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HomeMy WebLinkAbout74882D - SamplesEZCAMA / ❑ DREDGE & FILL NO, 74882 A B C O GENERAL PERMIT Previous permit# �1New •❑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 15A NCAC �C' IA.,��" s ❑Rules attached. �t'/__ �( �/ Applicant Name 0 h G I a Project Location: County Address I V rg. ✓I Street Address/ State Road/ Lot#(s) City cT MJ State /VC ZIP Phone 44 �;10 — E-Mailyg Subdivision Authorized Agent P1,4r City ZIP Y Affected ❑ CW SEW YPTA ❑ ES ElPTS Phone # ( '�" River Bastin W • (� AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body at an unkn ElPWS. Closest Maj. Wtr. Body C ��"' ORW: yes ;/ 'no PNA yes /r r10 1 r Type of Project/ Activity 1 ■■■■■■■■■■■■■■■■■■■■�■■■■■■■■■■■■■■■■■ ■■■■■■■■ ■■■■■■■■■ ■■■■■�r�■■;a►r�a!,■�■■■ MEIN MMINMEHILIMMEME ■■■ M101111FROME ME &UN1999-1W." ■ SURNM■■■■■■■NA110 ■■■■■■■■■■1■■■■ONE ■■■■■��■■■■■■■■■■vim■■■■■■■■■■�1■■■■■■■ mean 0"No ■■����■■■■■■■■■■■w■■■■■■MEMO■■M1■■■■■■■ .■■■■■��■■■■■■■I��ilrilli■1■■■■Ii■ rL'2■ 6 01114 Agent or Applicant Printed Name Signature ** Please read compliance statement on back of permit Sign re ZDD Zo rl - Application Fee(s) Check # Issuing Date Printed Name v Expiration Date . . ........... 6(/.57 bypy OCR /ep bc, -17 -all New tie 5D V44 Tona)d 58,(n?"c-5 gL5 1,aKe (�-S-X7isfl� filth? New Alum. �rnp-A E-Xistlny DocK—� �,- E, Cape Pea r R I u er, New La r4i (g New S-ir7W5 NQW lXx 16! Der-K a v NeW,5�4-a) 56 IV New Dec -KC do ujes+ ve R1verv,)eui Drive. I)fivtL))d� V n„sway l I V �rr Y' � J' y 'Y �, w Tan K c- -"" GraYeled Rre-D Ln 7 I 1 1 815 Riverview Dr. AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: F1 �?iJ 7'liS Mailing Address: R)._S R'Qeryiew e, Phone Number Email Address: -�i! I certify that I have authorized 1�j'�i►r 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 in { r, _ _County. l 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: gnatur 7" 1� dripe Prin ert or Type ame t �e Di, j3 ati­ Title l/ ' lLI Q oa a Date This certification is valid through c1%a p )e�jc n PF � ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to � O a i K C property located at -5 & , )e!y (Name of Properfy Owner) �_ ,,, .)�,,. (Address.,jot,� Block, oad, etc.) on C-apeear k� , in,mr +' ' 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 dravving) WAIVER SECTION i understand that a pier, dock, mooring pilings, breakwater, boathouse lift, or groir: 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) S' nal ure P ' �t Type Name Ilk, c,�� , M ' ing Address Cityl34telzip 4A�> _ W11 Te re,o h UTbr 72, �eG7� (� Date Telepho e N mber 1 Z� Date (Revised E/18/-2012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to c�;7 property (Name of Prope Owner) located at� �1 L1�1/1 �:� a (Address, ot, Block, ad, etc.) e. Fearon , Fearit�� in 1 , N.C. (Waterbody) (City n and/or County) The applicant has described to me, as shown below, the development proposed at the above location. 1 have no objection to this proposal. I have objections to this propos or 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) (Adjacent Property Owner Information) SignatUr ` Si j� ire P ',t Type Name Print or Typ Name ���p�fl 373 ' ►t'� -tom 2 Ing Address Mailing Address City/ te/Zip _? Ci y/State2ip - ; - 0 91 i 04-5) i29 -YS93 Te ephone Number Telephone Number / �f z- - l -1�- Zoz,o Date Date (Revised 611812012) Data Rseelved Om Cheek F Name of Permit Holder V—d- Check Number Check cunt Permit NumbMiC--ft R - Re/uM/Realloeeted 1 Cdumn2 Cdumn3 C.1-4 Columns Cdumn7 Column3 Cdumn9 202020 Southeast Harbor Homeowners Ass_oclrx Ridgestone Construction, LLC _ Donald and Janice Samples same North State Bank _ _ _ HomeTrust Bank USAA Federal Savings Bank 322 $ 200.00 GP #747850 _ _ _ GP #74862D _ _ GP #74882D PA rct. 9732 _ 2AM20 Chills Majewskl 1368 $ 200.00 JD ret. 109" _ 2/3/2020 _ Donald Samples 2269 S 200.00 JD rct. 10956