■ rnaxdistance'ffsh,re> ■■■q■■■■■■■■■E■O■IE■I■■E■E■■■■E■■■■ME■■■ ■■■■■■■ ■■■■EEMI■II■■l��l®c'JA■OEM■■■■■■E■ MEMO= =000 MENNMMLW IEMENNONE cubic yards EME■■■OEM E■�■EIM■E■■■■■■■ ■■■■M■E ■■■■■■■■E■■ MEMO ■M■EE■i■■■EMM■■■■E■■■■■E■M w ■■■M■■E■E■■�I ■wait■■■E■�NNNN��NNN��NNN ■■E■E■EM■a 101■�NNNE■ ■■■ EME■■HMEME■E■ ENNNC■MN■E■■HOME ■■®�N■M■NN■E■■■■■..■.... ': BEE■■EE■EEEHE■■EEME EEE■■■Et■E�■■EPEE■■■ V■E E EEEEEYY YYYY/ YYYYEYYYYYrYr ,. :CE'.'.".'.'.'.:MENNE■::'■'■'■'■'■I'■EEME■'■ilIMMUNE■ line Length SEEN ■■■■■■EE MEN ■■■■■■■=■■■EEO■I )J.■■..NMMN he ■C: .■■.■. ■■■EME ■E■E■ ■■ ■■ notsure yes M ®�C■■■M■EN�■■■��MM■MEMM■■■■■■E■■MOM■l■■■E■■■■■■■■ME' ::::::mo :: CC :NNNNNN®NNNNNNNNEN::.NNom A building permit maybe required by: t ( Note Local Planning jurisdiction) ` Notes/ Special Conditions [.. Agent or Applicant Printed Name Signature "Please read compliance statement on back of permit" Application Fee(s) Check #. ❑ See note on back regarding River Basin rules. PermitOmcer's SignatT`- Issuinj Dat6 Expiration Date '" ' 1M; •i - ii •pit "I Name Name of Property Owner Requesting Permit Amm PA-QCF fW4 4 _ Mafling Address: (ZA pA,A.,,a ""O' t T nC 2SS"I G — NNFf�xyN 4L1-� � S`l phone Number: EmailAddres5: GteQeaw�Oafeta.,..avr Cr�•<oµ� I certifyihat l have authorized NEZ Wocr :54 Aazo" Or- u,,6 � Agent/Contractor C7-7Y rvG to act On my behalf, for the purpose of applying for and otAafning all CAMA parmb necessary for the folkymng proposed development t" POL15 Ib 20AI G7 7 7-fL5z,A-V-,4fur,f at my property locates aY �{iirCarA� cu�0 `f dElH! ClUg rn4fzty�- in Gt1 rt r7 County. l fn kNOTIore certJfy that l am authorized to grant and do /n fact grant permission to Division of Coastal Management'staff, the Lace! Permit Officer and Their aganfs to enter . -on fha.aforementloned lands in connect/on MW evahrafing Wormatkn4elated to this Permit applkatlon., Propariyowner information: SYgnafura PrM or Type Name Me Ib Jzt i ZOA Dab This certification is valid through I A ACEkT PVARIAN PROPERTY OWNERR MEMENT I hereby certify that I Own propeAy adjacent to �U4ul; Ar� ktd2gf Clu b I1- ,r (Name of Property Owner) property located at UMT LX& DTtrvr rtrC4yPea ( /y( 7SS70 (Address, Lot, Block, Road, etc.) on_�3C�tif, 56�..n.p , In . Cr¢�1�RC-r (6nv('-rV N.C. (Waterbody) (CRY/Town and/or Counh4 The applicant has described to me, as shown below, the development proposed at the above location. ._ 1 have no objection to this proposal, DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPM15NT (lndivldual proposing development must fill in descripthm below or attach a site drawing) 1>74-,4wCt A-7f✓dtiN4!;5O i0 kM— "OL 44-77.lylt/ - yyAl1�RSECTION _ _ I understand that a pier, dock, mooring pilings, breakwater. boathouse, [It, or groin must be sot back a minimum distance of 16 from my area of riparian access unless waived by me. Of you wish to waive the setback, you must Initial the appropriate blank below.) I do wish to valve the iv setlt rk n Kluirement. I do not wish to waive the 15, SeM k requirement. Information) (RevisedWA-Af 11 U CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner: 60AJk S'o-Vj Club tA0,6i n6J Address of Property: Agent's Name #: Agent's phone #: 1u10 0,( , i tw (Lot or Street #, Street or Road, � I f%� (- (avR CA (6-M1V & County) Mailing Address: I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit has described to me as shown on the attached drawing the development they are proposing. A description or drawing with dimensions, must be provided with this letter. 4 I have no objections to this proposal. I have objections to this proposal. If you have objections to what is being proposed, you mustnotify the Division of Coastal Management IDCMI In writing within 10 days of receipt of this notice. Contact Information for DCM offices Is available at httn://www.nccoastafmanaaement.nettweb/cm/staff-lisflno or by calling 1-888.4RCOAST. No response Is considered the same as no objection if you have been notified by Certifled Mail. WAIVER SECTION 1 understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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. Qz2v_ 1 do not wish to waive the 15' setback requirement. (Property Owner Information) Signature (A&m QnrLV-\M Curl Print or Type Name Mailing Address No-w Q D6 , N (, , '2 U-10 City/Stat /Zip - Q3, H - a 3a� Telephone Number / Email Address �I-�,a/IC1 Date (Riparian Property Owner Information) Signature bV1111err, 4. pav, , 3k, . Print or Type Name v 30 F VFw - Mailing Address 6wimsh000, City/state/Zip 2 <2 -393 , 9//& Telephone Number/Email Address Zli-711 Dates (Revised Aug. 2014) (J a U, X 1191 1 X A� ��T 4 :.� :..��i►' �!f" �f � r� � � P J11f .:3 _ '�.. �'\ �;i}i;