84670C - Sanchez, Francisco

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AMADREDGE &FILL N9 84670 A B-OD
NERAL PERMIT Date reyPrevious e�i[
p permit issued
ew ❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized by the State of orth Carolina, Department of Environmental Quality and the
n� Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC ��(•%[ Rules attached. —p rt.enetzl Permit Rules available at the folbwkrg link: www.de4K.wdCAMAnAes
Applicant Name � C -
Authorized Agent
,!
Address �i ^ 1
t L
Project LocaCron
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City 1" 1 i ��i �Lt,.G
ZIP E
Street Address/State Road/Lot #(s)a
p__1
Phone#)
Email
Subdivision
City
ZIP
Affected ElcWW Q'TA
DES EIPTs
Adj. Wm Body
(na m ink)
AEC(s): FIOEA �IHA%UiW
�sPIMA �PWS
Closes[Mal•Wtr. Body -
ORW:yes/ PNA: Yesfnoi
V
Type of Project/ Activity
ntl
I I I I
(Scale
Access Len
Pier (dock)
Fixed Platfi
Floating Platforms)
Agent
Permit Officer's
proposed excavation
TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
See additional notes/conditions on back
Fee(s) Check II/Money

`DREDGE & FILL jQjCi N° 84670 A B'C D
GENERAL PERMIT �6 D tepre io slpermitissued
ew ❑Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the
State ofJ4orth Carolina,
Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCACy 14 of1,19 L.� ❑ Rules attached. eneraI Permit Rules available at the following link: wwwdeq.nc.gov/CAMArules
Applicant
City —4
Phone #
Affected ❑CW EW A TA
AEC(s): OEA ❑IRA ❑uW
ORW: ve /sPNA: ves//.?
Type of Project/ Activity
Shoreline Length.
Access Length _
Pier (dock) length
Fixed Platform(s).
Floating Platform(s)
1 AM AWARE OF STATUTES, CRC RULES
`y
cc
Agent oCAppIIcgJ1t PRINTED Name
1„1(:111.e f,-
Authorized Agent
e
Project Location (County):
.ZIP
Street Address/State Road/Lot #(s)
Subdivision
City ZIP
❑ ES ❑ PTS
Adj. Wtr. Body (na mink)
❑SPIMA ❑PWS
Closest Maj. Wtr. Body
� 5 Ca"00'
Permit Officer's
(Scale) it it)
A (circle one)
ig River Basin rules
ditions on back
Sur ""PleaskjW compliance statement on back of permit""" Sig
Hppiiccca.�(tioon yFe1els)) Check q

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner:&)COA1' � 1*11�Ac lsla C ��
Address of Property: / s� ��oC Q� 6�' NC
Mailing Address of Owner:
Owner's email: Owner's Phone#: oic Z'
Agent's Name:
Agent's Email:
Agent
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
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
I DO NOT have objections to this proposal. I DO have objections to this proposal.
if you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead Clty, NC 28557. DCM representatives can also be contacted
at [phone]. No response Is considered the same as no objection if you have been notified by
Certified Mail.
WAIVER SECTION
I understand that any proposed 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
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
v
Signature of Adja t Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
A Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: P I—vt-7)17ofe
// n
Mailing Address of ARPO: / / _3 4 i e fTC /' D/Q,
ARPO's email: ARPO's Phone#: �1 qD 0 n3
Date: *waiver is valid for up to one year from ARPO's Signature' cri�Cl
Revised Jfllrz?,TIVED
APR 041022
DCM-MHD CITY

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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: �QAR. r-A16 Ij 4e4^1C-/ S C v
Address of Property: 10A4- / x S, /Vrtm 62 �-' T�yc2-
I
Mailing Address of Owner: /'UDC 10
/=itAni K C S/i n1 c H/i L ct� ,4/ ✓7.Gt��^I
Owner's email: Owner's Phone#: S 2 '-6 y
Agent's Name:
Agent's Email:
Agent
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacentto the above referenced property. The individual applying forthis
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.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection if you have been notified by
Certified Mail.
WAIVER SECTION
I understand that any proposed 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
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Riparian Property Owner
IS ]e N
I do not wish to waive the 15' setback requirement (initiahfhe blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO: 1 T3 Lo go I ( �KS I Ac, 2
ARPO'semail: VtdI�Ot4PS / ARPO'sPhone#:
Date: � 2) ZZ *waiver is valid for up to one year from ARPO's Signature*
RECEIVED
Revised July 2021
APR 0 4 2022
DCM-MHD CITY

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APR 04 2022
DCM-MHD CITY

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APR © 4 2022
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