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Home My WebLink About78799A_Williford, Marshall_202111129CAMA / ❑ DREDGE & FILL r GENERAL PERMIT 9New OModification OComplete Reissue OPartial Reissue i°49 78799 Previous permit # 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 7 9 • /a Ob r5n R. d.. —"{..., Applicant Name fflarS6czIl Address Q, O, 90x 20$1' CityK�State NC ZIP_ Phone* ZIL)325- 019 0 E-Mail ` Authorized Agent CC C Affected D CW NEW 0 PTA ❑ ES D PTS AEC(s): D OEA D HHF D IH O UBA DIVA ❑ PWS: ORW: yes / no PNA yes Project Location: County C,{1main 0 C D Street Address/ State Road/ Lot #(s) I I/ Item hl-n ke. Subdivision i�mhr�e City Edenfor\ ZIP - 7 4 3 -Z Phone # ( River Basin 3t Adj. Wtr. Body ri ( be -K C&tz (nat /man n Gosest Mal. Wtr. Body Al le- Sn.,J ,s :. ENE MEN .■�.■■ii...i....■�■...CM■■i■ ■E■MIN ■■NI■■■■■■■■■■■■.. NNE ...■■ ■■■■■ ■■■■■■■■■■■■M■■■M■■■■■■■■tl■■■■■!iV■■■■■■ ■EEM■■EEME■■M■■■■■■■■■■■■//EM ■■N■■�>•�_ ME MINE q■■■■■■■■■■■■■■N■►�i�m lco.If■■■■■■■■■■�►,.� �'—WMIM■■■■■■■■f■ ■007■�■■■ ■■E ■■■■■r�llrailiii�iutZi►r■■ M=Mm EMO MOEM M ■C1:: MEN■ ■ ..■■E ■■■�i, ., - ENE ENO C::: MMY■■EM■■■■�■■■R�Q:.d�■■■■ ■M■■■E EM EME N■■■■.■■ man ....� �..�....■.■.■.. ■■E■ME■M■■■■■ E■■MEN ■■■. ...■...■■ ME ``�`�r�+..Now ■■■■■■■■■■■.■■..........,,■...■.....■...■ ..■...■...■.■PM A:.:..�+■........■■■■■.� ■ MEEMEM■■■■!-�■■■■■■■■■■■■■■■■MIME■EM ME■EE■E■■M■■%■MM■MEM■ NEON ■E■■■(■!��"I!t■■E■tS MEMEME MEN ME M Moog OWN Boom 11 Agent or pii • rinted Name —� Signature Please read comp ment on back of permit•' Applicaton Fee(s) Check i Row6ee rerrruttyrti er ss�PrinWe �!! l i Slgna ure I yrL/ ZG _ 3//7-/Zi Issuing Date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Mailing Address: I ply, CL" �rt N c t ! Phone Number: 2SaR — 3515 0 Email Address: I certify that I have authorized K • a A ent I Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMAA� permits necessary for the following proposed development: - X 14 r r,�Lul'Ia�Gtr_ 4 tom- at my property located at III Pl1 bak GA �ALrc w in O-Ao ) County. 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: Received - -- NOV 1 j �'::3 j 6� it /'U L L 11 I-VYvDCrA-EC Print or Type me ,tom A �b�W itle Date This certification is valid through 1 1 _® 0 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to MICUlWW s 66& n • t , G (Name oo rop Owner) property located at_ !! (,filiG(�, C(�ntA1 P�mb�orGt Get (Address, Lot, Block,.poad, etc.) on in W.Vt1n , N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above loca 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) 3(o'x I LI-' (,�oa-+hou 3 11-0 LF &Uhtak TD 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) (Adja t P�7;z Information) P ure Si ature* ag 1k) d ��M e S 14 �� n S o� Type am Print or Tye Name Maili g A dress Mailing Add ss t;c>�'gA , >L1C a7932 � �e(rl 4/C a?`?f C— O/90 City/State/Zip 7 c� _ O O 3 Telephone Number/ email address Telephone Nurpber/gmaiail address Dar- e ' 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 M ak" 's property located at ( ame of rop Owner) P �, (Address, Lot, Block—R6ad, etc.) m on Q Q� in Wm N.C. (Waterbody) (CitylTown and/or County) The applicant has described to me, as shown below, the development proposed at the above Io � i have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must rill In description below or attach a site drawing) 3(o')(►L}' 6o&+hw se d &at.Q:,�- 3 LF &WduaA, 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. or,Type MaBl g A dress �.c�tnI In, NC a793� City/state ' Telephoge mail address Date �� `Valid for one calendar year after signature' (Adjacent Property Owner Information) _Q 411,, SiFnf Lure IN+1l16lt Ewa IV Print or Type e r Mai(iag�iL��`& /V(f -7 `32 City/state/Zip - 2'S"� - 4/i9A - �13 3�� 3 3 Te ephone Number/email address (o/ f/2D Date' (Revised Aug. 2014) III Yei , lord Ke I ff Untitled Map Write a description for your map. WR Legend 111 Pembroke Cirl ON. .ri _ 4F