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)