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HomeMy WebLinkAboutWorth, TravisCAMA / ❑DREDGE &FILL N. 9 ���/.]�}^77 78492 n B c_ D ENERAL PERMIT Previous permit# New El 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 -- ❑ Rules attached. Applicant Name \ 1 Project Location: County 11 Address City State ZIPA. ` Phone # ( ) E-Mail — Authorized Agent Affected EICW '.b EW ��}PTA _--NES ❑PTS AEC(s): SOFA F1HHF ❑IH ❑UBA ❑N/A ❑ PWS: ORW: yes / no PNA yes / no Type of Project/ Activity Pier Fixe Float Fing Groff Bulk 8asl Boat Boat Beac Oth Shor SAV: Street Address/ State Road/ Lot #(s) i i r , f F Subdivision zip G �i Phone # O River Basin i/j dI l i (`' i_!Y Adj. Wtr. Body na m n unkn Closest Maj. Wt.. Body (Scale: �� ) m■■■■■■■■■H■NEC MEMO .IN 0 ...■.Nib On Platform(s) — NNE ■■■■■■■■■� ONE■■■■■■ EMEMNO■■ ■® SEE�.EEEE■:: ::::.EEI �EEEEEEE�::;BE�EEEMO EEEEE SOME ■■■■■■■■■■■■■®■■1l■ ■■ ■t�'.�!L1El�■■■ NOON a■■■■■■■■■■a■■■1§11/�■■■111113 ■EWE ME p■■■■■■■■■■■1!%�M■■►�■■�■M■■■■■■ No ■■■■■■■■■■■�■■Eli■■Is ME ■■■■■■ ■■■■■■■■ ■®■NINON ■■HENE■EufMgq■�■ cubic yards■0■■■■ON 1 IN ME ■I IiI■ ■■■■ ramp�■■■■■■■ . ■.■■.N■■ii®■.ENE■■. �■■ ■NONE■ �:1.::.� .■�m�■■ 11■■.E ®..EEO■■■■ .11■■■■■■■�■■■■■ Eii■® Bulldozing NOON NONE, MEII■■■■■■■®NOON■■ NNE..��...■�■■11■■■■■HHNo■Nei■■NNE NOON■ ■■■■..■■■1111■■■NNE■■�1■NNE NOON■ EEEEE�Emil OE�■E NEES MEMO I Aine Length ■■■■■■■�■■11■MEMO NOON■ ■NNE ;, 'EEEEE ::�:::::� EEEEE' EEEEEE � /e. ��:::::: EEEEE MOT Phot Wa' -Lr A building permit may be required by: ( Note Local Planning Jurisdiction) j Notes/ Special Conditions ^ C^ - ' I, 0) I ti C f -, A 11( vt( or S�rxnature •*Ptease read ccjipliance rZtement on back of permit U / r Application Fee(s) Check # ❑ See note on back regarding River Basin rules. , t,y I CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner: Address of Property: /,U t- 2"" v"' ° ` "—rq (Lot or Street #, Street or R ad, City & County) Agent's Name #: OLA) / Mailing Address: I&JU ! aWki - ♦ Agent's phone #: RI - 2�d- r�i4t IZc �P l� xx ?7&oLr --__ -- 1 herebycertify that 1 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 descriction or drawing with dimensions must be provided with this letter. I have no objections to this proposal. I have objections to this proposal. If you have objections to what Is beingproposed, you must notifythe Division of Coastal Management (DCM) In writing within 10 days of receipt of this notice. Contact information for DCM offices Is available athtfp•//www nccoestaimanaaement.net/web/cm/staff-listinoor by calling 1-888-4RCOAST. Nn resnnnee 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, breakwater, boathouse, or lift 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. J� I do not wish to waive the 15' setback requirement. (Property Owner Information) A... j i Signature W.A Al :.• Print or Type Name L (Riparian Property Owner Information) e6e�� SZatu AKNotaV Bno1AK0�SKi �buise U.u�9i0t -e- Print or Type Name J&)Q RaAAe,'i SF• Mailing Address �gle'cl�, NC 7: 6vq City/State/Zip q19-260-%4? / f t)J t1, fw.• Odt,++c,l,tc y Telephone Number/Email Address Date Z I W, Mailing Address CitylStatelZip Telephone Number/Email Addre ii 10-19 Date (Revised Aug. 2014) CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner: ��hm d imkl t4Lo,b, Address of Property: 702 ra,M.0 Cft&L LA <APxdJ fcrjl C�n�l0w CCAi. (Lot or Street #, Street or Road, City —T Agent's Name#: 01-✓ner Mailing Address: /6/(e ls'anncid it, Agent's phone #: `119 - rJV0 — 4Qr. vw(,; A. /Ve z700Li 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 provided with this letter. 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 wilting within 10 days of receipt of this notice. Contact information for DCM offices is available at hffn://www.nccoastalmanaaement.net/web/cm/staff-listing orby calling 1-888.4RCOAST. No response Is considered the same as no objection If you have been notiffed by Certified Mail. 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 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) (Riparian Property Owner Information) t7eillitfer Al 70W Rickakal S W09h Signature I USignature Print or Type Name _16/6 WPAAe 1( S1, Mailing Address Role rat NC 2z&o4 City/State ip j oft9-2Kti-�i41 I wcrlh�frc�a_�5r"�i•uti, Jennifer M. Jones & Richard S. Worth Print or Type Name Mailing Address C6,-wc , A/c 2g?-io City/StateMp 704-258-7973 jennajones067@gmail.com Telephone Number I email Address Telephone Number/ Email Address December 2, 2019 Date (Revised Aug. 2014) F m i m in m m = F f 6 0 A