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HomeMy WebLinkAboutSea Gate HOA' NO DREDGE -- FILL ^~ ]��~ /9000 A 8 / C / O ' GENERAL������N��NN�� 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 - ~�_�/ ��aea M�.YVtcBody `-/= ^� 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)