HomeMy WebLinkAbout76104D - Jordan (2)4 GA iA / ❑DREDGE &FILL ((�� O. 161 LI
�CL PERMIT 33`�.26 Previous permit# A B C
Newgod�ifi� �n ❑ to Reissue El Partial Reissue Date previous permit issued
As authorized by the State of rttabro► Uepartment of Environmental Quality
and the Coastal Resources Co mission in an area of environmental concern pursuant to
Applicant Name V o- � 0.1
Address 1i UL
City �'�. t .� State ZIP2 9 S3(
I SA NCAC O A -1 z U o
❑ Rules attac!he,d'..
Project Location: County�n V�--
Street Address/ State Road/ Lot #(s)
Phone # ) 2 (� `�31 S E-Mail ♦c, a Subdivision
Authorized Agent p,n City a (S ac ZIP
Affected ❑ CW A EW O&TA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ WA
❑ PWS:
ORW: yes / rt6 PNA yes
Phone # ( ) River Basin f
Adj. Wtr. Body C O%M , (nat unkn)
Closest Maj. Wtr. Body - OW-4
pe of Project/ Activity A
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Agent or Applicant Print d3R ee
Signature ** Please read compliance statement on back of permit*
4 260 * 2
Application e(s) Check#
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Permit r s ' ted (Name
Signature
'L42-4 2� Le26
Issuing ate Exp tion ate
AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Perms
Mailing Address:
t.��'t0 tiela'� � O�► C�C7►Y\
Phone Number: �c 3 - of CQ `'t - %A- � X ffj
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Email Address: 4c12 1 cQv,4�1'5-V-
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1 certify that I have authorized VA S Q4-,�-
Agent / Contraclor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development
-T�k-'S
at my property located at `j-' -
inCounty.
I furthermore certify that I am authorized to gram 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:
Sign ure (�
r—�C.i+�. h
Print or Type Name
O�rQ.r
Title
4�6 /-a" �
Date
This certification is valid through 1 I
Das waif bybelow.4
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be- set a-.t'h a mAr:.,n car!s---e m .ama
me- i�rJ ,y u�Vi3h to 47ahm ;hx SG wSd }2"3 mus* What %he di,"r V •s* t-m41k bores
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CONSTRUCTION
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Defe Received
Defe Do
Check From Nunn
Name d Prmk Molder
Vend-
Check Number
Check
emounf
P.imh NumOw/Comments
Raca for R✓—&RwllocafW
Column!
Coumn3
Column3
COI-41
Columns
Column!
Column?
Column➢
Column➢
3/26/2020
H5 Construction, LLC
Thomas Jordan
BB&T
2486
$ 200.00
GP #76104D
BB_ rct. 10851
3/26/2020
Ralph & Colleen Graham (1 of 3)
same
Wachovia
1205
$ 200.00
GP #75801D
BB rct 10923
3/26/2020
Ralph & Colleen Graham (2 of 3)
same
Wachovia
1204
$ 200.00
GP #75801D
BB rct 10923
3/26/2020
Ralph & Colleen Graham (3 of 3)
same
Wachovia
1207
I
S 200.00
GP #75801 D
BB rct. 10923
3/26/2020
Oceanside Management LLC
same
First Bank
31081$
200.00
GP #76276D
BB rct 16925
MH5=
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address: \ D Cp 1 ,, l "c 1 Q
Phone Number:
Email Address:
l ow, , �- <- b
t )14 3 - Q ( 9Gl - l--i- a 1 ::S
At C) — --X v. —, Q, V,1 e
certify that I have authorized C—\ -s �ur �r�, S ��� ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAAM(A� permits
necessary for the following proposed development: a
at my property located at -2�>
in ram, County.
1 furthermore certify that 1 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:
Titre
Date
This certification is valid through
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to I-Aarn,cs ,fie ►' °- % s
(Name of Property Owner)
property located at 3 ���� S>���
(Address, Lot, Block, Road, etc.)
on , in OGe.zK -:r-se &e-t . N-C.
(Waterbody) (CitylTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
V 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)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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) (Adjacent Property Owner Information)
Si na 9L, v 91� �2
a wu
1 7Prn�in
Nameke
in Address Ma' ing Address
City tate/Zip C! /Sta e/Zi —
Telephone Number/email address �- Telephone Number email address
—T(O
V Dine
er. i a oC.- a
(Revised Aug. 2014)
'Valid for one calendar year after signature'
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