HomeMy WebLinkAbout74809D - Buckley-jCAMA / DREDGE &FILL No. 74809 A .B C D
GENERAL PERMIT Previous permit#
LXNe%A( Modification ❑Complete Reissue CPartial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality �� e
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
�i-� -� r , `❑ Rules attached.
Applicant Name I� l�[ f t {fI{ t 'f Project Location: County �,r�iy p�;�'6'1 r
Address ; A! i-4t �d 1—r , r; Street Address/ State Road/ Lot #(s)
City State , � ZIP,
Phone # ( ' 9:; F-Mail ' ' ' ` _? f Subdivision
Authorized Agent : (Ji s f j /1,C, I rVjLJf `'�' °' City ZIP
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Affected El Cw ❑EW PTA ❑ ES ElPITS Phone # ( -.__. River Basin ? "
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Signature ** Please read cormpliance statement on back of permit
Application Fee(s) Check #
x
Permit Officer's Printed Name
IT e3i
Signature
Issuing Date Expiration Date
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 1 L1Q
Mailing Address: �L�� dZ \ L,5tvai/V
Phone Number: _ (o (p �3 �-77 9
Email Address: 0 tia cr - "ICk < < Cd
I certify that I have authorized Southern NC Marine LL ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Hurricane Dorian Repair and
possible additions.
at my property located atL� Z
in 4ILCounty.
/ furthermore certify that / 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:
Signature
M Z
rint or Type Name
bwA.;e(Z
Title
3 / (� / 2-0
Date
This certification is valid through /�_/ 2j
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i hereby certify that I own property adjacent to �_ 's
t (tj , �jName+of ropert caner
property located at �� �_
f;Address`Looad, c.)
(Waterbody) (City/T n and/or County)
Thecant has described to me, as shown below, the development proposed at me abue location.
I have no objection to this proposal,
1 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
1 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.)
{bi I do wish to waive the 15' setback requirement.
do not wish to waive the 15' setback requirement.
(P
rmation)
c;lYXIre ;p / -7-7 �_
Telephone Number
,pure
on)
P2 Cor 1 ype_ICA
G 4
malling Q dress 409
-,
c;tv oa�e2?.3 �214
Telephone Number
3-(.- ?co
Dale
(Revised 6/18/2012)
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �� �u�,kl� --- s
,.�_.r_ s o..,.,b.+u owner► _ ,
property located at
on WS
(Wa
WIM
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, 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 requir iment.
I do not wish to waive the 15' setback requirement.
(Property Owner Informatio) (Adja 4VrlrD y Owner information)
iKnarur Az
nulu
t >t Lc, h ,r, [-ram
Pft cr T eZI m�� � rl ���+ - Pr+nf or Ty}�pe Narne
C� 2411
L121L
g Add r s mpilinp Address
r? G bv� r t yni,� AlG
l Ct lStafe ip
Telephone Number Telephone Number
Date
J)ate
(Revised 611612012)
• o�
v
.r
h �1�
N 3 ,
xs3 �
Gazebo will not be ,
built
Addition of 4'
Length to allow for
bench
I2'* W;�e� c.c,. *v-1
�XGtca. 3� � I ems%
C:ra•SS
Addition of T wide
x 16' long fixed
platform along
creek bank edge in
line with current
NOT TO SCALE
Daft Recdved
Date Depodted
Cheek Fmw fA4,PW
Name o/ Pe—tr Holder
Vender
Chock Number
Chock
amount
P—if NumbenCommenft
R a RdbndRtedkxfd
C.k~l
Column2
COk~
Cnlumnl
Cakermd
Cok-7
Columnd
Calumn9
3/13/2020
Luigi Montesano
same
Wells Fargo
2287
$ 200.00
GP #76244D
GP #74809D
BB rct. 11470
PA rot. 9739
3/13/2020
Southern NC Marine LLC
Jonathan Burkley
First Bank
1272
8 200.00