HomeMy WebLinkAbout86717A - Dzielinski, Bruce & Deborah^ r� LAMA 'DREDGE & FILL
GENr=A�.rtiiiT Prevto�sp..rt,ttl-- — -- —
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Date prevtou; p•.-rotat issued
V, New j j Modification F I Complete Reissue I ! Partin Reissue
A' : W t,or.7ed Dy the/� Ha 6I Worth Carol--..Departnta•nt of Ertvuor.nk ntat Q rikty and Vac Cc .v .d for u ut ces Cua u.t.auon n an area of a•nv,r pwncnral m"• • • ^ W "' nt to
151NCAC -70,/jo 6 Y/L� _ I ,•tJtr�A.;..ti
, pules attwltsd � .. rd t'. rnu; Rat4•, ay..tl.tta'e at Isar (otl�wtn( I,nk vw.w hart ^� Lr
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r.ty rr.1rco 71P 2793C►
Affected CW csv PTA 90"ts lio.rts A.h wtr oodt, v ov% t 4e-� S *„t'A -- O._'Wkt
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great d
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Cut>.c yards A"
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P. par an J.':trrr Att eked ►Ps V
A Cu,Id,ea prrnrl/7dMt( perms may be r .:K.r d by _2J Ai �. GA Nl�- —_
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1AM AWA tTOf STATVTES,CRC``DUI��SAND CC##WT10N_STMAI AM'IO TMS►11D*(I ANO 11(WEWEO_ CO_MKIAW11 STATEMENT. (Pk-, In, tog) _
or &�xarlj
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Appl.a.non f"j-,l t I. -A P/AAttrtry Order lvs oo : Ik otv E■pnatton Date
JUL 17.1022._
.y
DCM-EC
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: �YuCL.#���^'•- '-�j-��,
Mailing Address:
---
Phone Number: (2-46 3 - Litol - 6Q09 --- -- -
Email Address: �11 U►Cnnl dZtt�llr5k� d�6o. Coj A - -
I certify that I have authorized -_ Y ��r�J VVVL - -----
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 'V4&j1C WU _{-1Wtx ,"Aj
CIO'
tx��k ,►.� . �oic4Ct r d n�c�c�ss ,
.L•+�.�.i - o-�rti.�T ac.k x; � it , �l rtic��— T�
at my property located at
a
in _ 96". County_
i I furthem7ore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal hlanagement 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:
� b1�1G� �1�►�UNS�
Signature
BRUCE DZIELINSKI
Print of Type Name
-- ---- - -- ---Title
5/3/2022
Date
This certification is valid through
V
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JUL 0 1 2022
DCM-EC
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j,pa yjsR our websfte'at K'ww.LsPs:com°=1
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AO- U=�� SFR� CE-
PST
KILL DEVIL HILLS
302 S CROATAN HWY
KILL DEVIL �8HILLS
275NC 27g48 9992:51 PM
07/07/2022----------------Unit ----Price
OtY
Product Price ---------
- -- $0.58
--------------
First-Class Mail$ 1
Letter
9r I (:k N.) 08723
W-14hi: 0 1b 0,80 OZ
Fytlme1e1 Delivery Date
Mnn 41/1t/2,,22
Cert I f 1 e.t Ma t l y $3.75
Tracking #
Return Rece?pilijrjr�trj5F,3i433
Tracking #: $3.05
Total 9590 9402 7539 2098 g954 94
$7.38
First -Class Mail® 1
Letter
Frisco, NC 27936
Weight: 0 lb 0.80 oz
Estimated Delivery Date
Sat 07/09/2022
Certified Mail$ $3.75
Tracking #:
70220410000105637419
Return Receipt $3.05
Tracking #:
9590 9402 7539 2098 8951 59
Total $7.38
First -Class Mail$ 1
$0.58
Letter
Kill Devil Hills, NC 27948
Weight: 0 lb 0.80 oz
Estimated Delivery Date
Sat 07/09/2022
Certified Mail$
$3.75
Tracking #:
70220410000105637426
Return Receipt
$3.05
Tracking #:
9590 9402 7539 2098 8951
42
Total
$7.38
First -Class Mail$ 1
$0.58
Letter
Sciota, PA 18354
Weight: 0 lb 0.80 oz
Estimated Delivery Date
Mon 07/11/2022
Certified Mail$
$3.75
Tracking #:
70220410000105637402
Return Receipt
$3.05
Tracking #:
9590 9402 7539 2098 8951
Total
66
$7.38
--------------------------------------------
Grand Total:
------- -------$29.52
-----------
Debit Card Remitted $29.52
Card Name: VISA
Account #: XXXXXXXXXXXX2121
Approval #: 280485
Transaction #: 037
Receipt #: 036091
Debit Card Purchase: $29.52
AID: A00000009EU84o Chip
AL: US DEBIT
PIN: Verified __
N-C DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER MOTIFICATIONfWAIVER FORM
f LQ of I iANQ j2LL!VLW(
(Top portion to be coniMpted hY Omer or tt*ir aq ent)
NBOV r4 Plomfly OV41h.s 07101 05W
Aoutc%s of Prwmy Tiw%bU 'TV I VWSCc tic VN-Mci
of r '0"(A UtAeCAI— 9cl *A%AJ1ekWVA W) 1-11 to q
Ovomf S emall b"cdotKhav�
Agents Na#r,,%(ft4m Z4.Zit, Aqent Pt"*!# —104 4 1% 'Worl'
C*
— -- — ---------- - -
A0JACkHT RIPARIAN PR0PtRTY OWNER'S CERTIFICATION
L204400 to too 1..corn 2!9—t0d—§y-QW AdW*nt PLeMlly Owner;
I neye4y certity jt�j I
r*e1W4 h3t. 4k*%Cj1hP .fj to Me -J4
ItW- devetopox"t" ate ptoposing
With dilMnsIOM, MUSI to Firnvidmi witti thus telter,
Nd ID
'AF�JK I M, NOT
A have 00jections to this protiovaj 100 have (Aitechom to this ptnposa
If you have obloctions t* What IS being proposed, you inust notify the N.C. Dj�jji
*U0A9QmVnI (OCOW) in writing within 10 days of receipt of this noftCe. on of Coastal
MOdOd to 401 S. Gf^n St, Ste. 70C Ehrobeth City, AfC, 2rM, C01rQzP0nd0r#c6 should be
Contocted at (2$2) 264-19ol. No response js con DCM representatives can also be
noth*d by Certified No# sidered the SAMOOS "D ObJectl0m it YOU have been
WAIVER SECTION
I ur-Eterstand that any pioposw Pmf, dock r"001111(l MJ114%. boat ra"), breakwater boatttokisc. j,ft �,)l
groin I nust tie sc. CaCk a mtn.mtjM distance of I 5, resin " area of i ipat wn arccss tj qf_,ss %-ta1vt � r, Ly ,
(thus
flees not aWY to btftheaft or trap tevetmerft) (it You Wish 10 waive the setback ym MLV_jL s , 0 n
the V;xopf4ate Wank betcrw,) __q_
100 rash tavaw.* Virnelam of the Is, "b"
.014- &V' W-s'an Pt4jj-j—jdw--ner
I do not 1,111,41) tovialve the I S seftck reqtmemnt ji"Olkal it* hW0*j
I i— ly
S'9POtUM of A018teN H parian 11topelly C)Wnp .t
a
TYPOWPf iOtOd name of ARPC):'-W*L�,-�Ih---�
"Jing Address of ARP0-
ARPO*s omail:
T
ARPO's Phone#� —1 j 'low
,�/03/4-a-- waiver's valid for UP to One YOU from ARPOS Signature-
ReWsed July 2021
-5- ; 7 /�. 4 2 L
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Of
■ complete Items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Chri S C Owe 1 I
-2
I�"I�I'I I'll I'IIII IIII I � I I'I IIIIII I III I I �II
9590 9402 7539 2098 8951 59
- - 0 Ager,,
x ❑ A ddressee
B. Received by (Printed Nerne) C. Date of Delivery
D.
If YES, enterdivery ddelivery address below, ❑ No
13 1p��
3. Service Type
❑ Priority Mal Express®
❑ Adult Signature
❑ Adult Signature Restricted Delivery
❑ Registered MaW "
❑ Registered Mail Restricted
❑ Certified Mail(D
❑ Certified Mail Restricted Delivery
Delivery
❑ Signature Confirmation"
❑ Collect on Delivery
❑ Signature Contirmat,on
I�,Q, Article Number (Transfer fiom serv1pQ 1eQ ❑ Collect on Delivery Restricted Delivery Restricted De1';very
-7 419 Restricted Delivery
,PS F T �814 AD -02-000-9053 Domestic Return Receipt
PV
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