HomeMy WebLinkAbout74842D - TanglewoodCAMA / ,❑ DREDGE & FILL No. 74842 A B C(J)'
GENERAL PERMIT Previous permit#
ANew ❑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 J 5A NCAC 10 77 H . 1 24D 0
J.L . + J /� ❑Rules attached.
Applicant Name �n�n C Project Location: County U��nSw ► C- 1G.-
Address Po 31j�,3=' t1 Street Address/ State Road/ Lot #(s) '3/8S
City ��C-'k164-e State�� ZIP a� 4 S9 WC eey �
Phone# t0 )-IK II 13 E-Mail -POA@afMc.h+ Subdivision_
Authorized Agent H-O . c/a, M0.Y H0
Affected ❑ CW W EW N PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ URA ❑ N/A
❑ PWS:
ORW: yes /6pj PNA yes /_0
City Q S4 ZIP
Phone # ( ) River Basin L�.Mber
Adj. Wtr. Body A\ vi \JU /man /unkn)
Closest Maj. Wtr. Body �k�UJ
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Agent or Applicant Printed Name
Signature *e Please read compliance statement on back of permit
.. 'ocy �-
Application Fee(s) Check #
13 ffe-kC oc
Permit cer's Printed Name
/�., �� ✓ P"�—ram'"
Signatu�te
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Issuing Expiralion bate
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
17
Mailing Address: _ ; ti. �i'x 3
Phone Number: `i I6 — it a 3
Email Address: + tfi L cl
I certify that 1 have authorized H5 Construction J
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at 3 j s-.:�- d� %�° , r F', 5 i_-' ,
in - KiCounty.
1 furthermore certify that 1 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:
ell ,, 4(z, - '1 , XL,"-;
Sigrfature
YL-':i r`► Y.i_ SIC: �n�'"� ��"r`:�iG� --
Print or Type Name
C4 "ct C,-t Di 4r L5
Title
Date
This certification is valid through I !
TY M A
I hereby certify tttat i ow edj t t.r
pro art iodated ai 3 a `, (Woo of Property r)
(Addre6m, Lot, Black, flood, etc.)
OP In N (41ia"ady) �, KC.'1� 1Krt aluilOf CQLf31fj►}
The applicant has deacr)badd to ine, as stum n WOW, the devetopM&M proposed at the above location.
I have no ob)ectfon to this proposal,
i leave @bJertions to wa propo$14
r posing +[�N
proposing p +gNDfO#t. DRAWftif6 QP PRDP0$9D f EVL,-- .t�PAMNT ~
development Muot MI In ctesedpMn below or etfech a site draw ft)
T�(�.
. 1
Ph Drk
k
f u+�l Ate�d. that a pier, dock, MWrin9 Akin a„>X ictA►a iitot+Re, fit, or groin must be Set back a
minimum dista"W of 15'.%vm my area of dpat'teh access wfess waived by me. (if y wi$h to waive
Me tietback, YOU must tnit#a! the appropriatte Wnk befovv.)
l do wih to waive the 116 s*Wrk requirement.
f &.nott+eish in waive tPsa5' setback regzlker��
(property 0" Infam:st cnji
P#tt or Type Mart
AfaWg Address
C*Y' eta2101
felsptw»e Number
ra- la;—�7
owner tntornoition) X
PT TP* Nears
Adet7fl�q ddirss
�-j r/:
I elepho Wntber
Date
(RevfSOIJ 5/1W012)
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Teo h 's
(Name of Property Owner)
property located at 31 3 ,5 �J)q Ic IL i,'
_ (Address, Lot, Bloc�ks. Road, etc.)
on %� C i�L' in JCc 0N.C.
(Waterbody) (Ci n and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
A{ 4 -( 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)
E45+ �1't
'' FD
1^loaii hj
WAIVER SECTION
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
rie. (If you wish to waive the setback, you must initial the appropriate blank below.)
X/ 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)
Signatte /
Print or Type Name
Mailing Address
City/State%Zip
Telephone Number/ mailaddress
/ L
!JOG, /I�'1 _�/�r1/�< �J /CarT ![i 1.1 /
(� V
Date a tiro
Signazu c*
Print or T e Name
Z3 C Y O ceg G r'+c S'� C •� • S w
Mailigg Address
�,3a (, 4 N ( )-�s�! G y
City/Sta e ipT—
Ot t 1 - SSA' 4' • 03 or Anurr�S.tc
Telephone Number/email address
Dule *
(Revised Aug. 2014)
Valid for one calendar year after signature"
(-Yl-o::[:
rz
0J
Ex is; o's �,
WOO>
.D. c:Y,,
( ,L
-r vn
-e
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 1" U/'1" 's
t� I
umproperty located at �� UC �rd/- 1/tev'� > s ,(o Property Owner)
l (Address, Lot, Block, etc.)
on , in uL4 N.C.
(Waterbody) (Cityfrown andlo County)
The -�ppfi ant has described to me, as shown below, the development proposed at the above
to
I have no objection to this proposal.
1 have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DZr Zi-W— ;—
findivifMal nrnnncing-rhvelnnnteant mulct fill In descrlQrlon below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
myq back a minimum distance of 15' from my area of riparian access unless waived by
lfwilsdo
h to waive the setback, you must initial the appropriate blank below.)
wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature yj
�L [! , -
Ale -
Mailing Addless
T91ephone Number/email address
Dare
"Valid fv:
i7ilnt g(Type *m
Mailing Add ss /
Telephone ber/email address
tie
Dare*
(Revised Aug. 2014)
Date Received
Daft
Check From /Name)
Nama ./P�I(Hokfer
Vendw
ChOO Number
Chock
cunt
Pe It Number/Cw ft
Recai t w Relund/Reall—ted
C.1-1
cat-2
Column3
cdumM
C.1um.5
M
Columa7
CdumnS
Column9
1/92020
Lighthouse Manne Construction Inc.
H5 Construction LLC
Brian ScheP rley
Tab lewood POA
Coastal Bank and Trust
B88T
3002
$ 200.00
GP #74853D
JD tci 10931
BB rct. 9470
1/9/2020
2426
200.00
GP #74842D