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Home My WebLink About78093A_Ford, Robert & Eric_20210331X CAMA / )( DREDGE & FILL GENERAL PERMIT X.New _lModification .Complete Reissue ❑Partial Reissue ICI° 78093 B C D Previous permit # Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality *� d j tZO #ihe Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 1 - % i Rules apxhed. cant Name Rao, d j-cq__ r-ordProject Location: County -C i�;A+'� _--- Address I Icl 6kmi on Street Address/ State Road/ Lot #(s) l l -9 6 City n State NC ZIP �43� !1q i��rt e itr�- Phone # (Z L} 3iZ JEZt. E-Mail .Q kbdivision_ C-C(et'k-,ft pOw plaft" Cn Authorized Agent 7,Q. V •_A%Qar% /Ocear s' .-%*ir" 10ty F r_ZIP 2- 43Z► Affected ❑ CW I� EW %PTA R) ES PiPTS Phone # (;) River Basin PQS l kbl�& k OEA HHF ❑ IH Q URA N/A AEC(s): G ❑ ❑ Adj,Wtr. Body_... A l be YY�a c-!Q at (man Junknl Pws: Closest Maj. Wtr. Body 2 S — ORW: yes ni� PHA yes J +o Type of Project/ Activity I -• V wt (Scale; Ij N = 3t Imams Prom length number oil MEN W. PJPr2P length avg distance offshore cubic yartis Iat ramp 00 AROUSE MEMEM ou ■1111E ■�ii■■■■■i■ a■ • . S■■ ■ ■■■■■nol � _ M■■�i/O1■■■■■■ I'; �M■ME ■■■■■ I■mmus ■■■� . f noture Yes -ioratorn= 0 yes no no 6 il�ilnli ■�■■■■ri ��►ui■WAMAa= AM■■■Mi■,W- ■"�i OR iL"II ' ■41 ' Sit ��V . �"tea■ ■ --�1 !no -N �■��,�Ill��■2■ ��r lu■■■ ■ A building permit may be required by: C ke (, c'n CA U_ X" ❑ See note on back regarding River Basin rules. ( Note Local Planning jurisdiction) Notes/ Special Conditions IWt or Applicant Printed�Nar e SlYnaturo Please read compliance statement on backof permit'• O_Q' _ _ ltSzirt ttS2O Appiimtion Fee(s) Check # Permit c Pjrinted e Signattffe 313//zt 7/31 /Z! Issuing Date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: �7 Zfn' 7201 Mailing Address: q kfttage,If N c Q IG3a Phone Number: 25 Z 312 - �fSZ6 Email Address: <(n �st•�rrJJ-,��a7f�-�cLrsr,ca-� I certify that I have authorized . �• %nutX!, Agent / contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: a LF VlrUA 6uhjaj,� 50 FT X (OFT- i Ilidf 1 I 0"11>oa _ I+XZ' boa" w/.Jt� C►a� a, � °��kt,�r:�n at my property located at I I I�r in 0AQw 0,r%-. 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 information related to this permit application. Property Owner Information: /J J Signature p K �j?r�5"fitih 6` — Print or Type Name DkAle- Title I Z 1 3 0 I ZU20 Date This certification is valid through W I �� IOil ADJACENT RIPARIAN PROPERTY OWNER y,STATEMENT I hereby certify that I own orooerty adiacent to uvj io ►() `OL 's of Property Owner) property located at II1 2fUU U //�� n (Address, L t Block, Roa tc.) on U�LYI')fi-� �,vroL in Vo-uan Q). , N.C. (Waterbody) (Cityown 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 AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill in description below or affach a site drawing) Epp LF vad 50 F->< � FT 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. (Prope Owner Inf un n) 2 Telephone Number/ email address 2-t-Z( Date *Valid for one calendar year after signature* (Adjacent Proper Si re Print Ty Name Mat ina Address _ �q S c> hI iUz/J)te V Telephone Number/email addre s Date* (Revised Aug, 2014) ADJACENT RIPARIAN PROPERTY OWNER 1 hereby certify that I own property adjacent to C /1 w rct I �+ p (Nanq of Property Owner) property located at Address, Lot, Block, Road, etc.) on 0AP) A in C4'iWA-n , N.C. (Waterbody) (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 AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) 100 LF �O FT X (U DT W tALbDd lk 4 I,UCIQ.V�L(JO-t�, W X b oca+hau LYL 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 O ner Information) (Adjacent Prope y Owner Information) igrr��aat tre Cr LL() %C L Si nature * , / i5 Rrr�' or T pe N me J/��.� Il�t Uoc t �Y Mir,�q Ad ress C t Print or Ty� Nam r, Mlaillina Addr s City/ t 2523lZFQ6 City/State/Zip Telephone Number/email address Telephone Number/email address — 1230`Zy �,ge_ &10 Date Dare • (Revised Aug. 2014) *Valid for one calendar year after signature* .4, -2 vot ---0, AM Untitled Map Write a description for your map. 9 -; Legend 119 Heritage Point Dr ti g k