HomeMy WebLinkAboutGardner, ChrisNCAMA / ❑ DREDGE & FILL
GENERAL PERMIT
4New ❑Modification ❑Complete Reissue ❑Partial Reissue
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 15A
Applicant Name i
Address
City 1 1"i a/ f : .'I iState M ZIP / CXl
Phone # (fir ),, (i (c' �'(� / E-Mail
Authorized Agent
1
Affected ' ❑ Cw IN] EW ,rat PTA ,C4 S ❑ PTS
AEC(s): ❑ OEA O HHF ❑ IH ❑ UBA ❑ N/A
L l PwS:
ORW: yes / no PNA yes /P
N9 78957
Previous permit #_
Date previous permit
Project Location: County ---
Street Address/ State Road/ Lot #(s)
Subdivision
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( �/ h
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Phone # O River Basin r
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(Agent orApplicant Printed Name
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Siatur's'Pease read com liakE
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Application Fee(s)
on back of permit"
Check#
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: C htV) S Ctrr YWC
Mailing Address: 10!5 C m-emcn-' Cf. .
Phone Number:
Email Address:
I certify that I have authorized
252 -af9i�- 4667
(-'- G-C(50Csp Msnt, c6M
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:�1xxa liC
at my property located at
in County.
1 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:
k
/� _- Signature
l_YtMS Gr1�Waaf
Print or Type Name
Title
Date
This certification is valid through
VIECEIVED
MAR 0 2 N'6
DCM-MHD CITY
ADJACENT RIPARIAN PROPERTY OWNER STATEMEN
n)1T
I hereby certify that I own property adjacent to LS Gs rJne Y- 's
�^ ��77 (Name of Property Owner)
property located at EEO S1l rs '1 i �0.
1/y'�� C -� (Addres ot, Block, Road, etc.)
on BM& �U� -,In �i We. KyNol �hc�teS , N.C.
(Waterbody) (City/Town and/or County)
The applic nt 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)
Q S 66u,r\ Ur\ Nf eke,
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'
—_ I do not wish to waive the
(Property Owner Information)
Signature
G.�iz.is Gw+�-o.Jsz
Print or Type Name
/of CLA7� 0"0+ rT Cl-.
setback requirement.
15' setback requirement.
Information)
Mailing Address M 7ing Address
Re'lei 1-4"'JT4- A/c- zaso Y tVC, a7fu15
CityCity/Sta�� City/State ip y/ y aq/ 61
Telephone Number /e ail address Teleph�'e Nuymber/email address
// �7
Date �Qrr2(sac1CO5 secur"d�/ r� l
RECEM96 G
(Revised Aug. 2014)
*Valid for one calendar year after signature*
MAR b 2 2020
DCM-MHD CITY
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to t-kt^13 C—,yA I ek- 's
t�
(Name of Property Owner)
property located at 55D tig- ee5 S1 &q2
(Address, rot, Block, Road,
on DCAV2 N.C.
(Waterbody) (City/Town 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)
r .x4t utc�.cl!�-� � a ,l�c�Cwa pk I ea�i /0,�ct�tr m P-/)4d
fig# a/J4'J�Lf/�'I r!11 m#raMchad 6*14�
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)
Signature
LNR�S &AV-PWCA—
Print or Type Name
o f c-""&- Po aa7- e-l-.
Mailing Address
Re CJCY Mo" ., N(L- 7-16o Y
CityCity/3ta p
z0-1-96-Ll G e•e/T t4SW-e4ti
Telephone Number/e ail address
Date
*Valid for one calendar year after signature*
Signature *
AN9P-U0 C, 3 Vns
Print or Type Name
lob R-vroy2A'Pr,
Mailing Address ,
cs,&�>, BAN j ry r✓ a 75) 7
City/State2ip
Telephone Number/email address
Date* RECEIVED
(Revised Aug. 011442 2020
DCm.MHD CITY
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■ Complete Items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the final piece,
or on the front if space permits.
1. Ankle Addressed to: ` D.Is
MP C�narleS `�O rNc\SD?J If
❑ Agent
from Item 17 u re:
69 below: ❑ No
MAR 0-2 0/'
3.
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PS Form 3811, July 2015 PSN 7530-02-000-9053
Domestic Return Receipt
■ Complete Ilbms 1, 2, and 3. rD.I,
- �1 p ❑ Agent
■ Print your name and address on the reverse q ❑ Addressee
so that we can return the card to you. ei red by (Pr ted Name) C. too Delivery
■ Attach this card to the back of the mailpiece, , Y - 2��
,tpr on the front if space permits. r`Yh� item 17 ❑ Yos
1. Icle Addressed to: eliveryES, ent� elow: ❑ No
12: /�ndre� �rhs
0 Ebx-O�v MAR 0 2 2020
b17 6-1U-uwnrd1y.-
3.
PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt