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HomeMy WebLinkAbout76453D - MartinhCAMA / ❑ DREDGE & FILL N9 76453 A B 3"ENERAL PERMIT Previous permit#�� 1CIew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued ized by the State of North Carolina, Department of Environmental Quality :oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC ❑ Rules attached. t Name 9Q'YO(v 'r �O�h m,;,Y 1't0 Project Location: County PtyJ (;V �--�t C State tJ L ZI P;� E-Mail ed AgentDO V)��� C CW EW COTA ❑ ES ❑ PTS ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A ❑ PWS: yes / a PNA yes / ))O ngth nber i/ Riprap length distance offshc x distance offslf cannel / )ic yards_ ip seYBoatliH Street Address/ State Road/ Lot #(s) sc yy�_L Subdivision 1 N I f City Sy w1 ('i ZIP L �� Phone # ( 1r--- River Basin Adj. Wtr. Body (V AA N� AA P, (tee C � Closest Maj. Wtr. Body obi w'L sLo N (� (Scale: ❑ See note on back regarding River Basin n AGENT AUTHORIZATION FOR CAMA PERNIT APPUCATf ON [Name of Property Owner Requesting Permit: kM59-r S%u'i —Wan l Mailing Address: kTI444So►J pry �SALE c,rna Phone Number: 103—�5�-3�11 Email Address: k►Jeti —Lo'k I certify that I have authorized thOiN . ��lu , Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all. CAMA permits necessary for the following proposed development:. n at my property located at PVI ATW4 41 So in County. G l furthermore certify that l 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: U' kgn`ature . Print or Type Name Title ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to r 's A //,, �� (Name of Property Owner) property located at I�3 1'jkitNS�O� KAiOD (Address, Lot, Block, Road, etc.) on WUL, , in LI , N.C. (Waterbody) (City/T n and/or County) The applicant has described to me, as shown below, the development proposed at the above location. f� I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must rill in description below or attach a site drawing) �t o5tlD \'-� WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to wain 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) ftiure %Q _ Print or Type Name /4-7 .dM#Jf6iJ IGAn Print or Type Name I -On dlJ �c ` CT ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to KJx 11' l na s (Name of Property Owner) property located at ��� A'fk la S er1 U DA a (Address, Lot, Block, Road, etc.) on , in N.C. (Waterbody) (City/T wn and/or County) The applicant has described to me, as shown below, the development proposed at the above location. V/ I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must rill in description below or attach a site drawing) VrJd'o N ► Qb� P i WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to wain 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. (Properly Owner Information) Si r e nl rMp.n,J ley 9= J Information) Print or Type Name I" A?ki.JSwJ ko. r (Name) _ _ Name o/WnNt Holder Vendor Chxk Numbw pack amount Ps ft Numfwr/C—ft R w RdundMoall—tod m3 Colu-4 Columnb Col.—O Column7 column9 Column9 rvices. LLC Cape Fear Manne Sean Winders nstruction Robert Park nstruction I Robert and John Martin FCB TrulieM 3313 $ 200.00 $ 400.00 . GP #71872D GP #74819D _ _ _ GP 4#76456D __ _, Ttnac rot. 10996 _ JD rot 10846 JD rct. 10782 WD rct. 10781 5548 _ _ Coastal Bank and Trust 3324 S 200.00 I Coastal Bank and Trust 1 3323 .00 GP #76453D