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Home My WebLink AboutBagley, IT 87357CSi-;t4�'ri'�t�k';:�P��i�n�r��{��`-�'`��,•p:sus'.d�i�,.ycF,3��2Y�',�gt��"{�F's.�+,'.��di�'�,fi`..✓i'.•�ik`�jm�,�'n*.��.n,,;_. yl�., � � t � � ,, t.> Ya3, 1*`jCO 4,LN❑CAMA ❑ DREDGE & FILL L�� 4 8735 A B c D �O GENERAL PERMIT Previous permit Date previous permit issued ❑ 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.gov/CAMArules Applicant Name Address City State Phone # (_ ) Email ZIP Authorized Agent Project Location (County): Street Address/State Road/Lot #(s) Subdivision City 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 Shoreline Length er 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 building permit/zoning permit may be ro Permit Conditions (Scale:;`i ) U 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 Fee(s) Check #/Money Order Issuing Date Expiration Date '1*°F(OAS r4 ❑ CAMA ❑ DREDGE & FILL Na 87357 A B C D GENERAL PERMIT Previous permit Date previous permit issued ❑ 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: I SA NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules Applicant Name _ Address City Phone # (_ ) Email Affected ❑ CW AEC(s): ❑ OEA ORW: yes/no State ZIP ❑EW ❑PTA ❑ IHA ❑ UW PNA: yes/no Type of Project/ Activity 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 building permit/zoning permit may be required by: Permit Conditions ❑ ES ❑ PTS ❑ SPIMA ❑ PWS Authorized Agent Project Location (County): Street Address/State Road/Lot #(s) Subdivision City Adj. Wtr. Body Closest Maj. Wtr. Body (Scale: ) ❑ 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 Fee(s) Check #/Money Order Issuing Date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: ' 7 1&2 %� `f � Mailing Address: Phone Number: Email Address: 2 Sd - 72 & _15-2-3 i Joa�i�yJr &eC.V'V" CCU I certify that I have authorized Kcq6 b, -' Agent/ Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: pier, oak (c O r.4 K at my property located at L(q0 t Co ra t in (fa r(e r-ef 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: natu Print or Type Name �UJA]2r Title 6Z 2- Date A/D c4em6 RECEIVED This certification is valid through / / APR 19 i i -12-' 1 b 09: 36 FROM If T-063 P0001 /0001 F-145 DIVISION OP.COASTAL.MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM CEaT1t=1ED MAIL - RETURN RECEIPT' RtrQUE5TE13 I hereby certify that i own property adjacent to . 's Properly located at. �{ c7 (Name of Property Owner) �-�-�r �. fir' (Address, Lot, Bloch, Road, etc.) °n a6� D �n L . N.C. (Waterbody) (City/Town and/or County) J Agent's Name #: ( �� Mailing Address: _5 Agent's ph . on 7 He/She has described to me as shown.below the development ahe/she is proposing at That location, I have no objections to the proposal. , -----------=------�_�-------- -_ .---nESCFIpiION leRWN -------------------------------------------------- - ----- (Individual proposingdeqd�ROPOSEDELONm�CowoPh aste drawl Jig:, rave obJeatlons to what Ig beiri propbsed M wilting within-10.days oIre f i+eceipt of th s not cetnCointaCt�nformafion for DCMfon of Coastal aoffices e is GIs ethtGv:1/www.riccoastalmanagem�nt iiet1weblem/staff listina orbycaUhig 1.88$-4RCQASr aonse is considered the same as no ob ectibn if ou have been notified by Certified Mall. � T Wfr , e- print or Type Name G-b PA L, Mailing Address C `t'e Clty/Stat9�Lip (_d3liqt,p_nihon2e Number/Email Address Dato (Riparian Property Owner Information) Signature v-� l -7� ,dU l� ( � i 5�W TC-� (,c � �C �l(, �� Print or 1 e Name �� e), cCi Mailing Address S5-7 City/Sfatell ip Telephone -Number/ Prnail A ddress RECEIVE[ Date (Revised: Aug. 2014) APR- 1 )02.2 0CM-MHO CITY 09:36 FROA1- .. 1-063 1`0001/0001 F-145 DIVISION OI' COASTAL MANAGEMENT ADJ__ g ER RIPARIAN PROPERTY OWNER NP IFIC TION FORM CEttTfFIED MAIL - RETURN RECEIPT REgUEsT—CD- -I-jl L n I hereby certify thol 1 own prormay adjacont to 44 ci a \ (Name of Property Ovmor) properiyfocatoctat CU ra //'d on (Address, Lot, Block, Road, etc.) �`J / LfP SOL ✓ ��, in . o? 85 s 7 (Waterbody) N.C.(City/Town and/or County) Agent's Name #: f1 06/3 /E wcBB MailingAddress:_�o box /lgent's phone #: a S-� • 7 '� , / S !nQl 4EAd C-rtl n/ �gji-7 lie/8fas described to me as shown grid I have below the development he/She is proposing at that location, no objections to the proposal. -------- ------------------------ -- ----- ---....... --------------•-------------------------- DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Ind'v/duaf�"rroposing dovo%pritent must fill In description be/ow or attach a site drawing) OSed 0 wdBitq ►ylthln io.days of i ece pt of thissn lice. nContactotillythu �nlorma t on fortDCMe offices s to al'hl!to✓rintn v»ccoasta I-aoaM rouse is considered the same as no ob ectrnn a „�,5 �� r�L�_ orby calling 1-888.4PCOAST. API' party Owner tnforma nature Print or We Name ,Q / �Xj aliiii ��/ O//% 7/ X Cr _Address G'/? 04d C, >� /Vc ass y Clly/Stats�Irp r°/r3Phoae NumberlEmall Address L1atp (Riparian Property Owner Information) �, Signature tl Print or Type Name N�'o Wailing Address C/tylStatelZip --- ' -- - 3v�-t�s3-3i,?dt�, \\4TelephoneNumber/Email Address J�k� Lo v,,-. IV