HomeMy WebLinkAbout76592D - MontgomeryAMA / O DREDGE • FILL W 76592 A B C
ENERAL PERMIT Previous permit #
ew DModification ❑Complete Reissue 01'artial Reissue pate previous permit Issued
.d by the State of North Carolina, Department of Environmental Quality l ,�-y
Istal Resources Commission in an area of environmental concern pursuant to I SA NCAC % 7 l7 • �� OR attached•
Jame Y�Go "roject Location: County, 14�
Street Address/ State Road/
Lot #(s)__
ZIP
State
Subdivision
Q)g _ E-Mail ZIP
I Agent _ City---6�'-r -
)E CW 2 jE W PO PTA El ES 0 PTS Phone # () River Basin
❑ oEA 0 HHF ❑ IH ❑ URA F1 NIA Adj. Wtr. Body
C] PWS:
Closest Maj. Wtr. Body-� ---- --- -
s / r�o PNA `J / no
'roject/ AI
Mal
E j +
latform(s) 7C] YZ - ber
-
Riga leeno
distance offshore
distance offshore
innel J; - r ---i— #
L.-
e/ Boadift n CC"C 171
ildozing-
Length
not sure
urn: r4a
ltrached:
W�
9fT
1
❑ See note on back regarding River Basin r
i
J//-I w I 1.
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that i own property adjacent to eorallkJIL^ e r 'S
property located at' ro (T/G�cOr �{ y (( ( "
1r 1L a
r�hp
on Ueir r C �P_Pt� (Address, Lot, Block, R ad, etc:}
in �zw ( tiuyer C� , N.C.
�aterbody) (City/Town and/or County)
The appllcant has described to me, as shown below, the development proposed at the above locatio
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)
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 wail
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 requi
(Property Owner Information) ( c It rope caner Information)
Signature
�rLf �
Print or Type Name Print m
��w ,� rrK k,1o11 o e o� , 0
iy
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to fit 6'Y- t t k too 0 r,-,e ►- .s
/ (Name of Property O er)
property located at 02 �(p �t/C�cor k&' I l l9Ci _
c
on )�7Ue rv7Ts Cie e (Address, Lot, Bloch, Road, etc.)
in 1P.G✓ H-Gi-,oL)e-r- Co N.C.
(Waterbody) (CitylTown and/or County)
Three applicant has described to me, as shown below, the development proposed at the above locatior
44— 1 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)
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.
1 do not wish to waive the 15' setback requirement.
(Property Owner Information)
Sn ur��, l` `t 1 Print or Ty,ppe N me
�Qlv N! c r► kho(1 /2d
(Ad ja ent Property Owner Information)
Signa Z
L
Print or Type Name
21 D Kw-r-'oaY KN4LL. izr
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E, v fe--t- EJ
C, v
Check
Name o/
Column$
_.'PNC Bonk _ 130 E 400.00 GP K76595D Pgrt 70Y54
same PNC Bank_3116, E __ 400.00 GP a]65480 BB rt 11528