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HomeMy WebLinkAboutHorner, RichardC CAMA / ❑ DREDGE & FILL N9 78497 A B C D �PENERAL PERMIT Previous permit# VNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date pre lvious ermit issued As authorized by the State of North Carolina, Department of Environmental Qualityw f and the Coastal Resour�es Cofnmission i an a.e of environmental concern pursuant to I SA NCAC ! 1 I7, „_` I Rules attached Applicant Name �t� Project Location: County ! ;f — Address //: q ( 1 7 / Street Address/ State Road/ Lot #(s) _ U4ti Phone # ( 81 A 6 - Authorized Agent _ \ El CW ElEW El PTA ES ❑ PTS Affected OEA ❑ HHF ❑ IH UBA El N/A Affecte ❑ PWS: 1 ORW: yes /' no PNA yes /(no Type of Project/ Activity Pier (dock) length_ Fixed Platform(s) _ Floating Platform(s) Finger pier(s) Groin length number Bulkhead/ Riprap lei avg distance o max distance < Basin, channel cubic Boat ramp Boathouse/ Beach Other Shoreline Length SAM not sure yes !'no . Moratorium: n/a yes no Photos: yes no Waiver Attached: yes no - A building permit may be required by:, ( Note Local Planning Jurisdiction) Agen[ or Applicant Printed Name j Signat re *Please read compliance statement on back of 'er iit** i Cityl, �( i,(_,G / (._ ZIP % d �y r Phone # { ) River Basin Adj. Wtr. Body / I (nat_/man /unkn) Closest Maj. Wtr. Body — (Scale: ) i' ❑ See note on back egarding River Basin rules. Application Fee(s) r / Check# Issuing Date E4iration Date I hereby certify that I own property adjacent to t liotzNe2 's Property located at _ _3oo r~t- P¢ (Y.niNa�no of Prop" Owner) on hit c (,�<t,h (Add Fn, 0% Block, Road tl f J N.C. Mf � Y) m4n 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 proposa►. DESCRIPTION AND/OR DRAW( G OF PROPOSED DEVELOPMENT (Ind}vidual proposing development must In description below or attach a site drawing) Xra'nN C; ..7fm+ gar 7-i "R tt%E.J � ksti f� iko"f �$-Al O-e --�, WAIVER SECTION I understand t at a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the appropriate blank below.) I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) � Y lam''.•' -- (Adjacent Property OwP nkmation) lr 3iAe140, L-$cfls �(e+i✓F 8c(%� Print or Type Name ,s2= 313- C&01 Telephone ly!Umbgr Date (Revised Wf&2012) I hereby certify that I own property adjacent to /T icA l 's Property Dated on lice c in (Waterbody) and/or `." The applicant has described to me, as shown below, the development proposed at the above k>cation I have no objection to this proposal. DESCRIPTION AND/OR DRAWRIG OF PROPOSED DEVELOPMENT Ondvidual proposing development mu in description below or attach a site drawing) FXlgyoM C 1 7 �4Aey'O/ .Ss�i � , �a 1ktr�►r .F WAIVER SECTION I understand t at 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. (Property Owner Information) care (Adjacent Property Ow Si e Prin or 7 Name QS— Mailing Address c�srwantv%p I— All -7/o -33o-2 Information) r'rpw! t 104AJ &S-P fFievisad 811 &2012)