HomeMy WebLinkAbout76579D - Ward-ICAMA / DREDGE & FILL
3ENERAL PERMIT
!Aew ❑Modification El Complete Reissue El Partial Reissue
>rized by the State of North Carolina, Department of Environmental Quality
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
N9 76579 A B
Previous permit #
Date previous permit issued
it Name U, N'k 4-'v o V\ s ° V v A' d - Project Location: County
Cj5 U b U ✓xn T z A (jL• Street Address/ State Road/ Lot #(s)
U
State NC— ZIP 2%(1I4
E-Mail
zed Agent
I ❑ CW EW 3aPTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
yes / no PNA yes / rfio
Subdivision
12c 1 U
❑ Rules attached.
tr NT �
city -� C, (" :,- 1 L, -:!�, (-) U N 1,--, ZIP Z '�L
Phone # ( —1 River Basin W
Adj. Wtr. Body T3 r ^) k--` C-+YNN e" na
Closest Maj. Wtr. Body Tp(�'-'A I L SU v N
f Project/ Activity :�J D o 1 i/ N'j ^ F F t- U A 7 f PZ- -A7 f=O,
('
(Scale: _
xk) length
'latform(s)
; Platform(s)�—�
a gth
� r
ad/ rap length_
(g distance offshore_
iax distance offshore
:hannel \
jbic yards_
mp
use/ Boadift
3ulldozing
d
Attached: ye4-) n X I—
ling permit may be required by: / i��f� �L / �` 1� ❑ See note on back regarding River Basin
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to I 'Q,YY?erno ai' va—'s
{Name of Property
property located at VS p� er )
on (Address, Loaf
�n W(aferbod in �L�� Gl�` �'1 N.C.
yf (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above loca#ion.
I have no objection to this proposal./qw", K
`t' Y \
I have objections to this proposal.
DESCRIP71ON ANWOR DRAWING OF PROPOSED DEVELOPMENT
(Individual prapasing developmentmrist fill in description below or aftach a site drawing)
5-ez Ada e.hd .9 W-VVA �
WAIVER SECTION
1 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 set ck, you must initial the appropriate blank below.)
' I do wish to waive the 16' setback requirement.
I do not wish to waive the 15' setback requirement.
(ProPer'tY Owner In
Signature
meron Ward
Print or Type Name
15501 Possum Track Rd.
Mailing Address
7614
Property Owner I fornnatio
/ 1 iLAa�
i Ktre' w �
o dit, L. a
ADJACENT RIPARIAN PROP---- OWNER STATEMENT
I hereby certify that I own property adjacent to
Property located at
on a ( (Address,
(Waterbody) —"m "
Ct,V Is
of Property er)
and/or County)
, N.C.
The applicant has described to rne, as shown below. the development proposed at the above location.
I have no objection to this proposal.
�.._.� I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMF-w
(Individual proposing deve/oproerrt must fr/I in description below or attach a site drawing)
S,fz A- ached.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, baathouse, lift, or groin must be set back a
minimum distance of 15' front 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
Signature
ron Ward
Print or Type Name
15501 Possum Track Rd.
Marling Address
7614
City/Statetzn
(Adjacent Property Owner Information)
Si txa e
Print or Type Name
Marrng Address
AGENT AUTHORIZATION FOR CAMA PERIMIT_APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address: c.
Phone Number: r I y L� -/) /� 1
Email Address:
certify that I have authorized Z,1 ! l/I/Wo vs t, fll
9
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: El, ra tr!
at my property located at
in C21L",L/ County.
I 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;
Signdture
r? 71 ic'VL
Print or Type Name
Title
Namo
Name or Pwmlf Noldw
Vendor _
Chalk
Chalk Num6ar mount
Par -if NumDar/Cammanfa
R-4pf or Raf—dIRaa11— W
n9
CdumM
_ Column5
CdumnB Column?
Coh-8
C01umn9
istruction, Inc.
ctruction, Inc
Cameron Ward _ Coastal Bank and Trust _
same BBBT
Carolyn Cogdell FCB
SaConsumers U
Sam
3284 $ 200.00
8298 $ 200.00
89001 $ 200.00
5022200.00
GP #76579D _ _ _
GP#76560D
GP #74652D
1 GP #76534D
JD 1Ct. 10244 _
JDrct.10245
Ben nct. 10420
IPA rct. 10774