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HomeMy WebLinkAbout74865D - ThackerJ?L-NCAMA / El DREDGE & FILL NO. %4865 A B C GENERAL PERMIT Previous permit# AN2w Modification ❑Complete Reissue El 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 p �� / Rules attac Applicant Name Th(A `" �V 1 - Project Location: County j tl jm xe/ Address , (7 UL J N 6� S S a V Street Address/ State Road/ Lot #(s) City State_ ZIP�/S`�2M C) Phone #11V—/Q)�IZ'Z?j70 E-%Mail Authorized Agent T i ( 'i 14 Affected ❑ Cw `I W )kPTA ❑ ES ❑ PTS AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A ❑ PWS: ORW: yes no , j PNA ye no f Type of Project/ Activity 5 Pier ( Fixec Float Finge Groii Bulk[ Basin Boat Boatl Beac Othe Shor SAV, Mon Phot Waiv Subdivi 'on City ZIP Zg Phone # ( River Basin �V • O Adj. Wtr. Body S at an unkn Closest Maj. Wtr. Body O UNQO V (Scale: 3 e, ) � ■■■■■■■■EEO■■■■■■■E�r■■■■■■■■ ■■■l�lr;�■ ng Platform(s) ■■■■■■■■■■■■■■■■■■■� 1■1■■■■■■■■■■■■■�;ffi\\ r pier(s) ■■■■■■■■■■■■■■■■■■■1®�■■■■■■■■■®■■■ VIiJ■� � length ■■■E■■■■■E■■■■■■■■■!�■!�J■■■■■■■■■■■■■■■■■ number length MEMO No ■■■■■■■■■■■�■■■■■■■■■■■■■■■■■ I - offshore ■MEMME■■■OEM■lrl��■■■■ ■■�1/.1■■■■EEO■■■■■■■ J-fe .,Ice offshore EEO■■■EEE■■■EiIE■■■■■■�■E■■EE■■■■E■■E■■■ cubic yards ■■■EE■E■OE■■■■■■■■■ ■■■■■■■■■■O■■■■■■■ ramp ■■■■■■E■�■OEM■■■■■■E■■■■■■■■■■OE■■■■■■ ■■■■■■1!_�c+Rio_,E':�:�■�uir■iw®i■■■■■■!■'■�■ Bulldozing E■■ MEMO HE ■I �i'J■ ■■�■ �!■CIE■■■��■■■■■■ fline Length not sure yes ■■■■■■■■EI I�JlICE■E■Y■■■■■■■ili■�Il�i■!■E■E■■■ FS: yes OEM No �- A building permit may be required by: ( Note Local Planning jurisdiction) Notes/ Special Conditions orf Signature ** Please reacl6mpliance statement on back of permit Application Fee(s) Check # ❑ See note on back regarding River Basin rules. Printed Name (/Z.- I � • 2 0 � , q76 Issuing Date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit:v L4kejr dry Mailing Address: , //, f Phone Number: Email Address: ----�� I certify that I have authorized UGC/"! �ti� �� , 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 _QL in County. I 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: Title l/7 Date This certification is valid through ZZ / '3/ 1 A�Vo ADJACENT RIPARIAN PROPERTY OWNER- STATEMENT I hereby certify that I own property ad'acent to % /`1 [� �y . is (Name of Property Owner) property locc�at`ed at S on C ?/ (Address, Lo Block, oad, .) in 71 f , C� �f�� N.C. (Waterbody) / (ChylTown 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) 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. I do not wish to waive the 15' setback requirement. (Property Owner Information) 01 Si a ur�-�-----�- o PH t or Type amp Mai ' Addre City/Sta %Zip Telephone Number E� D ri . (Adjacent Property Owner Information) Signature Print or Type Name � � 1 Ise n ►-,,�d� �cl • Mailing Address l 1 C4VStateOp 'olI C) 7 yoy 7 Telephone Nu ber Date (Revised 6/182012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to b,V� Kc�� .,s property dZi i �J (Name of Property Owner) located at lJ / 575 l r (Address, Lot, I ck, Roa , et ) on Gt/ , in - , N.C. (Waterbody) ityrown 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) 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. I do not wish to waive the 15' setback requirement. (Property Owner Information) Mi{in, ddrMess /J Crty�ip &-� Telephone Number ,?-/3--;0"71) Date (Adjacent Property Owner Information) lzf�e-� Signature i1116&4 L. Gc-, ,Ocrc�G.ZSI S.f' Print or Type Name ai//ing Address QV State/Zip `7/'0-5- /z-5 ?y/ Telephone Num er ��y/2ozv Date (Revised 6/1WO12) AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Mailing Address. - Phone Number: Email Address: I certify that I have authorized 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 rt County. I 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: Signature Print or Type Name Title 1 Date This certification is valid through / ���5 Data Rac~ Data Check Flom Name or P—W Noklar Nrtd- Check Number t:h.* amcunr Permit NumberlC—ft Rece/ t — Re/u,.MWlocated coi mm C.1-2 cok-2 C h-14 COMM5 Cck-6 Ckwwy ColumM CWu-9 2/18/2020 2/18/2020 Bude Smith Money Order Robert Thacker Jr. BancFirst 1628189" $ 200.00 GP #74865D GP i74808D JD rct. 10829 PA rcL 9736 Trinh Thanh Luu same Chartes Schwab Bank 1365 200.00