HomeMy WebLinkAbout46267D - Bauer7❑CAMA / ❑ DREDGE & FILL No. 76267 A B C
G.EN ERAL 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 U) 4 , I 'Lo c)
Applicant Name C
Addres 1�1��
City Stater ZIP
Phone # (tf_00' _Mail
Authorized Agent �V /J
Affected ❑ CW IN EW 4Q PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes J no-," PNA yes [_no
Type of Project/ Activity - f
Pier (dock) length ,
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Ripraplength
avg/distance offshore
m I distance offshore
Basin, channel
cubic y s
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes o
Moratorium: n/a yes o
Photos: yes o
Waiver Attached: 6051
n l
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check#
❑ Rules attached.
Project Location: County
Street Address/ State R ad/ Lot
i �'�
Subdivision
City ZIP 2 S-A-A-1
Phone # (------- River Basin ' f7
Adj. Wtr. Body T I l�(L d�(iat�lm�nkn)
Closest Maj. Wtr. Body'
(Scale:
❑ See note on back regarding River Basin rules.
Printed Name
U-3 . f v , zo 77 ,1 Z ? 20
Issuing Date Expiration Date
ADJACENT Rip ARtAxt pROPERTY OWNER STATEMENT
hereby certify that ,'own property a6acent to aj
_ S
property located at r. :� ( !Name of Property Owner t,/ a
on �= ,' i �., » , /--,'Address, Lot, Bloc , Road; etc. ,
Mf terbody} „ � N.C.
C)tyiTown and/or County)
The applicant has described to me, as snowrn below, t he develaptnent proposed at the above location.
have no abjection to'his Proposai.
f have objeections to tins proposal,
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
r.
WAIVER SECTION
understand that a ,tier, decK, mcoring pilings, ' reakWater. boathouse, lift, or groin must be set back a
minimum distance of :5` from niy area of riparian access ;;mess waived by"me. 'if you wish !c waive
=_ he setback, you must iniffat the aporcoriate blank be;o.ti•.1
;--�� do wish to waive the 15' setback -eauirement.
i do not iisr to waive the ; setback recuiren,ent.
qOwnerI rmativ
rrtn�iY,ae t�rre -
Mailing Adore
Telephgne &niber
(Adfnent Property 0,Wner information)
,'Tint or T
Ylas Ala e
Ma"'ing Address
Q "rslatef rp t
x efepltorre tuber
i?ra�a
(Revised 6f18/2012)
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that 1 own property adjacent to s
t ( (Nape of Property Owner) i
property located at t
on (',�;fa ('Address, Lot, Blocki Road, et .
/ r �� N C.
( aterbody) (City/T n and/or County)
The applicant has described to me, as snown oelow. the .development proposed at the above ocation
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)
(X !�
S.
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
ou must initial the aporopriate blank below.)
do wish to waive ;he 15' setback requirement.
do not wish to waive the 15' setback requirement.
(Pro ner orntation)(Adjacent Property OwrZer lnfarmation}_
J'r xctJur i�
Prn ype Name Pnnt or Type-Nage
Maim Address t r Mailing Address Jr-- �----a—
City/StatelZip Cit /st
_t i L' ?i`a-'�< 7 y
''etephohe Number Telephone Number
Dare
(Revised 611812012)
G
-�
�r (V4 J
� 5�� I- I ....... ikk-
1� -
J
/V I PC
9
1 �J
Date Received
Date Deposited
Cheek From
Name or Pe rt Holder
Vander
Check Number
Chock
mount
P~ Numb-Cor—ts
R—Iot or ReNmr/Resl ocatad
Columnr
Column2
Cdumn3
Cokaonl
Cdumna
Cdumtr9
Cdumn7
COMM"
CokVM9
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--
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