Loading...
HomeMy WebLinkAbout76427D - Dodson?�CAMq► / 7(DREDGE & FILL ,ENERAL PERMIT blew ❑Modification ❑Complete Reissue ❑Partial Reissue N° 76427 A B Previous permit # Date previous permit issued rized by the State of North Carolina, Department of Environmental Quality -7 ( 11 oO// �Oo :oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC jT (� ❑ Rules attached. it Name D, ►' o \y D Dd SG►'1 Project Location: County ��LAY\ S W I. Lk D1410L 190ye Street Address/ State Road/ Lot #(s) 70044 F # � Qo k 1� State., 06 ZIP 761- E-Mail dAn,1rdcdfcr\ /�tal j/mow+ :ed Agent 'ftn1 r d /v ,^ l A.► 1 ❑ CW XEW APTA )(ES ❑ PTS ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: yes / no PNA `yes no f Project/ Activity Gt ck) length atform(s) B , X log Platform(s) z ngth tuber / Oipraplength7 g distance offshorey' w distance offshore cannel bic yardy np ise/ Boatlik ulldozing 1- —1_ n A — - .I 1 S6;r S e Length not sure yes no ___ -ium: n/ yes no yes no ..,,... kttached: yes no ng permit may be required by: Local Planning Jurisdiction) , Subdivision city DaLk _:t7S (ano( ZIP '�,T % Phone # ( River Basin GF f Adj. Wtr. Bod6� nat i Closest Maj. Wtr. Body w (Scale: I = d ��W h O 6%LK T_ ( � ❑ See note on�ckt regarding River Basin r AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: ki Mailing Address: Phone Number: ? 6 76/3 - (/n� Email Address: Atlp,\j PJ0(-)'6"\ ,,,J. Cpyyy I certify that I have authorized Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: A"/ k �� /I " r at my property located at %U �ac►�ovl iJr- , in dratPjA 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: Signature tint 6r ype ame Title i i "I llz� ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to (NanA6 of Property Owner) I property located at /(X2!1 /'Q5T �arJl•t �LJ — pp (Address, Lot, Block, Road, etc.) on c�eGk- OA-lr .-C w , in , N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above I 'on. 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. ;a"J Oroperty Owner for tion) G� Signatf� A-� C'-� Print or Type NaMe yb