HomeMy WebLinkAboutMurray, Vicki H.❑ CAMA / ❑ DREDGE & FILL O
N. 78495 A B C D
GENERAL PERMIT Previous permit# 7.
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue ` kao Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission' an area of environmental concern pursuant to 15A NCAC J
'El Rules attached.
Applicant Name V j L+ I i" i I� `; ( E: �l "(i''I Project Location: County ; (.l f' t-t )a
Address (� �. - jlf {,(, ;6'
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Street Address/ State Road/ Lot #(s)
City-t�€'.i
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ry'
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Phone # (rr 1 t River Basin l i 1. t i E L-
Affected
❑ OEA
AEC(s):
❑ HHF Q IH ❑ UBA ❑ N/A
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PNA yes / o
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Agent or Applicant Printed Name '
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Signature ** Please read compliances t tement on back of permit ••
_ _- q05 r2
Si nat re - � --
Issuing Date Expiration Date
Application Fee(s) Check #
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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION JqN
8 2020
Name of Property Owner Requesting Permit: 1 8 L IJ r I"A I
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
C&'2 - 7 /q y5i7 r
I
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Cle(t 14601 liar) -,4 i
at my property located at
in County.
I furthermore. certify that I 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:
��76
Signature
%okr. )4. Yu cz2� �l
Print or Type Name
Title
Date
This certification is valid through I
ADJACENT RIPARIAN PROPERTY OWNERSTATEMENT
hereby certify that I own property adjacent to D?/,v- 1/1 fit rli V ,s
(Name q P/ope Owner)
property located at �l U i% /CI ( L Us-z- U),AV ��(d
on Z��k (Address, LQQt, Blo , Road, etc.)
(Kin ICE in in F( `?? /7�7n 2ep/,)e-l) , N.C.
'-J(Waterbo ) ( ty cFwn and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc fion
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)
RECEIVED
JAN 2 8 2020
DCM-MHD CITY
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.)
T:7 % I do wish to waive the 15' setback requirement
'x
f I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Cimmtvro
Date
*Valid for one calendar year after signature*
(Adjacent Property Owner Infc
)-gs I.?
Citylstatelzip
Telephone Numberlemall address
Date* T
(Revised Aug. 2014)
I hereby certify that I own property adjacent to IWI AtlU� ' // ti L4'—vv'
(Name ofProperty Owner)
property located at it
(Address, Lot, B k, Roa , etc ,
on in It N.C.
(Wat rbody) (Cityrrown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
i, 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)
Kc:giyl=11
JAN 2 8 2020
DCM-MHD CITY
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
/1261z 2
'Valid for one calendar year after signature`
(Adjacent Property Owner I f mation)
fSign ure* C
enny
Print or Type Name
Mailing Address
Clty/State2ip
Telephone Number/ email address
/2l126
(Revised Aug. 2014)
RECEIVED
JAN 2 8 7020
DCM_MHD CITY
RecEl el)
BAN 2 8 2020
ADJACENT RIPARIAN PROPERTY OWNER/TATEMENT �� AN 2 8 2020
I hereby certify that I own property adjacent to -� 'r slat l �( s
n, (Name of Prope Owner)
property located at J/L'
(Address, L9t, Blo k, Road, etc.)
on in f `'a r tl'ilc%7 N.C.
(Waterbo ) (�wn and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
A /j 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.)
I do wish to waive the 15' setback requirement.
,.:,.
I do not wish to waive the 15' setback requirement
(Property Owner Information) (Adjacent Property Owner Information)
? ,.... ;
�-iL GjLCli.i.C(r!^ l rn k `I 4
Signature Stgnalm e*
rnnt or type tvame
r.�(' ) K/1)4 c!° K /(w
Mailing Addres .
Telephone Number/email address
Dare
*Valid for one calendar year after signature*
Type
G 1
2. si 1 Z
/Ai�t G r'hck 1��
City/state/Zip
Telephone Number/email address -j,7k
Date* Ir
(Revised Aug. 2014)
r�ecel,,b
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT BAN 2 8 2020
1 hereby certify that I own property adjacent to i)CAI'�n® olry
(Name of Property Owner)
property located at
(Address, Lot, Block, Road, etc.)
on , in N.C.
(Waterbody) (CitylTown 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)
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.)
I do wish to waive the 15' setback requirement.
r I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Inf •mation)
Sr$nature Sign ure* r`
icdk, R Alai-lt<" �el�nclh
Print or Type Nafne Print or Type Name
Mging Address n I%S� S Mailing Address
/State/zip City/State/Zip
Telephone Number/email address Telephone Number/email address
Dati� _ Date* t C'
/12L1Zc
_ /- G'
2 (Revised Aug. 2014)
'Valid for one calendar year after signature'