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Home My WebLink AboutGodfrey Creek Landowners Assoc. Inc 91141C�OF COASTq,&❑CAMA ❑ DREDGE & FILL Na 91141 A B C D 0 Previous permit GENERAL PERMIT y Date previous permit issued ❑ New ❑ Modification [—]Complete Reissue ❑ Partial Reissue 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 ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.Qov/CAMArules Applicant Name _ Address City Phone # ( ) Email State ZIP Authorized Agent Project Location (County): Street Address/State Road/Lot #(s) Subdivision City P Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk) AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body ORW: yes/no PNA: yes/no Type of Project/ Activity Shoreline Length _ Access Length Pier (dock) length _ Fixed Platform(s) _ Floating Platform(s) Finger pier(s) Total Platform area Groin length/# Bulkhead/ Riprap length Avg distance offshore Breakwater/Sill Max distance/ length Basin, channel Cubic yards Boat ramp Boathouse/ Boatlift Beach Bulldozing Other SAV observed: yes no Moratorium: n/a yes no Site Photos: yes no Riparian Waiver Attached: yes no A building permit/zoning permit may be reyu—u uy. Permit Conditions (Scale: ) ❑ TAR/PAM/NEUSE/BUFFER (circle one) ❑ See note on back regarding River Basin rules ❑ See additional notes/conditions on back I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) Agent or Applicant PRINTED Name Signature "Please read compliance statement on back of permit" Permit Officer's PRINTED Name Signature Issuing Date Expiration Date Application Fee(s) Check #/Money Order o1*%,§COA-ST"1LN❑CAMA ❑ DREDGE & FILL NQ 91141 A B C D ti y = Previous permit GENERAL PERMIT J Date previous permit issued ❑ New ❑ Modification [:]Complete Reissue ❑ Partial Reissue 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 ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules Applicant Name _ Address City Phone # ( ) Email State ZIP Authorized Agent Project Location (County): Street Address/State Road/Lot #(s) Subdivision City Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk) AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body ORW: yes/no PNA: yes/no Type of Project/ Activity (Scale: ) Shoreline Length Access Length Pier (dock) length _ Fixed Platform(s) Floating Platform(s) Finger pier(s) Groin length/# Bulkhead/ Riprap length Avg distance offshore Breakwater/Sill Max distance/ length _ Basin, channel Cubic yards Boat ramp Boathouse/ Boatlift Beach Bulldozing Other SAV observed: yes no Moratorium: n/a yes no Site Photos: yes no /--L------- Riparian Waiver Attached: yes no A building permit/zoning permit may be required by: Permit Conditions ❑ TAR/PAM/NEUSE/BUFFER (circle one) ❑ See note on back regarding River Basin rules ❑ See additional notes/conditions on back I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) Agent or Applicant PRINTED Name Permit Officer's PRINTED Name Signature "Please read compliance statement on back of permit" Signature Application Fee(s) Check #/Money Order Issuing Date Expiration Date ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to `irgAa la(,I r�o�(„1at5 !a !�'yN�J I (Name of Property Owner) property located at 1 'LI (Address, Lot, Block, Road, etc.) on in o"Y , N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above�focation. ��III////// 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.) a:- I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) Signa^ture 14 Print or Type Name I.LdG Giu"yur,' �htl Mailing Address City/State/Zip tair�1 °7(� Telephone Number/email address 1- 4-Ly Dale (Adjacent Property Owner Information) Signare .Io_ 7/4 tv\*(- Jw'w -you Print or Type Name (?qu 1D1jrUk1.L ? Mailing Address i� ►e1 say rv, City/State/Zip Telephone Number/email address (-;ii -23 Date (Revised Aug. 2014) *Valid for one calendar year after signature* ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to C-kf--c )= iJ 0 X1 I (Name of Property Owner) property located at 1-1,01C (Address, Lot, Block, Road, etc.) on ��`� (tvc.f - , in [A04(l ..)< 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) � lck Qiv— Nf-GvNr, f,Ar(`-,juftx-t-FNT� 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.) C �/ I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) Signature Print or Type Name 1 1GCs Mailing Address �1p�11vZ1� Nc- City/State2ip 4 Telephone Number/email address I' `i.Z) Date (Adjacent Property Owner Information) Signature Cl-,- 01`1rJy xGC: i Print or Type Name Mailing Address City/State/Zip Ls"- l' S 13:u? Telephone Number/email address i Date (Revised Aug. 2014)'' *Valid for one calendar year after signature* ` C3 4 S 1 1 I L A +i Del, � •I • r j•14 1 o 11114 •r�;°^j� s` dp 01 P�,•I `, . 1 :_. tom_ .tea i" E tt 15 � '�'d'y• � SAL; ��. �$� •.i,*� • U .M