HomeMy WebLinkAboutKirkwood, Betsy❑CAI'AA/❑DREDGE&FILL ��f-� °t'I�31�� No. 73316 A B �c) D
61
i7� L PERMIT Previous permit
#
❑New odification El Complete Reissue ❑Partial Reissue Date previous permit iss
ued
'„/ As authorized by the State of North Carolina, Department of Environmental Quality I' 6 / ,
and the Coastal Resources Commission in a Yea o environmental concern pursuant to 15A NCAC v" v
ulej attached.
Applicant Name (�/ �` % / Voy ,:r Project Location: County (� /
City_
Phone #
Authorized Agent
Affected D Cw
AEC(s):
OEA
❑ PWS
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StateWe- ZIP y Ai / 7
SEW ❑ PTA ❑ ES ❑ PTS
❑HHF ❑IH ❑URA ❑N/A
ORW: i` yes / no PNA yes
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Subdivision >
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Phone # O River Basin '
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11311INMEMEN
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A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
A,, , i' .1 L -.I r ❑ See note on back regarding River Basin rules.
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Agent or Applicant Printed Name PermitOffcer's
Signature '* Please read compliance statement on back of permit** Signature
Application Fee(s) Check# Issuing D:
i Na
Expiration
MYJMtiGl�l mirNRIMIv rnwrGm I I VWyllCm J I A I G"["y1
I hereby certify that I own property adjacent to anle / + &-� U ill'- kat )rxy 's
� „ . , , n , (Name of Property Owner)
k�
25,)' y2y
property located at
(Address,
on 1�610k C11riJ(V1 in
(Waterbody)
N.C.
The applicant has described to me, as shown below, the development proposed at the above
location.
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)
j.� .
r 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.
Date
I do not wish to waive the 15' setback requirement.
"Valid for one calendar year after signature'
(Adjagent Property Owner Information)
Signatur�}�� nn r/in/1^1q _
Print or (ype N me
dM4 �a` ro6-i
Mailing Address City/state2ip
Telephone Numberlemall address J
Date *
(Revised Aug. 2014)
RECEIVED
NOV 2 6 Paid
lKuA tl', CV•`0A
DCM-MHD CITY
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to e i Ige1,5i4
/ L I� [ / (Name of Propert Owner)
property located at / / / 7 L t
(Address, Lot, Block, Road, etc)
on in t<r e/.; lj ( %P , N.C.
(Waterbody) (Cityrrown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatiotr.
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)
_ 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.
✓AMC"
�reofh
Dare ! Date*
� 64, e ���i r��1,. oo&-1 7�C t A, ! , Lin (Revised Aug.2014)
*Valid for one calendar year after signature*
RECEIVED
NOV 2 6 2018
DCM-MHD CITY
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CAMA / .-I DREDGE & FILL No. 73316 )
A B (C D
GENERAL PERMIT Previous permit#
?New ❑Modification LIComplete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental' Quality -7 / I 1 - 6 G.
and the Coastal Resources Commission in rea environmental concern pursuant to I SA NCAC / V
/ / ulej attached.
Applicant Name i`11 I t / Voa / Project Location: County (. :77 *Llz
Address y Street Address/ State Road/ Lot #(s)
City State ZIPp / 7� t / ( i,
Phone # )_
Authorized Agent
Affected""
AEC(s): LJ OEA
❑ PWS
ORW: (ye /no
c<&
, PTA ❑ ES ❑ PTS
❑HHF
❑IH ❑UBA ❑N/A
PNA
yes / no
Subdivision
City !/ r ZIP_
Phone # ( ) River
Basin
ody /
Adj. Wtr. Bna[ man unkn
Closest Maj. Wtr. Body a
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Agent or Applicant Printed Name
i
S�nature ** Please read compliance statement on back of permit**
A �Jv i-1 /
Application Fee(s) Check #
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to I )C,n; e l k et k,r 1 wUco C, 's
(Name of Property Owner)
property located at qCl I `F I�j� uf� C'I'
2 (Address, Lot, Block, Road, etc.)
on \ BLS Inc (i nQ ( —,in 2_—uV1'c'(,Q d q5\ -e N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
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)
RECEIVED
FEB 11 Z019
DCM-MHD CITY
-)t 7.7vhn'ta/
WAIVER SECTION I
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)
Date
*Valid for one calendar year after signature`
(Adjaclent Property Owner Information)
SignatuE.e * J
Print or Type Name
"AI'?_ �IuFF CT
Mailing Address
t-Wer' c) :Ls)-e r JL
City/State2ip
Telephone Number/email address
Date'
(Revised Aug. 2014)
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 4 b' e,1 Lin; oC4 's
�� (Name of Property Owner)
property located at -I� � � ��I �i 't"
l/ r (Address, Lot, Block, Ro
on-x(1 I S 6 Cti lln� ( in "711C'�-i L1� 1ST{ N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location
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)
ami(47
RECEIVED
FEB 1 12019
DCM-MHD CITY
5Ju
l
VITO Me
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.
City/State/Zip �,nielKr� Jl
L(Z4 �''I la3 /757-)(el l?7�' � fn c�, 1. C cyv-)
Telephone Number/email address
Imo, I �l
Date
(Adjac t Property Owner Information)
Z
Signature *a M / nA'yl�
Print or Type NaMe
0 �� IC4� Cc&,
Mailing AddrossC �
City/State/ZipgjO- 71g9l��`? /
Telephone Number/email addr ss�
I �e�wt nAl/1 0ACt cow,
Date*
(Revised Aug. 2014)
`Valid for one calendar year after signature`