HomeMy WebLinkAboutNeese, DavidUCAMA /,O DREDGE & FILL
GENERAL PERMIT
`New ❑Modification ❑Complete Reissue ❑Partial Reissue
N9 78403 A
Previous permit #
Date previous permit issued.
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 �� j.'%�, r�'' -
❑R les attached
Applicant Name A_ n(\]" ,"Q I' �t E� - -'�'�
Address ) ��, I� f '�r �(' A � i1 l /I n
City L., 7 Stat�'�� ZIP 'iln
r/
Phone # (�f) i E-Mail
Authorized Agent /��1,1 ('; if ri''
Affected ❑CW ,� EW ,. IPTA >ES ❑PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes /-"no
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Project Location: County n kA
Street Address/ State Road/ Lot #(s) r/
Subdivision
City ZIP
Phone # (_)((r��" �ri%/' River Basin
Adj. Wtr. Body I�Sh ? x r 1 /t f (nat /man /unkn)
r
Closest Maj. Wtr. Body �' �? 1 t( N t I A
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Agent or Apelliicant Printed Name
Si n ture'k'"`Pleaseread compliance statement onback ofpermit"
�n
Application Fee(s) Check #
:VI r �„ ►►
Permit Officers Printed Na h ,
4�
Sign tur
/ ) o
Issuing bate Expiration Date
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: �[I..,
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
3,-! BL�k_< )-,
) V 117 lL n , i) t I - b, < Jam; . ( . , ! ' ..
Z 5 z .21 k,t 1 "l i"
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: T-)3 c i "� I o,), �,-. ,
r c_IL LX�cw
at my property located at r 0
in &kmr --) County.
S7 c• C tL--- 'P
l furthermore certify that 1 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:
!! Signature
Print or Type Name
ins vt_
Title
l
Date
This certification is valid through
RFCFIVED
DEC 0 2019
DCM-MHD CITY
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to I /13 a� 's
(Name of Property Owner)
property located at q l _ �- _I 4r 0
(Address, Lo Block Road, etc.)
on I A U A in 3 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 descriptiorf below or attach a site drawing)
ET 15+,nCj
L; fa
9— zS o <z z
gSc . LrP5
RECEIVED
DEC . 6 M9
DCM-hliHD CITY
'RE? k c2
'SCw,. A--_ l _.
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
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.
(Prr erty Owner
I formation)
S7tknature
!. JLiJl7 �j=XSC�
Print or Type Name
%ay 7Sar'rNr_t r,,, t
Mailinq Address n
(Adjacgllt Property Owner Information)
z
Si e
P ' t or T pe N me
Mailing Address
zip City/State/Zip ,
le Nymber Telephone Number
) t � � �1 :✓ i 1 -
Date
Ioe-6--E, � .,„rl
(Revised 6/18/2012)
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that 1 own property adjacent to Dh� 1, b n r `'� 's
(Name of Property Owner)
property located at 9 i J � " d
L (Address, Lo Block. Road, etc.)
on , in < . N.C.
(Waterbody) (Cityfrown 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 descriptiod below or attach a site drawing)
�.S
� rT`�C`c
1�
2l 2 c 18CC
`i D df IC
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
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.
(Pr rty Owner Information)
1
Sinature
1�� de��sC-
Print or Type Name
la�l A
Mellor Address n ( Z
TS_Z 6
City/Siate/Zip
Telenhone Number
1.
Da e
�r�e 17 L - V:' l'v><1c'iz
(Z
QF't2�IT.
DEC 30 7019
Date
bC10-MI-11) CITY
(Revised 6/1&2012)