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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) nj iU M e sr o o d -oI'l. o C ailfied tvl l Fee , � '460 .. -ervIces -fee 7 rri Extra8s Fees pie cAcbox,add .air atej iw] Raturn Receipt 17 rU C 3 (hardcopy) Return Recelpt ;sltictrnrle) $ _. •'J »- 1 Ganified Mail ticstdcted Delivery $ � Postmark Here L7Ll. Adult Slgnatum required $ El Adult Signature Restricted Delivery $ Postage $0 . 55 r- 02/12/2020 Total tgd Er P-0 Cy(yy�' R7T%Qh ai» »pX� K �p'�i...X --b i�? !/Qri}-UB- r�N(------- --. ».. - - .« .T ..»..._ �»»._. ». J eC of fftr, r a,�' �.a_.. »....»_«._.»..R a Complete items 1, 2 and 3. ■.. Print our name and address do the reverse A. Si furs Cl Agent Addressee XAiQ y 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 ; ' l 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 'J kook5 14A. Millie jI j{ 3. Service Type 13 Priority Mail V*ressO C7 Adult Signature 13 Registered Mail'fm Jill 11111 E Adult Sig"bicted Delivery ❑ pegliveered Mail Restricted 9 Q2�� 4� i 4 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 ; --- - - i I fy i i I I j I � i l