HomeMy WebLinkAbout75810D - Tanag:AMA / ,❑ DREDGE & FILL No. 75810 A B C
ENERAL PERMIT Previous permit # i
Date previous permit issued
Jew Modification ❑Complete Reissue El Partial Reissue P P
ed by the State of North Carolina, Department of Environmental Quality 74I 1200
astal Resources Commission in an area of environmental concern pursuant to I SA NCAC ❑ Rules attached.
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Project Location: County
Vame
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Street Address/ State Road/ Lot__#(s)
State ZIP * 7 7
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E-Mail �'
Subdivision
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d Agent C��cA
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City
ZIP
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❑ CW �EW
PTA ❑ ES ❑ PTS
Phone # (-�""� River
Basin I
❑ OEA ❑ HHF
❑ IH ❑ uBA ❑ N/A
Adj. Wtr. Body LT ill
❑ PWS:
Closest Maj. Wtr. Body Ja �:
,es / no PNA
/ s no
Project/ Activity —
3'
k) length__
tform(s)
Platfor
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distance shore
Lc dista a offshore
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bic yards
Ise/ Boatlift
Bulldozing"'--
ne Length t (D�
not sure yes CO
)rium: /.O/`aJ yes no
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Attacnea: yes 11v -- ` _/
ling permit may be required by: 15 W h 0� r la -: ' jaVf p
I —ni Plannino lurisdiction) , . - I I
❑/See note on back regarding River Basin
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Owner:
Address of Property: LAD2- G• `4 (�ch� DC -
(Lot or Street #, Street or Road, City & County)
Agent's Name #: C>(-eq �(f- Mailing Address:
Agent's phone #: Q 1 b 520 -- -1 18 4
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are propo ing. A description or drawing with dimensions must be provided with this letter.
objections to this proposal.
I have no objections to this proposal. I have � l? P
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405.3845. DCM representatives can also be contacted at (910) 796-7215. No response is
considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
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)
Signature
Print or Type Name
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Adjacent Property Owner Information)
gnature
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Print or Type Name
Mailing Address
Mailing Address
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