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HomeMy WebLinkAboutAllen, StevenrACAMA / ❑ DREDGE & FILL O .� N. 78938 A B C D GENERAL PERMIT Previous permit# NINew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality -�'v �., and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC ' % / /, / '�X .% Rules attached. Applicant Name �'� t \l f, () �'� �, �C , Project Location: County `>� Address C %, `, U` it I l)kP City �''�t (�lf�:ll(-�l;)I/(, Stater ZIP Phone # (r�`t� )�' ��� E-Mail Authorized Agent ^^(Ir; 114t nf Affected 2fCW OEW -NPTA ,,DES ❑PTS AEC(s): 0 OEA ❑ HHF ❑ IH ❑ UBA ❑ WA ❑ PWS: ORW: yes /no'� PNA yes / no Street Address/ State Road/ Lot #(s) I n ,r 41 ; :c%ldc (k r(c City ZIP Phone # t( ) River Basin Id I -1f , K t Adj. Wtr. Body"A F' it' `�� F' malt /man /unkn) ( Closest Mal. Wtr. Bodyi�i SEE MOON ■E■ OEM A■ ■■■■■■ NEE ■■■q IS ME ■ �::: i::�:::�CCE:n '::DE': M111 NONE SEE om�MEE M IEEE momom IN MEN ■Simms ■■■■■■■■�■■■■■ I1■■■ E■■■■■ ■■■■■■■ON■A■EO 1ti In NOON■■■ B■■■■■■■■H■A■■irot. ■IFa NOON■■■ NINON■■■®■■■■■■■■.l�■ l�I� NOON■■ M. ■� ■�yyI■■®■■■11�1■�11■■■■■■ 1� ■■NONE OEM IME IIiM I ME ME � 0 EOI■■�No ■ �ME M No IN � ■■■ ■MUN ■■NE MIN MEN EE�■O�■�■ ■■■■■�� :M MONOON■■■ Emmm: ::�:�':Ca ■■■I■■ MEMO C' ■E■■�■■■■■■ S■■OMEN■■ EE■■■■■■■E®■■■u• ■®■■■I■ ■■EEm■■■■■■■■ ON■■■■■ MM MM ■■E■■EN®■■■■■■■■ ■■N■ ■■■■■■■■ ■ M■■■■■ ■■E■ ®CCE... : ...so ■■.IN MEME ....C�C Signature •► PlVK'eread comp iince statement on back of permit's Application Fee(s) Check # PermitOfficers Printed NNaaamme'� j ✓✓ Signatture / Issuing Date rxipiration Date AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS Name of Property Owner Applying for Permit: N lei, Telephone Number: I certify that I have authorized lsc-L ISde F" iClflr`C lF) �+ (agent/contractor), to act on my behalf, for the purpose of applying and obtaining all CAMA permits necessary for the proposed development of CEO(' {L ���j P / at my property located at in i r This certification is valid through(date). (Property Owner Information) Signature kj is ~ At to Print or Type Name Title, co. owner or trustee for property L/v /6 o ate Telephone Number Gll�h,do71'e,i e mQilm Email Address ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to GtL Xa-) N le r 's (Name of Property Owner) property located at 11'4 p-llp,%1 -1 C-Ir" (Address, Lot, Block, Road, etc. on ia�-'bY1fiC. Y_ n4-tTA • in 12�1. 7L�(J nn 1") , N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above locatior� �_ 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) y Gt % J S� t/ G ✓�-� /`ciJ 7 V '-e r,/ GL le, clJ P / [7 S Y (?�S 40 cut 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. EC I do not wish to waive the 15' setback requirement. (Property Owner Information) Signature Print or Ty e Name 9sting Address 1- �t 1 CAJti le �%A City/State/Zip Telephone Number d��� Date Date m) (Revised 611812012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to SicceYI Allen 's (Name of Property Owner) property located at r-1 SC Car. (Address, Lot, Block, Road, etc.) on PQ,iUf i'1C. ti.r)AIMC , in :F42SQ► I :j r jo , N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above locaton. % 1 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) �s Jiu ��,�,y y©tea s����� II.J4- SPq is wC-r ke P" 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. f j 4 I do not wish to waive the 15' setback requirement. (Property Owner Information) �Si �e nalur n ► Alen Print or Type Name 0085 •Mpiling.Addrerss City/State/Zip Telephone umbe daces Dale (Adjacent Property Owner Information) Si �nnti�re IiCuS X rLJJQ Print or Type iNe SEDS L=N hcpe cr llin ,address tz�t'aah, NG C�aal3 City/Stat ip cl1 `I-yr7407z Telephone Nu ber o �I�L&Q90 Dale (Revised 611812012)