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Home My WebLink About79989D - Brackin :<CAMA/ DREDGE & FILL N° ]l)l)S ) A g C GENERAL PERMIT Previous permit# New Modification Complete Reissue Partial Reissue Date previous permit issued la As authonxed by the State of North Carolina,Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to ISA NCAC e 7 h! r2G L? �,./- �/ Rules attached Applicant Name_r'/tf./tlL4_Lady Project Location: County_f r7CA-,c IC Address 34 ,y 1L) 'L4-n.// Street Address/State Road/Lot #(s) City_-.1-1„-(t6.41E—€4121..__-__state G ZIP 2V4 6 2 __._5 ¢_. _ Phone#(tom) 4g9 1 j� 4m(_ i _E-Mail r PC.fr 16161 Subdiv Sion ` Authorized Agent CT'G,_LLC__ —_ — City ZIP ---_- s• Affected ''CW EW PTA ES OPTS Phone# ( )_ _ River Basin Lf tti bey' _ .7.7, E A HHF IH TUBA ❑N/A AEC(s): Wtr.Body 4/_44(/__ 1 _lunkn) t_PWS. ORW: yes ab PNA yes / Closest Mal.Wtr.Body /(iy- itev�d""C f-q�uiL Type of Project/Activity Pep-isrtir A frfri 4' 1?;1M •n?i't�,f'4I'Cn t% -e-f'1St/ 7 (✓ll t"/Il_�_ lb" i�4a-17 t si c( �it%ll/ i f (J (Scale: isle 5 �) Pier(dock)length _ i Fixed Platform(s)_ /+ n r" Floating Platform(s) �` (� ` 1� Finger piers) + - 6 , _ig 477 N, lt`1 Groin length I — number -- — -_ Bulkhead/Riprap length avgma distance offshorffshoree. �_ J d /� max distance olfshore ai1 1�7J(ij/ % Basin.channel - _ _ � l f Of /� /C/ 9i, Irk �AI �/f1n- N/} cubic yards � t Boat ramp - :t vizfi'i ilk'? - Boathouse/Boatlift JS r O nto Beach Bulldozing _ Other -l: c- - ' 1 Shoreline Length jet, 1. SAV: not sure yes 60 Moratorium Na yes Ca; ' __ / Photos: yes i Ai.tit ,41 sr flab` Gclr}e' Waiver Attached' yes t� - - �j'4 7 j�Y1.t-, t1 ih/ ks(�C A building permit may be required by: Tedvr, ,i ,1i 1 & . See note on back regarding River Basin rules. (Note Local Planning Jurisdiction) (/ Notes/Special Conditions fie„tem i ",��- Q,(. / /ie zl; £,9/d 67 €t-L i" frtyi ill i 4". i h1'1n&z./7 s✓n Zys- ✓e/ k .f 'il� Zxl fi ��l I / 1L'Gf�/ J / / Ben Brink (CPi6, LL ) �n�itC� JAI f�a_ (0.2M}2.1 Agent or Appl.cant Printed Name PemtitOlficer s Printed Name r 434 fddbr I( 24•2I Signature ••Please read compliance statement on back of permit" Signature Application Feels) Check# Issuing Date Expiration Date a 0 LCAMA / DREDGE & FILL N9 79989 A B C CD GENERAL PERMIT Previous permit# )'C _ New ❑Modification ❑Complete Reissue ❑Partial Reissue 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 -'" //*.. ale de) E Rules attached. Applicant Name i%Ckad pap) Project Location: County p 31'lswyr Address 345 5wcv1:f cl / �.k�.4 Street Address/State Road/Lot#(s) City �� (ck o r€ 1 ti-e- , I State N C ZIP .2 4J 6 2 Stt,ln-k9- Phone# (<134) 4E 1 X E-Mail y b10--r"I4 i i 1 �`rr,V(J/Owl Subdivision `---'-- Authorized Agent ( FG, L LC City ------- ZIP ----- Affected ❑CW ❑EW ❑PTA ❑ES ❑PTS Phone# ( ) River Basin 1.401 b}rr.- ❑OEA D HHF ❑IH ❑UBA ❑WA AECs : Adj.Wtr. Body( ) ❑ PWS: 4/l t/IL/ 'jiiiP ly/man /wi ORW: yes / no PNA yes / Closest Maj.Wtr. Body Xed-z1 �� ' C Al Type of Project/Activity ..( 1/ s Yy777%c,C/f/Dh � f_w_si#77 LVe',f'///7 7 /(-2- 4 ,G 17/,-if/ (Scale: /./-I 5 ) Pier(dock)length Fixed Platform(s) j� j `� Floating Platform(s) _ !lei' I • , Finger pier(s) t 1!%g r� '- n/1 Groin length } � i ' � - : number — Bulkhead/Riprap length ��'�1114j i avg distance offshore 1fl1'.h1L max distance offshore 111111 Basin,channel < r— N� �r � /L '� '/� 0 cubic yards r I Boat ramp Boathouse/Boatlift /5 J./3 A6/sui — _.. I I Beach Bulldozing Other CV. 1Cs } I v, I Shoreline Length "'/v0 i SAY: not sure yes i _ E } I I Moratorium: n/a yes 63 1 i i ) , ...i Photos: yes (p a - Waiver Attached: yes 0 "g45- <�'a i� 4.yl'-'17 t-h p! lt�l -f ( l A building permit may be required by: 70/4/4 v !/v/de;y B( j4 . ❑See note on back regarding River Basin rules. (Note Local Planning Jurisdiction) Qv `/ -�/ / / / Notes/Special Conditions IU ,7 tm� '�/� /�(f�1/, ��OG, �! /4/ 4?7,_„4,,-,/ i' Lj/j4 r PA- 4) ii/i� d7 > , C// , A itl ?s,p c'ii, 9s 4.7D I i- �kX'.l�pc� -7gsr,c l/ f Agent orApplicant PrintF176-,(/C , 'C 0 PermititOfficerr's Printed Name Signature **Please read compliance statement on back of permit** Signature AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: lCra(.\—ice Mailing Address: ?Jy� Sexeyk.t /A ze i z Phone Number: - Li - C39 - ! SCO Email Address: r(,>ta.c--in&tC- Coastal Permit Guy, LLC I certify that I have authorized Agent/Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits r_7 L (� necessary for the following proposed development: i T at my property located at Q in 1�..�rµrStNi c 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: Signature 1,\r0-r Gi grt�C.�t►^ PPrint or Type Name to rop Title C9 / 17 / 202 t Date 1 7 This certification is valid through ZoZZ \ . e . I 'IMIMI Illft r II I — �b,a . r r 4• / ° ,i c' :Mild ,4 iiql : ,7 ' ' ,iii ; ti!,? '0 ,':;: ..,,,' ,..... .•_.-- . • I;,, • }; C• f w•i,+1 S r j '� "_ 4 kw. " f 4i • ! 0,, ..I., . ,.., . .:, ,_,,__. 1,...L.....,,min , . .. ......__ ,,,, _ • / r I'll , _ . 1111r -".. ' . r .r', ';:r1 .5::'rr'r ... . INN .,re* ik.,._ t • r Iliiji{ ,�� II' 4 01 �., i •aa' i it I!I1.�1i1lill( 1 ��III III. - ,;: ICI ili'{i hi Limited Liability Company Legal Name GRAY GOOSE PROPERTIES LLC Information Sosld: 2097077 Status: Current-Active O Date Formed: 12/15/2020 Citizenship: Domestic Annual Report Due Date: April 15th CurrentAnnual Report Status: Registered Agent: Bills, Don Andrew Addresses Mailing Principal Office Reg Office Reg Mailing 1111 Rockford Rd 1111 Rockford Rd 1111 Rockford Rd 1111 Rockford Rd High Point, NC 27262 High Point, NC 27262 High Point, NC 27262 High Point, NC 27262 Company Officials All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20. Manager Don Andrew Bills 1111 Rockford Rd High Point NC 27262 AUJAt:ENT RIPARIAN PROPER OWNER ST TEMENT I hereby certify that I own property adjacent to 12.I Ctxd t akr 41 's MKS St r^Phi L (Name at Property Owner) property located at Q (Address,Lot,Blocky goad etc p on /I�W�"� ,in tfof4t�is � /)ri L.i .. N.C. (Waterbody) (Clty/Town or County) The applicant has described to me,as shown below,the development proposed at the above location. ANA7tW bar J..M.%O:.'M1G.2022142.CT1 I have no obfection to this proposal- I have ob;ections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) ��C - ad jAcei-,I.- ? eyi f1004.1— It* qc �►y a;;Wrii ee. gichd Drat WAIVER SECTION I understand that a pier, dock,mooring pilings.breakwater,boathcuse,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 tc waive the 15'setback requirement. ,7)Air dm/eT2?Li - —a.:--:40— I do not wish to waive the 15'setback requirement. (Property Owner Information) (Adjacent Property Owner Information) ifilRf2W Blf Signature K, + .0 4 B ret 1 J N Signature D on (Z J S ( , 00c .�f I Print or Type Name , t F+ Print or Type Name 1 Pn'p u`` 3 y S 5ereA. e, d11,1 Q Rd Mailing Address tr�1�� Itez Mailing Address al k �am�-� �11G Z7z4iZ city/�state2ip y3aY-Ye9—i9o0 ary/State2o 3 3(0 a03_Yo30 Telephone Number w j 7/Zc 2 r Telephone Minter Data Date 6/18.2021 '.Reused 6'f8r2012) Au4AcENT RIPARIAN PROPERTY OWN �y'^ STATEMENT✓J I hereby certify that I own property adjacent to • t" "' • f 4Ck r n 's (Name of Property Owner) properly located at 3y S S ere, m L La —Y y (Add ,Lot,Block,Road etc.) on � li3l� in 14v)1eh rbbruntwi 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) ofek Lei �4=4"Li. 96° - owl a ken 4-I-0 eex.r J K, WAIVER SECTION 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 npanan access unless waived by me (If you wish to waive the setback,you must initial the appropriate blank below) I do wisn to waive the 15'setback requirement. N. = I do not wish to waive the 15'setback requirement. (Property Owner Information) (Adjacent Property Owner Information) me �p��j�� Signature r luu'ttar�► rat n N<AL Sur►t' ?riot or Type Name�/)).;445 cervv-1 _`I' Print or Type Nature JZL Z�9��,�/ R�/m'S� :Wailing Address /�0Val P r1J/ C/28 44 Z Malting Ad�dreu/I tv�ww t t i v c 2�` Crty State Zip " City'StateFZip -I9,00 rbL1-64&6-734. Telephone Number Telephone Number Dare Dr1e 06/17/2021 Relied VI 3 2C12) 345 Serenity Lane HB st,o3 Stmcteies 1• ~1 a• ' C'? 1 i I II A. ✓ Y ,� •- •. .14-: '. ".�.,., ' . A Google Earth- ' `• 4." `, ., �' • *,.i ice. , 345 Serenity Lane HB -toF sed Re,:•:.'ron-.t-e F.,t.III F Mate'90 x<y ees adpr e,-t•-e •ong I'aorg-v,r, V 1--'''- te.4Ver:j.,3 Ilii4 \ \ 1 1 Rotate 6k boat lift llr Google Earth -� y N w i loot Check Date Received Date Deposited Check From/Name) Name d Permit Holder Vendor Check number amount Permit Number/Comments Repkot or Re/und/Rwlloeeted Coumnl Coumn2 Column Column) Columns Column(' Coumn7 Columns Column(' 7/1/2021 Richard Brackin Jr. same BB&T 2256 $200.00 GP#79989D TP rct.14877 7/1/2021 Lighthouse Marine Const. Joel Smith Coastal Bank and Trust 3818 $200.00 GP#74823D JD rct.14081