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HomeMy WebLinkAbout76423D - Whiteside�CAMA / ❑ DREDGE & FILL 9N ,IN ❑MRod'iALon P❑Complete El Partial Reissue N° 76423 A B Previous permit # Date previous permit issued -ized by the State of North Carolina, Department of Environmental Quality wy .oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC G j Ur� "14—rl t LCElRules atta`chhed. t NameProjecocation: ounty�f 14/\ S' "C.F- 5 - 13 bri guN -Ur ►y p Street Address/ State Road/ Lot #(s) ,r.tv�► Fs- tl S State NC. zip ')-8ly 3 v 11 r g Sf (M) 30 Z - 03 7&ail kw � 1 �es�c{ a rfl Mo I * Subdivision ''JJ ed Agent Can r i f L 011e 11 7i Q / Grit'; ►ip City 4 S a'ZIP a 7' ❑ CW XEW *TA ElES ❑ PTS Phone # ( �/ River BasinPe(�nat ❑ OEA ,❑ HHF ElIH ❑ URA El N/A Adj. Wtr. Body b Y\�j 0 ❑ PWS: yes / � PN� no Closest Maj. Wtr. Body Project/ Activity :k) length ` )O U itform(s) N Platform(s) ier(s) ngth nber i/ Riprap length distance offshore x distance offshore cannel _ sic yards ip se/ Boatlift Aldozing 1 Length n not sure yes no um: n/a yes no yes ;0E ktached: yes (Scale: I 24 " awv� ig permit may be required \by: O� b'1L 2:S El See node on back regarding River Basin n _ocalPlanning Jurisdiction) All c (' '11 AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property owner Requesting Permit: J Mailing Address: Phone Number: 8 3Rd- Email Address: k vA 'ye-f;ofer� aoI cfl. i certify that I have authorized CA rs pie rCtractor to act on my behalf, for the purpose of applying for and obtaining all LAMA -permits necessary for the following proposed development -. at m property d at � 7 .S� l 8 �� Sf fr�•k � �"`'' d N. �. a � 5�65, my Locate ' in_u�s+.-•`c f{ County. 1 furthermore certify that I 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: Signature Print or Type Name Title I - - CERTIFIED MAIL - RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner: Cka;cd Address of Property )/ 7 S E i 8 tA_� 124k �� € Lot ar Street #: Street or Road, City $ County; Ageni s blame #: "Kf Lt &44 Agent's phone #. 9k-��Y-0246 Mailing address. I herebv certify that I own property adjacent to t;ie above refer�ea property. The individual applying for this permit has described to me as shown on the attached drawingthe development They are proposing. A description or drawing with dimensions must bs provided with this letter. Vol ': iiave Tit, ol�l-cctions to this proposal. 111av oNeciions to diL`: proposal. Pleas . kek 6 : P r Prr3 rntte, . ; sv-��+ a ' per �t�p G�1 i ?f you have objections to what is being proposed, you must notify the Division of Coastal Wanagement (DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext., 'Mtmingron, NC, 29405-3845. DCM representatives ca» also be contacted at (910) 795-72t5. No response is considered the same as no objection if you have been notified by Certified Afait. WAIVER SECTION i i;nderstand 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 w,,sh to vvaive the setback, you must initial the appropriate blank below_) i do wish to waive the 1 `' setback requirement. I do not wish to waive the 15' setback requirement (Property Owner Informbon) (Adjacent Property Owner Information) ,,xutrerc Pnnt or Type Name Print or Tyne Name FLf�ifinn l., rttlrac : Mdl�lllCf /�t�Cjf $�S CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER-NOTIFICATIONIWArvER FORM Name of Property Owner- ���t � �`► �` 4 � Address of Pfaperty: )/ 7 S E i 8 '.15 f j� Z ., c>✓ �/. C. a2 ���J plat cr Street #, Street or Road, City & Coilrlf. -; Agent's name Mailing Address - Agent's phony i ^area: certify that i own property adjacent to the above referenceci property. The individual aootying for this permit has described to me as shown on the attached drawing the development:hey are prGposing. A description or dr_a1vintz, with dimensions must be pro -ir4od with this lette . JUIVC fit) � rn�tcctiotrs to this Proposal. -- ? ita�:c cil�ieriic�ns to t;;i;: t:rtilx�sal. It YOU have obj ectians to what is being proposed, you must notify the Divisian of Coastal Management jflCM) it :vrr"ung Within 10 days of receipt of this notice. Correspondence should be mailed to 12T Cardinal Drive Ext., .2rilmingtan, NC, 284t15-3845. DCM representatives can also be contacted at (910) 796-7215. No response is considered the same as no objection if ou have been notified by Certified Mai'. WAIVER SECTION understand that a pier, dock, mooring pilings, breakwater, boathouse, tit or groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me. (if yeu v.,sh to Naive the setback, you njust initial the appropriate blank beiow.l I do wish to waive the i;; setback requirement, I do not wish to waive the 15; setback requiremen, (Property Owner Information) 6f 4179-or al .... G/A'A s. td/ rr7;;r 0,- Typf? Name Ad Al t..1 ChfvlSfalel7ir --r' ,tie +gAddless n1C- �73�