HomeMy WebLinkAboutSea Gate HOA'
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PERMIT Previous
O'New []Modi8catipn [] Complete Reissue LJPartial 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 I SA NCAC
EE Rules attache
ApplicantName/ Project Location: County
Address Street Address/ State Road/ Lot - ~ (s)
State A-,
City —
Phone # Subdivision
ZIP
Authorized Agent
River Basin q J`c,
Affected
AEC(s): — OEA — HHF — Adj. vvrr.
o
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OR�y �m/�p/ PNA �m�y� ----
--
Type of Project/ Activity
'jerk ""°=
pmedplatfom
Floatingplatfc
Fingerpier(s)_
Groin length
Rip
avg dist2
U moxoun
cubic yu
Boat ramp__
Boathouse/ B,
oeac»auomo
o cmxar
Shoreline Len
x*v n
Moratorium:
Photos:
Waiver Attacl
A k HA;~ �
'`"=="6p=""`^~,~~'~,~^^~~/ - `
,,-'Agqni or App!icant Printed Name
Application Fee(s) Check #
PermitOfficer's Printed Name
Signature
Issulng Date Expiration Date
AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: ,�Fa c-yyQ Cm Nu�-s !-N-s-SDc
Mailing address: 7-27
Telephone Number:
I certify that I have authorized CQ-0,0_ (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all LAMA permits
necessary for the proposed development of 1 c�& sf. Ao rA-LL
Q C P � 4(l61 � `ten �Z-PXVQ, _
at my property located at lag � � �fj. "V
This certification is valid through
(Property Owner Information)
L Signature
Noammj A Piv :::,o.
Print or Type Name
Title, co. owner or trustee for property
3 // 2o2v
Date
a sa 72 S as a 3
Telephone Number
Email Address
(date).
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i hereby certify that 1 own property adjacent to - -1 r &-,t/Ys{Z 5 ,4�r 's
(Name of Property Owner)
property located at
(Address, Lot, Block, Road, etc.)
on CS.,�, , in 1i(ao? lx-k , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locati9p.
Vi I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
TC
�hll.1L�+EQ4
10
WAIVER SECTION
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Sj*gnature
CSC
Prin � Type Name
lG�
Mailin Address
- /�8G sAFr+ D/Z
Cityh&O�Jaltr
p JC7C,, lid. �
Telephone Number
a? CA '2as as 3
Date
3 J /2,0
z�
(Adjacent Property Owner Information)
'al 9
Signature
cwat&s
Print or Type Alame
Mailing Address
t\U413009-1-
City/State/Zip
Telephone Number
� -1/ - a)-Oxo
Date
(Revised 611812012)
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i hereby certify that 1 own property adjacent to ! .... l 's
(Name of Property Owner)
property located at
(Address, Lot, Took Road, etc.) --
on in ii&wDo x , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatio p .
VT 1 have no objection to this proposal.
-_ I have objections to this proposal.
DESCRIPTION AND/OR DRAWING GP PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or aftach a site drawing)
100
WAIVER SECTION
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 ln.iflaiI 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)
ea�
Signature /may
..YY_ wM4 CZ-47- emu.
P) or Type Nam
lV 0 *V *4)
� S'�Addr ss
/
-- - i*
C1tYV'$tate1z10 Md as s?o
Telephone Number
Date
l
(Adjappnt Pr perty Owner Information)
�/ 40/2 e-11, �;J/'//
Si nature
CA W�/ �.
Print or Type Name
Mailing Address
cltyi' tegip
9-. -5
Telephone Number
7 — i I --2--o®to
Date
(Revised 611812012)