HomeMy WebLinkAboutWorth, TravisCAMA / ❑DREDGE &FILL
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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
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Phone # O River Basin i/j dI l i (`' i_!Y
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A building permit may be required by:
( Note Local Planning Jurisdiction)
j
Notes/ Special Conditions ^ C^ - ' I, 0) I ti C f
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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)
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