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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 Project/ Activity [ Vv; b y ,-I-A O l i -6A r r (Scale: (ly :k)length 1 I tform(s) Platform(s)FF i -- -- -I I I I I I I I I I I I I I Is III I III I 14-4i igth nbe nber I/ fZprap k distance 4 K distance annel ,ic yards ip r oa ' �Z illdozing ,Length 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 W Coumn4 Column6 Columns Column? Columns C./um-9 _ Glenn Lee Soach Same _ - David Lane _ -same LLC - games Allred - -_- Mindie and John HenryFC , BB&T _.. _ _ _ _ _ ____ Bank of America �.FCB ITower Fedeml CU B _ 2241 5366 S _ _ 200.00 . GP #76600D $ 200.00 GP #76424D S 20000 GP #76435D _ S 200.00 GP 976438S _ _ _ _. _ 0.009 _ _ 0 G1 ;BB rcl. 10223 Ben ret. 10293 _ _Ben rd 10288 _ Ben r a. 10291 Bd102DBB 1 1507 3704 223E