HomeMy WebLinkAboutHightower, JosephCAMA El DREDGE & FILL
NO. 78500
GENERAL PERMIT
A B C D
Previous permit #
A'New El Modification [:]Complete 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 NCA C
nRules attached.
Applicant Name Project Location: County
Address
Street Address/ State Road/ Lot #(S)
City State zip
Phone. # E-Mail
Subdivision
Authorized Agent
City ZIP
El CW E Ew _Zll PTA [I ES El PTS
Affected
Phone River Basin
[I OEA El HHF El 1H 0 UBA El N/A
AEC(s):
'J,
Adj. Wtr. Body (nat '7mftn'/unkn)
Ej PWS:
ORW: yes nor PNA yes
Closest Maj. Wtr. Body_
.-J
Type of Project/ Activity J
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
T
Other
Shoreline Length
SAV: not sure yes no
Moratorium:
Photos:
Waiver Attached:
yes no,,, -
yes no
yes no
A building permit may be required by:
Note Local Planning jurisdiction)
Notes/ Special Conditions
.Agent or, Applicant Printed Name
Signature Please read compliance statement on back of permit
1
Application Fee(s) Check #
(Scale:I.
El See note on back regarding River Basin rules.
;�► AGENT AUTHORIZATION FOR CAMA PERMIT: APPLICATION
Name of Property Owner Requesting Permit.10 1A 111"Cteb_-we
�
Mailing Address: ..
Phone Number:
Email Address:. I �` nci5
I certify that I have authorized
v v
7ne,,s ,
Agent / Contractor
to act on my behalf, for the purpose of -applying for and obtaining. all CAMA permits
1
necessary for the following proposed development:
at rn property located- at4" PrI V,
Y l� N y /
in Cr' County.
1 furthermore certify' that .l 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:
Signat
Print or Type ame
Title
Date
This certification is valid through
DCM-MHD CITY
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
thereby cert- that I own roe adjacent toP
Y >fY property >tY J
_ .,(ame of.prwerty Owner)
property located at �
(Address, Lot, Block, Road, et
on -,in (t� N-C..
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
ioFation.
�► i have no objection to this proposal.
�I havecz�j��tior_ts�o�is_pCopos�L
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must ill in description below or attach a site drawing)
LISt
r)1) (-ct2 0
E&
--- t-
I understand that a pier, .dock, mooring pilings, breakwater, boathouse, lift, or groin 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-)
Vv� I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
Si ignat e
Print or Typd Name _ Print,or Type/?tame A
/ Ve
Mailing Address V
rzi n C a
City/Sta bfgip
V/17 got 29 9K)
Telephone Numbpr
Date
ECEIVE
(Revised 6118 ���)
1 ®2oZo
D-HD CITY
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i I hereb
y certify that I own property adjacent Ito
property Jecated at (Name of. PrWertyOwner)
(Address, Lot Block, Road, etE'.)
on
lWaterbody) (City/Town andlor County)
he applicant has described to me, as shown beiow, the development proposed at te above
I have no objection to this proposal-
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing dift-velopment must Fill in description below or attach a site drawing)
. j Jea t,-t I r
AD rz—
rz-4 ��, m
i-,it a pier, dock, rnooring pilings, breakwater, boath onise, lift.; -or groin rnust be Set
-.-.ack a minimum distance of 1,55' frorr, my area of Nparian access unless %tiaive—rd by me. "if you
,Msh towaive flhie setback. yo-L, -must initial the appropd. ate blank below.i
!:S:�> — I do wish to waive the 15'setback raquirement.
I do not wishto 1,uaivre the 15'setback requirement.
(Property Owner Inform. ation)
Prim or —7yp-JN3,-17e
—
A Aelailing Address IJ
--fephcne iVUMD'ier
Date
In -formation)
Pfin.,"or T�ype fiame
41aftine Address
V46 -4 o
Cjtyl-StatelZip
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Teleiohone iVurnber
DC 4- e
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