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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