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Home My WebLink AboutKittrell, Gray (2)^ ❑'LAMA / ❑ DREDGE & FILL AlNo. 73365 A B (C 1 D GENERAL PERMIT Previous permit# e7New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Qualityand the Coastal Resources Commission in are of environmental concern pursuant to 15A•NCAC / ❑ % / RuI s attached. Applicant Name ii l 7 fit" / .t�/ Project Location: County l__ s '7"" -/ Address Street Address/ State Road/ Lot #(s) City State VC ZIP k 1.4.�j1 / Phone # (%) rrt f E-Mail Subdivision Authorized Agent Affected OCW AEC(s): El OEA ,36W +n'PTA Li Es ❑PTS ❑HHF ❑IH ❑UBA El N/A ❑ PWS: ORW: iyes ) no PNA yes /; nod City < t' ''' i ZIP S/•' f Phone # O River Basin Adj. Wtr. Body (nat /man /unkn) Closest Mal. Wtr. Body ■■■■■■■■■■■■■■■■�■■ri■■1:� :::BEEN::rm:��:0 ■■■ ■■■■��■�■■�■ .■■■■■■■■■� mom ■■C■■■ C■■N■■■■N ...■■. .■..■■■■.. ■■■■■ ■■ .■. .... ..■.... ■■■■■■■■■■■■■■■■■■■■■■■■■■■�■■■B■■■■■■■ ■■■■■■ mom ■ ■■■■■■■■■■■ ■■■■ ■■■ ■■■■■■■ ■■.■B■ mom ■B■■■B�■■■■■■■■■E■■.. ME .■■■ EB■MEN .■■■■ .■...■.. ■■■:: ME ONE NB■■■■ ■■■■■■■■®..■...■■■.. .■■■ ■■■r�a ■■n�■�■■■■■■■■■E :. B:� ■■ :■ E■■■■■■■■■■■■ NONE ■■■■■■■.Cgc�n�nlirr�i■■■■ n■ ■■■■:■■■■ MEN ■■�: ■■4■■: ■■■■■■:■■■�=B■■�■■IN E■i■N:�■'EBE. BB\:EBBB:BNBBB�NC BBB::N E:N ::: :: ri .. ��■N::■■i■ ■:. ■►..■■■ MEN ....■■�I11■■I\■■■B■■■■■■■■II■■ • E■■■\■B■■■■.■I■■��1�■■ ENE ■■■■B■■■■ ■INN■ ■NOON /I■YZ■�I f a1� ■ ■�■ ■■ ■ NOON■ ■ ■■// �1'lillr■:N■■ NOON :EE■■■■►1�I■■■■�IJ■\b71 VA ■■■. NOON \NOON ■■ NOON ■ O■■► ■ a ■■■■■u■r�■■o■:■®■ri■N■■ :::::::N::::::c::::B::::�B:B:::►:: MEME a MENSFAME a FAME 1111■■■MM i ■■.INERM m m EMEEME WANE , 4�i, c- Agent o�Applican Printed Name / r� Signature "'Pleas read compliance statement on back of permit" Application Fee(s) Check# ADJACENT RIPARIAN PROPERTY OWNER STATEMVW I hereby certify that I otwn,,property adjacent to aoYN I , ` - rp s property located at 0 o I INa of Pro a Owner) on Cp IL (Address, Lot, 131 ek, Road etc.) in _ Kckrsl,,.11 ize K N.C. (Wate►body) (Cltylrown and/or County) The appl ant has described to me, as shown below, the development proposed at the above locatio I have no objection to this proposal, I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (7ndlviduol propoWft detreloP)*G t M&W'0# in ddscri?ptyon brioW O.afdreh e'site drawing) /��'F� y✓/• ,ie 7 rd z`N'/Fa ,yya.. Y rr.N •,. .,...�9 `I tr �. ,.iJ"_ .«��""F'f..fe:. �'�1:(edSP F' f'•.f�"�1i 1P'd.'�.rr'-yP•6•,:a r� (�,•�.� J lfjiAIVER SECTION I understand that a pier, dock, mooring pllings, boat remp, breakwater, boathouse, lift, or groin must be set book a minlmum 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 'valid for one calendar year after signature" Property Owner Informatlon) Sign6kre t Sc.rnv r F 4, w nt o�Tjtpe Nome b-aI Add . ress f � t73G l0 R.P' Telephone Nwnberl emaY address (Raviesd Aug. 2014) 2'd XHd 13CJ3SH-1 dH WH62:6 8102 Lo daS C)pej� � f ")1) 6 d Xdd 13C 3SH-1 dH WH62:6 BT02 LO daS ADJACENT RIPARIAN PRQPERTY OWNFII R STATEMENT 1 hereby certify that I own property adjacent to re (� � i) �4•, �� s ( ame o property wer property located at r W e001"1 • (Address, 1310c Ro atc.) on GorC Sa kV1c� , in CATS J N.C. (Waterbody) (City/Town a or County) The appliclint 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. (Individual pmposin8 cpave/opi(fei►!'mua! H►1-M diIIBC//p//on be1641ofalihipb rifle d'rai bask 6CnS 1 to f 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. (Property Owner Information) (Adj n / -A / L acent Property Ovmsr Information) ;Fri � or ype Nemk kCS u TT j �.3 0 hone Numbarlev 1 . IN fn�c 1 t1 N C- 5-gtO `Valid for one calendar year after signature` y•d XWJ 13CH3SH-1 dH WUG2:6 8102 LO daS