Loading...
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 <Z-q,z Teleiohone iVurnber DC 4- e i1j.-61vised 6/18120121) FEB ."10 ?W-U DC -HD CITY