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Home My WebLink AboutBass, Anderson - 91418CSa��toNr, LCAMA ❑DREDGE & FILL N9 91418 A B C D GENERAL PERMIT Previous permit 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: I SA NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq nc Pov/CAMArules Applicant Name Authorized Agent 1-- r ` . � A Address Project Location (County): - 1" " r City State ZIP Street Address/State Road/Lot#(s) Phone # (_ ) Email Subdivision City ZIP lk�, co Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk) AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body y/ ORW: yes/no, PNA: yes/no Type of Project/ Activity (Scale:l ,W ) Shoreline Length Access Length Pier (dock) length- FixedPlafform(s) I Fleadng Platform(s) Finger pier(s) Total Platform area Groin length/#j- Bulkhead/Riprap length I Avg distance offshore f - - - -- r- -- --�-- I - - -- -I----- Breakwater/Sill Max distance/ length �� C'p - --- - j - - }- -' - Basin, channel � � � r e o i_I - P Ls - Cubic yards Boathouse/Boatlift ek A-! Beach Bulldozing --- Other -' { - j - SAV observed: yes no Moratorium: n/a yes no r -- - -i- - - - - -- �I--- Site Photos: yes Riparian Waiver Attached: yes no I I d 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" Application Feels) Check #/Money Order Signature Issuing Date Expiration Date ❑CAMA ❑ DREDGE & FILL No 91418 A B C D Previous permit t GENERAL PERMIT � 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. I I, General Permit Rules available at the following link: www.deq.nc.gov/CAMArules Applicant Name _ Address City Phone # (_ ) Email Affected ❑CW AEC(s): ❑ OEA ORW: yes/no ❑EW ❑PTA ❑IHA ❑UW PNA: yes/no Type of Project/ Activity Shnrplinp l pnoth ZIP ❑ ES ❑ PTS ❑SPIMA ❑PWS Authorized Agent Project Location (County): Street Address/State Road/Lot #(s) Subdivision City Adj. Wtr. Body Closest Maj. Won Body (Scale:) ) Access Length Pier (dock) length - Fixed Platform(s)— --- — j i Floating Platform(s) `-/f) y /( I � Finger pler(s) Total Platform area Groin length/q Bulkhead/Riprap length .,--'' Avg distance offshore- Breakwater/Sill Max distance/ length Basin, channel Cubic yardsBoat ramp Boathouse/Boatlift Beach Bulldozing Other ' ). I— — ._ X — _- - I -� - I I' - tl - -� -- y g cr-"-- - - .f .n 4, l T��aF°v I i SAV observed: yes no Moratorium: n/a yes no Site Photos: yes no Riparian Waiver Attached: yes no - ttS t A building permit/zoning permit may be required by: Permit Conditions CRC RULES AND CONDITIONS THAT APPLY TO THIS Agent or Applicant PRINTED Name ❑ TAR/PAM/NEUSE/BUFFER (circle one) ❑ See note on back regarding River Basin rules ❑ See additional notes/conditions on back (Please Initial) Permit Officer's PRINTEDIName Signature -*Please read compliance statement on back of permit** 7 Application Feels) Check M/Money Order Signature - f i,, l u I i �l 101161 Issuing Date Expirati n Date I herby certify that I own property edJaconi to i (/"J <' ( ;>n Jc, S S a Aroperty loaeted et o„IC (_�Q INe Pof Proper ty Owner) �� =- —�> 1 JL,w� r nJL Z�S 1Addrose, ot, B)oak Road, etq) C on rvi in _ I_\JLv,,,!..JJ�- fdYeter ody) ICI y/Town endlor County) The atrAiioant has deeorlbed to me, as ehown below, Iha daveloprnenl proposed at the above locatipn. U _ t h" 00 obift-Aion ill Ihl$ proposal I titi1'a obw1ions to ibis ptoposnl DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMEN-r } *Pr proposing development must fill In description below or attach a site drawing) �.`�.0=LQ dn� WAIVER SECTION ~� t understand net a pier, dock, mooring pilings, breakwater, boathouse lift, or groin -waist be set ba�it a minimum distance of 15' from my area of riparian access unless waived by me (11 you wash, to wave 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) (AdJa ent Property Owner Information) (;�)Ia��fl/ Mol/r 1 AddiosaY 5 �7 =tAll h 7' :11 @F RF.(, IVE( MAY 2 ?K' "Pa`. Aft RA 1"^4n ADJACENT RIPARIAN PROPERTY OWNER STATEMENT C85 I hereby cemly that 1 own properly adjacent to property located at _ 30�- r�m� (Address, I of) (Waterbody) County) � NC l"he applicant has dencnhed la me, sa shown below, the development proposed at the above Ioc t n I havo no 00jeclien to Ihis proposal. I have otyections to this proposal DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT -,dlvidual proposing development must fill in description below or attach a sits drawing) p ¢r 1� �J(_(� i.. mil✓ � cl�, , WAIVER SECTION, _ " _, understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin -must be set 1-acx a minimum distance of 15' from my area of riparian access unless waived by me. Cff you w+sr :o 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 informa Ion) (Adjacent Property 0 er Information) f.;' or if- Slgnatyre Ge Print or Two Nat�ne �8 70 act;,' Telephone Number Dare MAY 26 20I.'� (Revised 611812012) OCM.,MHD CITE' r i , f. o !. J Phomm iVik tjt Mat Y have Wv i —mot v ry for thawowtngp r cfasvirr{e�q�t1; #& �}r ii ° X my of IUII IMa W, MOY filar t Om 040zed to Omit and do #) (act gtaof pearti5sion m #':itw mn of CoasiN . artagorn ra7t staff, ft tocat Pwmq Ofttv aro ttjc�jr agpigs 10 efPtt T if !tom Mods if, roat *Ih evatoafing m(of"TTatkia lehl-Ted tip rrtas P, Uq rty Owile'r Ifflo than. ra# a± cv Typo A