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Home My WebLink About84624C - Crisp, Gail�FICAMA El DREDGE & FILL N9 84624 A V C ; D Previous permit GENERAL PERMIT Date previous permit issued ,ONew ❑Modification ❑ Complete Reissue ❑ Partial Reissue As authorized by the State `7of{)NJgrth Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to: 15A NCAC !� i / `7 i ° �J'- ��C.-/ ❑ Rules attached. Q General Permit Rules available at the following link: v ..deq.nc.gov/CAMArules Applicant Name .2 a lJt \ l : `l 1 Authorized Agent a�i \ iJ `"'J -_ .A. P" / 1, I - . /.�.(� F,'_.. ,.. Address ..-_ �. � CA.f �1„� Project Location (Counwl: - City - State 1 ZIP Street Address/State Road/Lot #(s) < 'i Phone # (_ ) Email Subdivision City Affected ❑ cW ❑PTA ❑ ES ❑ pT5 Adj. Wtr. Body P-sih rn�. %O i A J I �..Ti� ((naym:tin/unk) AEC(s): ❑ OEA ! ❑ IHA ❑ UW ❑ SPIMA ❑ PINS Closest Mal. Wtr. Body 0 (,10 OR .yes/no PNA: yes/no Type of Project/ Activity Access Length ■ ■■ ■ ■■ ■ ■■■ ■■■ ■ Pier (dock) length Fixed Platform(E)E� Floating Platform(s) �.a..■ - ■ ■■ ...:.. ■■M Finger pler(s) ME M::�':■�••IN 101ME Total Platform area M 0 EMS Groin length/# Basin, channel Cubicyards MR Permit Conditions - ❑ See note on back regarding River Basin rules ❑ See additional notes/conditions on back AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Pleaselnitial) L lgent or Applicant PRINTED Name - Permit Officer's PRINTED Name r f Signature *'Please read compliance statement on back of permit*" Signature Application Fee(s) Check #/Money Order Issuing Date Expiration Date L]CAMA ❑ DREDGE & FILL N9 84624 A B C D Previous permit 3 3 G E N E RAL PERMIT Date previous permit issued New ❑ Modification []Complete Reissue ❑ Partial Reissue As authorized by the State of Nprth Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to: I SA NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: w .den nc gov/CAMArules Applicant Name Address City Phone # Email Authorized Agent 1, Project Location (County): i State ZIP Street Address/Stare Road/Lot #(s) City Affected ❑ cW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. War. 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 �.,i■ME■■ MOM■■E ■■■■■■■■■■■■■■■■ ��■ �■ �im .■ an ONE 11=C■01111115� MM■..■ NEE .MEMO �.■LIM ■CC No M NONE No M ■ MUM MEN ■■■■■■■■M■■ME■� .■■■■.......... .■ ■I■ ...■.■...IN■.� CEEB■■M■ME■■ ■■M �■■ ■.■ �1 ■.■■■ ... uM■M■on E■i��1MM■■M■■ ..■...■.. ■ �0 .� .��■� ON MM�!iLiinni�■ ■ me on ■I�■■■■ M�■®■ I as .::.. �.�..®so C.....�mI:.�®C..�■■■� .... ..■■■.■.■■■■■M■ MEMO■ .■ ME A building permit/zoning permit may be required by: Permit Conditions ❑ TARJPAM/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 PROJECTAND REVIEWED COMPLIANCE STATEMENT. (Please Initial) 1j or Applicant PRINTED Name Permit Officer's PRINTED Name Signature "Please read compliance statement on back of permit" Application Fee(s) Check N/Money Order Signature Issuing Date Expiration Date AGENT AUTHORIZATION FOR LAMA PERMIT. APPLICATION Name of Property Owner Requesting Permit: �y r Mailing Address: Phone Number: Email Address: I certify that I have authorized 4�5�--r-).L7-79Z 2�53 to act on my behalf, forthe purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: _ : l-e uc d1 /< /I .GrtroS,� E-, at my property located at in _ — County. r 0 l furthermore certify that.l 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: Signilture Print orlrype Name ®C6!J e[,- Title - tLi3_i 7-0 2 2 Date This certification is valid through /E- 1 -3 � l , M 44 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to 4cw : / C K t S ty s (Name of Properly Owner) property located at q (Address, _o31ock�, etc a�1 on VIIN(Citylion ndlor Co nt)a The applicant has described to me, as shown below,.the development proposed at the above Io�0,L,io,1 1. 1 have no objection to this proposal. -- _ hI l .a_v--objQ-cftons tathis_p[oizosal`--------...._. —.._. DESCRiP T ION AND/OR DRAWING OF PROPOSER DEVELOPMENT (individuai proposing deveiopmenf m sf fill in description below or attach a site drawing) VIVO _ .n 1.n/f _ ..I0 L,,W %5 er L'= CIS pr pp ZF^T`� Qr�cl I understand that a pier, dock, mooring pilin s, 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.) s I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. �53 Telephone Number y-- M - Olt) ;1, Date (Adjacent Propefiy Owner Signature 14n : �ek Oe, 1.5 Print or Type Name 0 n 12-!R Ile Zrs( GDv.F-11 rs53 (Revised 611812012)