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Home My WebLink AboutSVPOAZCAMA / C REDGE & FILL No. 75944 A B C D GENERAL PERMIT,. + Previous permit# KNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality ./ 1 j and the Coastal Resources Commissio in an area of environmental concern pursuant to 15A NCAC > I ❑ Rules attached. • Applicant Name Project Location: County i Address LJ �'f�' I (� �' — Street Address/ State Road(Lot#(s) ) y City i i I ( "� State :ZIP Phone # ( ) E-Mail Authorized Agent ( L Affected El Cw Cyk-rA D ES 10 PTS AEC(s): LJ OEA ❑ HHF 0 IH ❑ UBA ❑ N/A ❑ PWS: ORW: yes / no PNA yes / no Subdivision City /y;%(;� -- ZIP Phone # ( ) ' i 6er Basin Adj. Wtr. Body J,�€L' ! i . l (nai hrian (unkn) Closest Maj. Wtr. Body Y ■■■■■■MEME� `INA1NE■■■■■■I■■■■■■ND■■■Nc� SEES No MEMO: WIN IN■■ r�N■■■■■ ■a�■ ■■■i■� ■NMEN �■E■■■NNall is ■�ii E�+aff m■N■■ ��N/ra/■ ■SEES ■■■E■\ \■\NN■■■E■■S,�i ■�11lII�`■///fill ►\II■f�■ ■SEEN ■■■■■!L�`�E'SEEN■■ filrTiJ■■■■I�i1N7illJJIVI ►'E■Iu■ ■■N■■ENN■■■■ ■MEN■■■■� r�■■ EE:� �►i��4jfil ■E�■■ ..■■.■■.■■ so MEN ■E■�►`F11911 f!'ME OMEN ....■.■■.■■N■■ N■■■■ .■. N■E v ..■.. ■■Eu■N■■■■■N■■Ei7■E■■ S■■■N■■E�■�■iEa= fNN■ENN■ MEN N►! .rN'1N■E■■■IN11■■■NNE■NN■w ■NIli1�tZ so ME ME ME am ME No w ME no MEN NN■■■■■NEE■I■N\\N\!■mom ES. E■EN ■■N�NN ■■No■ ■E■!®�S':lE�■NEE ® ■■ /I■ENC■■■I C �C: C::::IC��:I�:®® ■■NNE■NEON ■ IN /Nr NiOMEN :E :�ME ■■■NNNUNN■IflJrim ■N■■� • ■■■■Emom �■■IN■■■■■■■■■■N N■■■NEu mom ME N■■NE■■N so mom E■I■N■■EN■■EY■� ■I■7N■■■■■■�■ ■uN■yNN■N■QI■� ■NC�� ■■ E ■ ■■ iiii�i iia a IN. =a0TIll 'uni � MEEiME N�■�■N■N�■j■■iii a C■ ■■■■ ■�■�w_ll.■� ■■. '��■:WOME■■�i■■E�ip■■® N■NN■�■NNE ■■NEC E ■. ■ .. ■!E■■IEEE■■■ ■J■■■..►■E■ ��■ iiiuw��iiiiiniiiiiE■iiiiii�ii�i�i�E■i■ Agent or Applicant Printed Name Signature - Please read compliance statement on backofpermit" Eli Application Fee(s) Check # Permit Officer's Printed Name Signature_. I .;` f/ �� l f _ _ 71� C, 4) 0 _ Issuing Date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT. APPLICATION SuuPo ✓o�/ Name of Property Owner Requesting Permit: G w P<roe iAT)o�' Mailing Address: % /-/ O// y &(i Phone Number: Email Address: 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: at my property located at O%Pirj r'arr Nc. !,�rjuv)o yJs 1oa , in ¢fT County. 1 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: �r- Signature Print or Type Name POF'.slo-LcNT Sv'oo-A Title Date This certification is valid through RECEIVED NOV 0 5 2019 DCM-MHD CITY ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to xAAi x (SN.J 190I4 's (,Name of Property Owner) property located at 5d0K1>_)JXeL4_/ A4MVC1 Y'M9eAi ��o'°/p (Address, Lot, Block, Road, etc.) on q/de!—t�=—,� ��fMpG in r N.C. (Waterbody) (CitylTown 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. DESCRIPTION AND/OR DRAWING & PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) �. MP)9T'C—NANG'e9 G'4-&-D 67 0C VA m�41At 44Y744- �J A/A( GA nAL. 0 v L,-�) (lop 06Y ir( CiF�IvAC� ll WAIVER SECTI Q gI understand that a pier, dock, mooring pilings, 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 I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) Property Ow er Signat e r u u' r U ✓��'�er��) P int or Type��vvame Print or Type me / �6 Maiing Addr s Mai in ddress Cit Sfate/Zi City/StatelZi Telephone Number Tele hQ olr Tjey� � Z� / ��! of f7 FCFIVE® Date C �� Date �y�vG� 3G s®(�rai 10CM-Mwi[5 01"N' ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to 1AAQV64041- Silt Is (Name of Property Owner) property located at �VJN n,,)Ir�— W l.W-VC"' V)C. 17" gay' $�u►p (Address, Lot, Block, Road, etc.) on Z'Yta.� � �'P• r�nl G , in /�(EkV�D i` , 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. __ eve objections to_this_pr-oposaL___.__ _____ _ DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill in description below or attach a site drawing) . �✓lAl,�ft"NAN*,1& .06(NC Vr M,4/A/ 44YI*L- t3+�>.s�o�f MAN "n41- Lv �rUov�hdy � ir( � Obi=iDAt� WAIVE� ' � f RSECTI Q __._.-_._.. _ I understand that a pier, dock, mooring pilings, 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 C- wish to waive the setback, you must initial the appropriate blank below.) QI I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) Signature or Type Name Mailing Address City/StatelZip Telephone Number Date C�djacent Property Owner Information) \ Print or Type _ 7Z'f'� C, Telephone Number RECL-1v" Date NOV 0 5 -10� (Revised 6/18/201 DCM-MHD 01 - ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to Mv4 k(CA-041 S"4 iPC3t4 s (,tJa a of Property Owner) property located at SdOK f)-0 !.� �G # eA7" (Address, Lot, Block, Road, etc.) on ' �17a"Rr✓d / i t G in //NV D2 2— 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 objaQlions_t-o_this_propos_aL_-____._..____.____ — DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) AN v L-J)(lop gh8y Or-PI0Ap �[ h 6Q�R � I I !1 WAIVER SECTI Q---- gI understand that a pier, dock, mooring pilings, 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 C wish to waive the setback, you must initial the appropriate blank below.) Q! I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) C1.4AdjacentProperty Mn7foirmation) Signature Si re Print or Type Name not or Type Nam Mailing Address Mailing dd ass � � «, Citylstate/Zip afyistatelZi .3 Z7�fi Telephone Number Telephone Number ( ypcFIVEq Date Date (Revise,��,(fl � 1I�I9 tDCM-MH D CITY Icy — rib _ e1 +11 P= 141� , N Q iLA j ��,' _ ` ' �� `- C _"+ ,n��..._�r fit• s.� vn, �� ,,��" ., �� +"�� ~ `� �v, �SJ�Jo J � �.) ,�'i'9 �J +..� � '' `�' � � �-`� Via'+ � �J-a �/' s�Gy �;g �\�..�� ,s.�; 1 �( s•.t ,� � tiI �`�'� <.� e N �.�\.1` ,_.. _ ..___� � _ _ .._.. .� t __ .r,.. .��. - I � . e. y' t � a.. •.i �� ^ > "-`ice' - — _•__... .___._._... _yam' d_.._...... _.�_ _'_-'-ab.4�"ssa`i.__- .{yam_._.. `' � s`b..fuy�„•. v i i� Y Ma r� jti I RECEIVED NOV 05 Z019 DCM-MHD CITY