HomeMy WebLinkAbout74818D - Henry1'CAMA / LI DREDGE & FILL NO. 74818 A B
MN ERAL PERMIT Previous permit #
1$4ew --]'Modification [-]Complete Reissue El Partial Reissue Date previous permit issued
•ized by the State of North Carolina, Department of Environmental Quality
:oastal Resources Commission in an area of environngental concern pursuant to 15A NCAC
/ ❑ Riles attached.
t Nam �'1 `� / U AeA^! Project Location: County /Q
Q G S Street Address/ State Road/ LoG (s)
State rG ZIP 7/%4-(
`�L)� Subdivision //•�
ad Agent v c� Y City C -�/ ZIP
-ICW )j�EW ❑ ES ❑ PTS Phone # ( )-------- River Basin W '
OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
PWS: Adj. Wtr. Body � p �� 6 . � nat
f��`y Closest Maj. Wtr. Body U �✓
yes /(fi ) PNA yes )O
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not sure yes
um: n/a yes
yes n
ttached: yes
ig permit may be required by:
.ocal Planning jurisdiction)
❑ See note on back regarding River Basin ru
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
D
W, 1) -714? s
c
45'541'- 539' &6 36
11
I certify that I have authorized L2& "�007:�
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at
in 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:
Signature
Print or Type Name
`Uzz . X/-.
Title
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i
I hereby certify that I own property adjacent to VQ 's
property located at 0 by v-h 6&& � ( me o Prop r1 Owner)
on � (Address, Lot, Block,, e � /
, in N.C.
(Water ody) ( ityaown nd/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
h 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)
vy m 1
460 J %1 lfYl 11�'
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 waiv,
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) (Ad' cent Prope Owner Information)
Si a Si ature
Print or Type N e J P6nt or Type Pme
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to S ? s
property located at %'7` J-�' ^(Name of Property Owner)
(Address,LLo� lock, Ro d, etc.)
on �'.C�f Z _ in �' , N.C.
(Wat body) City/Ta and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
I� �Z ICI I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in descriptio/n- below or attach a site drawing)
J 4
1
� f J
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 waiv
the setback, you must initial the appropriate blank below.)
l I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
14,112e4 A�o V, '�— - I
Si ature
SI y
i e / ` �l
Print or Type Na e T Print or Ty e Nr� l -
n arm
Name./ P.—It Ho"w
vendor
Chock Number
Chock
mount
P—it Numhar/C—.—M
or RalundIReallocatae
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Coumn4
Column6
Columns
Column?
Columns
C./um-9
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Glenn Lee Soach
Same
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LLC - games Allred - -_-
Mindie and John HenryFC
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Bank of America
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ITower Fedeml CU
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S _ _ 200.00 . GP #76600D
$ 200.00 GP #76424D
S 20000 GP #76435D _
S 200.00 GP 976438S _ _ _ _. _
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