HomeMy WebLinkAboutBayshore HOA,2'CAMA 1:1 DREDGE & FILL NO. 78979 A B tC' D
GENERAL PERMIT Previous permit #
ITNew El Modification ElComplete Reissue El 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
F1 Rules attached.
Applicant Name
Project Location: County
Address Street Address/ State Road/ Lot #(s) c7
zlp;�:
City. State
Phone # E-Mail Subdivision*
Authorized Agent City ZIP
Affected El Cw D EW WtrOTA ❑ ES El PTS Phone# River Basin
El OEA 0 HHF El 1H 0 UBA El N/A 1.
AEC(s): Adj. Wtr. Body t "(Pat /man /unkn)
0 PWSI:
N
Closest Maj. Wtr. Body
ORW: yes.,, no PNA yes /,",no -
Type of Project/ Activity
(Scale:
Pier (dock) =
Fixed Platforn
Floating Platfc
Finger pier(s)_
Groin length
number
Bulkhead/ Rip
;avg dista
max dist
Basin, channel
cubic yai
Boat ramp .
Boathouse/ B4
Beach Bulldog
Other
Shoreline Len
SAV: n
Moratorium:
Photos:
Waiver Attact
Y
A building permit may be required by: 0 See note on back regarding River Basin rules.
Note Local Planning jurisdiction)
Notes/ Special Conditions
J I
Agent or Applicant Printed Name
'41
Sign, ature "Please read com iah` ce statement on back of permit"
Application Fee(s) Check #
/'Y
Permit Officer's Printed, Name
Signature f
issuing Date Expiration Date
AGENT AUIHQR Z&TION FOR ._LAMA jPERMIT APPL1QA.T19N
Name I of Property Owner Requesting Permit: Im � L Lffle ✓50
Mailing Address: E ve,
Pho*ne Number: C 1 a " �u � "
Email Address:
I certify that I have authorized L110L 11
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all LAMA permits
necessary for the following proposed development:
at my property located at cAUK',
in 6 l � i b Lb . -county.
I furthermore certify that I sm,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.
Print or Type Name
b A
Title
'7
Date
This certification Is valid through I
010 A4 c. i►(. i Al.:
f
Name of Property Owner Requesting Permit:
A
Mailing Address.
Phone Number:
Emall Address:
I cert'rl~y that I have authorized
1.1-1 -� / 0 -.2
^WW It ! LOW luidt;tur
I
to act on my behalf, for the purpose of applying for and obtaining all LAMA permits
necessary for the following proposed development: 1 "�° � ,�
at my property located at Ll V f .i (301
in ' County.
i furthermore certify that i am authorized to grant,, and do in fact grant permission to
Division of Coastal Management state, the Local Permit Officer and their agents to eater
on the aforementioned lards in connection Wth evaluating information related to this
permit application.
PrO aner Information:
Print or Type Abme
Title
Date
This certification Is valid through 1 !
CERTIFIED MAIL -RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Mailing Address: ' L�*/)Jji # L41�
Agent's phone #: '�--�-%�A,�r�
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. t.,.n� .� n., j o
S _ . , , y am:,, ..wi ° #' � �.4 . .
14
l I have no objections to this proposal. I have objections to this proposal.
P 17
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 h.tt L/1www nccoastalmana ement.net weblcMlstaffiystinct or by calling 1.888.4RCOAST.
No nes once is considered the some as no ob action if you have been notified bX 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 m s�tial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
1
l do not wish to waive the 15' setback requirement.
(Property Owner information)
Signatur
1!,-Ve-, -----
Print or Type acne
4haq Din ve
Mailing Addra
&r
City/Stste2ip
Telephone Number/Email Address
_A - I I :-8
Date
(Riparian Property Owner Information)
Signature
Print or Type Name
/0-(9 • A,,,- .
Mailing Address
City/StatelZip
9Ia- . -Z 7-3 3 c?
Telephone Number/ Email Address
Date
(Revised Aug. 2014)
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C ailfied tvl l Fee , �
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Extra8s Fees pie cAcbox,add .air atej
iw] Raturn Receipt 17
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(hardcopy)
Return Recelpt ;sltictrnrle) $ _. •'J »-
1 Ganified Mail ticstdcted Delivery $ �
Postmark
Here
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Adult Slgnatum required $
El Adult Signature Restricted Delivery $
Postage $0 . 55
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02/12/2020
Total tgd
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a Complete items 1, 2 and 3.
■.. Print our name and address do the reverse
A. Si furs
Cl Agent
Addressee
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so that we can return the Card to you.
r Attach this card to the back of the maliplece,
B. ef�red by (PH,
Da of�DeNvery
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or on the front if space permits.
1. Article Addressed to:
D. is delivery address different from item 1? Yes
if YES.- enter delivery address below: No
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14A. Millie
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3. Service Type 13 Priority Mail V*ressO
C7 Adult Signature 13 Registered Mail'fm
Jill
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E Adult Sig"bicted Delivery ❑ pegliveered Mail Restricted
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0 Certified MWiV
0 Certified Mali Restricted Delivery ❑ Return Receipt for
n r.,,►la... -» "slivery Merchandise
elivery Restricted Delivery 0 Signature Confirrnation'rm
2. ArticlmK� T '- - 0, Signature Confirmation
D D 2 3 4 6 6 Q 3 �� ;Re�trt�tea Restricted Delivery
D y g Q 7 0 D D .
Delivery >
over $500.
P3 dorm 3811,; April, 2015 PSN ,p530-02-000-9053 ;
Domestic Return Receipt ;
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