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HomeMy WebLinkAboutAtlantic Ice Co.LCAMA / J DREDGE & FILL N9 78483 A B c D GENERAL PERMIT Previous permit# ©New ❑Modification ❑Complete Reissue ❑Partial Reissue 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 I SA NCAC } i I Q Rules attached. Applicant Name ' ' Project Location: County _ Address r Street Address/ State Road/ Lot #(s) City �' ' 1' State 1ZIP 4_ . Phone # O E-Mail Authorized Agent pCW h]EW PTA ❑PTS Affected AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A ❑ PWS: ORW: yes r oo) P N A yes (/ no ) Type of Project/ Activity t Pier Fixe< Float Fingt Groff Bulkl Basir Boat Boat Beac Oth( Sher SAM Mor Phot Wait A Subdivision City I "' i ZIP - Phone # O River Basin Adj. Wtr. Body fnat man /unkn) Closest Maj. Wtr. Body (Scale: SENSE ■■■■CM■■■■■■■■■SI■��l�l■�!■■ N■■■■■■■ �■■■MBEEM■■ ■�JYI■■■l11■■ 'm■■■■■■■■ ■■Mi■■■■■■■ W■®■W■■ �5E::: No C: M U ::■:: :::::_'. MMCC':::: EMENE:: � d■■��■■■■ ■iiiman ■■■■■■� d■■ ■■■■ ■■■■■ I i■■■1 ■iia��A■■■■■■■ ■ ■■■■■■■■■■■■■p■■■®■ ■■■�i■■■■■■■■■■ .■■■■�.■■■■■ :::C:::�.N■MEN m■■■■■■■■■H■■■■■■■■■■■ C:■�■ :::::::::::: E® ....■.■�. ■■H■■■ ■■.. �G.. �■■■■■■■■■■■E■ ■■■�■■■■ SEEM ■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■ ■.■CNONE .MEME 0 .....■N■.■.■�....V ES'■'■M ME'■'■:C'■'■o'.'. . �■■0� eMEN ■� ■� .■ ■■■■ ■ i�■■ ■. ■i■ u ( Note Local Planning Jurisdiction) Notes/ Special Conditions i�' '� L )" ,tIJ Agent o Applicadt Printed Name S(ig1at ermi[•" r(2(V, 01- ,/"I /Application Fee(s) Check # , iE..� rJ Permit Officers Printed.Name Signatyre Issuing Expiration Date ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to P-1,1414le prG I (Name of Property Owner) property located at '7�3 725-7;41"' R,4 r (Address, Lot, lock, RRa , etc.) on l-✓e&y44bJh in �4 IC1� N.C. (Wa erbody) ( ity/To n and/or County) The applicant has described to me, as shown below, the development proposed at the above catiop. - �/ 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, 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) Si nature Print or Type Name g Adlress y,tScL1 FtYt-l$' Ci/ l �te2i � 7 q11 Telephone Number Date (Adjacent Property Owner Information) Date (Revised 611812012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that 1 own property adjacent to 's (Name of Property Owner) property located at (Address, lot, Block, Road, etc.) on , in N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above locati 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) 1g(� rTaal� t�az v,u�t_ WAIVER SECTION 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. (Property Owner Information) / ussrll Trn�� Print or Type Na(�nne YQ rJ Hrtrgzf1 S'% 3�'S7 $ `i-LIt ? Date (Revised 611812012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to 's (Name of Property Owner) property located at (Address, Lot, Block, Road, etc.) on ,in N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above locat*g�. have no objection to this proposal. 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, 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 Owne) nformation) Si ture A�US;1�4( JOi�rS Protd o Typeto /V ��'c M " g A 6dregs tC11. S Cify/ tatelZip, Telephone Num er Stu 3�ra� Date (Adjacent Property Owner Information) CK� nature nrO� Cam( cr��„ 1t' 4 Q Print or Type Name Mailing Address ciry�/ III lClr� Telephone Number �- t), - a Date (Revised 611812012)