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Home My WebLink About86188A_Campbell, Bruce_202109223o1*oC0ASiq1 &❑CAMA ❑ DREDGE & FILL �� N° 86188 'A B C D �� Previous permit Jl GENERAL PERMIT Date previous permit issued M New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue 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. ❑ General Permit Rules available at the following link: www.deq,nc.Yov/CAMArules Applicant Name _ Address City Phone # (_ ) Email Authorized Agent Project Location (County): State ZIP Street Address/State Road/Lot #(s) Subdivision City P Affected ❑ CW EW PTA ES ❑ PTS Adj. Wtr. Body (nat/man/unk) AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body ORW: yes/no PNA: yes/no Type of Project/ Activity (Scale: ) Shoreline Length Access Length Pier (dock) length Fixed Platform(s) Floating Platform(s) Finger pier(s) Total Platform area Groin length/# Bulkhead/ Riprap length Avg distance offshore Breakwater/Sill Max distance/ length Basin, channel Cubic yards Boat ramp Boathouse/ Boatlift Beach Bulldozing Other SAV observed: yes no Moratorium: n/a yes no Site Photos: yes no Riparian Waiver Attached: yes no A b 'Id' 't/ n' erm't ma be re wired b w mg perms zo mg p i ❑ Permit Conditions TAR/PAM/NEUSE/BUFFER (circle one) ❑ See note on back regarding River Basin rules ❑ See additional notes/conditions on back I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) Agent or Applicant PRINTED Name Permit Officer's PRINTED Name Signature "Please read compliance statement on back of permit" Signature Application Feels) Check #/Money Order Issuing Date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: /3rvc c�_ L Mailing Address: Phone Number: Email Address: et I certify that I have authorized Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: -,, T�ir1 s�/ Lof at my property located at in <nerv�;,��n S County. 1 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: v Signat e L Print or Type 19ame Title 0 1 / 31 1 Date This certification is valid through 1 I ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to /3ry L G =4Z e- s If (Name of Property Owner) property located at (Address, lot, Block, Road, etc.) on /��ry m�h_s�,��> , In 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) 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 Owner Information) (Adjacent Property Owner Information) Signature 13ryG� Signature * /f Print or Type Name Print or Type Name Mailing Ad ess Ma jinn A dress City/State/Zip Ci y/State2i ` 75 7--53e-3.5-3 3' Telephone Number / email address Telephone Numb r/ email address' 1-31-2,.1 2/i-:�zL Date Date (Revised Aug. 2014) *Valid for one calendar year after signature* ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to , e- G , ,o /,- // I (Name of Prop rty Owner) property located at vf (Address, Lot, Block Road, etc.) on in _ /f r f � r7 N.C. (Waterbody (City/Town and/or County) The appli nt has described to me, as shown below, the development proposed at the above locatio . 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) fa // '� /tAl,�ace-1 /00' 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 .sh to waive the setback, you must initial the appropriate blank below.) v I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) (AJacent Propel Owner/ Inf rmation) Signature Print or Type Name 0 Mailing Ad res City/State2ip 7, 7 - 5 3 C� Telephone Number/email address Date `Valid for one calendar year after signature" d MLC dd V yrC �.3�5U City/State2ip g y I �OZ Q UG l� 7 di-4niceec- Q, Telepho e N mber/email address C&YVtC26t--Afc't Dole* TT (Revised Aug. 2014) 114� io fro. rx F - RINI 7. . , Ni 1 i6 Nerqulmans 615 r. 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