HomeMy WebLinkAbout76263D - Grisel�cAMA / Q DREDGE & FILL NO. 76263 A B c
GENERAL PERMIT Previous permit #
:504ew El Modification 'Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality O7 I ydQ
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Rul attached.
Applicant Name /4 � S� L
Address D � 5 � p
City ✓✓ State /✓G, ZIP7O 1 `
Phone # ( )V Z 9 1/ TE-Mail
Authorized Agent //bi�
.
Affected ElCW $OW PTA AES ElPTS
AEC(s): ElOEA ❑ HHF ❑ IH ElUBA /Z N/A
ElPWS:
ORW: yes / r!� PNA yes
Project Location: County C!
f 4U W
Street Address/ State Roa51/ Lot #(s)
Subdivision ,
City a ZIP
Phone '# ( �— River Basin '
Adj. Wtr. Body!litit4 lS ' nat unkn
Closest Maj. Wtr. Body
•
EWORN
NE■NEE■E■■■■■■■■■■�■■■■■■■■■■■■■CVO
- -
■■■■■■■■Ir''fir■■�■■■■■/f■■■■■■EI■■■■■■■■■■■■■
■■■■■■■■■17■■■■■■■■■■■of■�1■I
■■■■■■■■■MEMO
■NEE■■M■■�
I �■■■■OEM■■■■E■
�:-�
I ■■■■■■■■■EOM
■■■ ■■■■■I■���■■
■■■■■■■�■■■■�■■■■■■■■■■■■
r
. ■■■■■NO:NIMMUM0
■�■■1■■■■■I■■■■ME■■i■■■■
• - EE■EEO■■■■oEE■■������oM■EI■o■■■■■■■■■■■
EMOEM■EEEMM■E■�����n�H■M■■SEE■■A■■■■■■■
Elm■■■■■■■■■■N■EEEi■E■■■■■■■NEE
:E■■NONE
��■■■Rlisfhi■�EC�fll■EliiiiL'eli
. . , �E�%Nisi%E■■E■M■■■■■■o■
■ ■■
■■■■ Boom
■■■M■■■■■M
6M,4� 1, i9��--
Agent or Applicant Printed t4ame
ignat re Please read compliance statement on back of permit
Application Fee(s) Check #
Pe it f icer's Printed Name
t--
Signa re
.Zq-.7,tj -7.24.�
Issuing Date
Expiration Date
-
_
yl.
! f �
41
i
i .., j
f .
14' I 1 !
i
Rip
7
i r
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: i U Q n m( 5e I
Address of Property: o r �� �(
(Lot or Street #, Street or Road, City & Cou )
Agent's Name # Ej1j►� e M4r! e ns Mailing Address: AU E4 dt L4fie
7
Agent's phone #: I
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A descriution or drawing with dimensions must be provided with this letter.
l
I have no objections to this proposal. _ I have objections to this proposal.
L K you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available athttp /,�rvww.nccoasta/management -rreVweb/cm/staff-li- sting orby calling 1-888-4RCOAST.
No response Is considered the same as no oblection if you have been notified by Certified Mall
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15' from my area of riparian access unlesswAived by me. (if
YOU wislyto waive the setback, you must initial the appropriate blank bel
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pr arty Owner Inf rmation
Signa e
�rq6jj &1 d
Print or 7ppe Name
6 I &A 5-�-e --
Mfu►g Address j
QW/Sta*Zp
C
Telephone
Nu/mber/Email Address
Date J
(Riparian Property Owner information)
Si to —`
�r Lov )Piet
Print or T e Name.
o -Donni Pd
Mailing Address
17
City&,***�
q / q - !F�-7,)-- -=� ct
Telephone Number / Email Address
6 a off,0
Date
(Revised Aug. 2014)
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: yC
Address of Property: �, r
(Lot or Street #, Street or Road, City & County)
4
Agent's Name # inn �qj'1 n C ailing Address:
Agent's phone #: q 10 - ��j- �t� ry5 r C a14 6
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing, A description or drawing with dimensions must be orovided with this letter.
1
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at http:!lwww.nccoastalmanagement net/web/cm/staff-listing or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwaterboathouse. or lift must
be set back a minimum distance of 15from my area of riparian access unless waived by me. (if
you wish to waive the setback, you must initial the appropriate blank below.)
'�tQ` �• I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
J
Signature
-
rua h C l 'e,e 1
Print or type Name
1 rc� ce-+
Mailing Address
Ct , NC a1�
City/State/Zip
�L.9 Ag- 994 5
Telephone Number/Email Address
Date
(Riparian Property Owner Information)
Signature
Print o Type Name
�Icl uc
Mailing Address
�%-!� tl -,ch, N C, z 75-(2y
City/State/Zip
IIIg-
Telephone Number/ Email Address
3 -/ 8- dQ
Date
(Revised Aug. 2014)
AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit.
Mailing Address:
0
Phone Number: gig- LLA1719 4-r
Email Address:
I certify that I have authorizedI
Agent ! Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 5ed l I DC C k 6111
at my property located at
in ) County.
I 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:
Z-A I, 0-n-ze-41,
/Signature
UI
Print or Type Name
D oijer
Title
I 4-
Date
This certification is valid through / !
NC Division of Coastal Management
9 Cashier's Official Receipt
6rV
Received From: 6-, `—
Permit No.: 3 - n
Applicant's Name: F "'
Project dress: Address:
10399 AB
Date: 3/ 2 20 ,
Apo
Check No.: D7/
County: Q (f
Please retain receipt for your records as proof of payment for permit issued.
Signature of Agent or Applican
Signature of Field Representati
Date:
Def. Recelvetl
Date De etl
Cl—k From Name
Neme of Pwmk Nok/w
I . Numbw
Cneck
I
Permlf Numbw/Comments--j
Recal f or RWun&Ra llocatctl
Column
Column2
Culumn3
umn
Cole
Co/umn5
Column#
Column?
I column#
Column#
3/24/2020
Wry Ennett do Ennett Marine Constructic
Bryan Griser Coastal Bank & Trust
2802
600.00
GP p76263D
JD rd. 10399