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Home My WebLink AboutMcCoy, Cynthia 76389C-&LAMA / ❑ DREDGE & FILL No. 76389 A B D GENERAL PERMIT Previous permit# ew ❑Modification ❑Complete Reissue El Partial Reissue 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 o� �t Rules attached. Applicant Name MProject Location: County Address S Street Address/ State Road/ Lot #(s) 16 6 , City 0 State NC- ZIPo /6 Phone # E-Mail Subdivision Authorized Agent Z City ZIP Affected ❑ CW _4EW PTA ❑ ES ❑ PTS AEC(s): ❑ OEA [IHHF ElIH ElUSA ❑ N/A ❑ PWS: ORW: yes no PNA yes no Phone # ( ) (River Basi � ✓L--he K Adj. Wtr. Body Ski a /man unkn Closest Maj. Wtr. 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"aim ■�n ■N ■■ONN■ MEN --- N■NN■ONN ��®■■■ ■NON ■■ONON ■■■■ .N■��__-■�...��■■ ■ N■ X, NEE ME NNE■■■■ON■■a ON■ ■ ■ ■ ■EN ■■ ■■EON■NN■ ■■■iN�■■■■■■■■■■■■■■■■■■■RI/�■■■■■■ ■■■.�I..�.■.�....■■■■.■■■■i'i.■■..■■■ ■.. . �.. ■. ....■■■....■.■■®■.■NON■ .. ..i..�NEN.NN■■■ .■ . ■ON■N■ ■NEONNIN IN NONNN■■N■NN ■■EON■■■NON 1 ■■ ■■■ �■ 11Il1 ■■■�■■■ ■■ ■■ ■■ MEN I■■■■■NI N■�■■ Dav'l 4 AnAt,C_q&l) (, Age or Applicant Printed Name Sig ature "Please read compliance statement on back of permit" Application Fee(s) Check # AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Mailing Address: Phone Number: Email Address: ('ni) gn - -3u q 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: 10 at my property located at Li ILUU 1 5"L in C-22IPUa County. l 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: Signature Print or Type Name A n/P " Q-0 , Cal I>4 Nk�z- Title T\ / ZOZO Date This certification is valid through I I RECEIVED APR 2 8 2020 DCM-MHD CITY CEF1IFlED RETM U ECUE TED DIVISION OF ADJACENT RIPARIAN PROPERTYCOASTAL OWNER NOT FIE ATIO N/W, Name of property owner: Address of Property_ Agent's Name #: Agent's phone #: (Lot or Street #, Street or Mailing Address: 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 i they are proposing. A d cr ti or "aw th< `me sio hi st a ovi :: YFii <fett I have no objections to this proposal. I have Objcctiol)s to this proposal. If you have objections to what is being proposed, you must notify am Division of Coastal Management (DCM) in writing within 10 days of receipt of this notice. Contact information for pClI9 afficQs is avallable at :llwww_ ccd stalman ern ine weblcm/staff_!'stin orby calling 9-$$ M off OAST. No re$ once is considered the same as no ob ectiQn !f ou have been notified b Corllhed Mail. WAIVER SECTION i understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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 t In" ial the appropriate blank below.) I do wish to waive the 15' setback requirement- —7-1 do not wish to waive the 15' setback requirement, (Property Owner Information) (Riparian Property owner Information) Signature Signature . Print or Type Name 1,4 -5 PlYnt or -Type !Name Mailing Address Mailing Address f C/State/Zip City/Sta#e/�ip'~�'t - — 4ele�phLone Number/mail Ad Chess Telephone Number/Email Addre`lss . Dare (Revised Aug }riifi,)� 202Q CERTIFIED MAIL - RETURN RECEIPT REQUESTED )AV ,f 7r Z v DIVISION OF COASTAL MANAGEMENT `�_ k ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Owner: C kJ�� Address of Property: l0 a , k" Vl (Lot or Street #, Street or R ad, City & County) Agent's Name #: Mailing Address: Agent's phone #: 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 description or drawing with dimensions must be provided with this letter. I have' no objections to this proposal. I have proposal. objections to this I I p sal. �E- /�'S I D, � �' u1 cal Gc'vt S'Tn�( hu •ti r s �; �S� � �'rC o��s-% �� cYl�, ` J If you have objections to what is being proposed, you must notify the Division of Coastal Management t f (DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is C_ `J available at httPJ/www.nccoastalmanagement netlweb/cm/staff listing orby calling 1-888-4RCOAST. 9 ,� No response is considered the same as no objection if you have been notified by Certified Mail S< ! WAIVER SECTION `!!!I I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse or li ft 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) (Riparian Property Owner Information) 9 A-, 7 Sit nalu •e if,7ncflitr( 3 1A c� 0 b Mailing Address LiFSS , Z____NC City/State/Zip TelephoneNurnber/Email Address Dale 0A-M E S "_ r3ly_lv + Print or Type Name 1{ST04, 46-W 04� C Mailing Address /R4 1 46`21;K. A,", —' 27L Z City/State/Zip yl!— M7-07?-f l elephone Number/ Eme#7qrd e s 'ef-Z!-2L,2-0 Dale (Revised Aug. m4m"u oTY M T vC°i W `V O� v ul 00 N `o10 4,,,, v 2 N F: f0 c0 C O C O p^ N cd s '3 c 0 U O 9 co o p N, G .G N N N n O .0 ;� e m o. �• u c a eEo o� o w . o � a E v s n A 3 v o '- `o w s v � 0 'fl c x a U 0 O O L1 � U CL a G � O A � w o C " w U U Uo oaa � h IVED 'E a =� r U O vyi a N 2020 W V v AP R 2 04 'UO O 0. [ii ow x nck�limUgHU CITY� U � Q 04W 9 El x