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.
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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
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit Sign re
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Application Fee(s) Check # Issuing Date
Printed Name
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Expiration Date
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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