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76446D - Puckett
]_CAMA / ❑DREDGE & FILL 1.t`1so No 76446 A B ENERAL PERMIT —`'0.` ` Previous permit# kNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued -ized by the State of North Carolina,Department of Environmental Quality (j ��0� :oastal Resources Commission in an area of environmental concern pursuant to ISA NCAC 7("I ` ❑Rules attached. t Name 1 a. '1 ck r A G=e-Tk • Project Location: County e 1('Ltkr` w i t,4 I y VS 'e r W►'\Io)S C,4e\ RcAd Street Address/State Road/Lot#(s) sv.g0.1rJ State NC ZIP d$41ZS 505 L.oCkWo1 tky f Rd SE ( gloll) (i(Z ►2 q g E-Mail /...... Subdivision „„/""---..... ed Agent —50e,, VA 0.ST. City gvl.V 0 ZIP d-gL/2 ❑CW 'FEW XPTA I*S ❑PTS Phone# ( ---''/ U River Basin L n' ElOEA ElHHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body - w (nat C PWS: �� } yes / no PNA yes /'no Closest Maj.Wtr. Body �J 'Project/Activity Re,Q1 ace... P f eX ckyj �;x er;, ae cX } (Scale: I ; u`atform(s) I A ck)length 1 x �Z, �D l(t f V � � � Platform(s) / ifit P ier(s) ngth T X ?O'Dea- mber _.;....._...., ; j......._._._ ���{ N IIMC d/Riprap length —' ' _....0...__. ;_......_......_./�^' I _. Jr / ►) — distance offshore r Q6(l�lll����� i IXdistance offshor / • ; i « / ' 1 cannel Dic yards z . I I k Are E frh 1L/ np Ise/Boatlift t -`—; 1 — ulldozing j r / ; ; I 1 t i ,1 «./ N).1 titi if i yr itfyi,,, ,,/r. 1 e Length .-3 Ct Co.. ! ::\/! % ti i I / ,' not sure yes 0 +..-..- i ......--I- --T--- afkki •cum: n/a yes no F ...-4, 1 ! .. 1 ... _ _.' � {. ..__.— A� . ..... M V41 S...L V yes no f-F�7- Il... C. 4ttached: yes no L 171 e1 Sv Fd 14 Q j is�1.,{b�'- ic C. ng permit may be required by: Of�r S wt ' C-DULVTLI I I See note on back regarding River Basin r Local Planning lurisdiction) - , i 1 _ i I . i I r ! I i , AGENT AUTHORIZATN FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit rQ X .a X . T v'k e 74 74- Maing Address: / /�' 5 fit? r1itq S CA Pe / Rd �lirga� NC o? 8APc2..5 Phone Number: qi P / / 9 4y' Email Address: t/Arpu e n'1a ;l, c a I certify that I have authorized Joel Klass Agent/Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development Z l c c u' QLla/ d L 1►'t q q ;Ai !orNt, at my property located at c h ocksi. oo 1 /c//. �pr S� )/, J, �- 'F 01 in j1-,4 n s A.J.' k 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 Infornatlon: Aire-A*1- 7o Tu G7, 74- Print or Type Name ©0//L,t-f� TitYe 5' l3/ l07-e7 Date ADJACENT RIPARIAN PROPERTY OWNER STATEMENT ,7 /� hereby certify that I own property adjacent to ; t d� 's r � � n e of Property Owner) property located at S f_,) h- c C� Lr�I ne/1 'i Kd. S (Address, Lotlock, Road, etc.) on . k' , in fit lr�� A prow la, , N.C. (Waterbody) (Clt�i!Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. t t 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, boat ramp, 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 setback, you must initial the appropriate blank below.) f f"-1 Y I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) (Adjacent P perty Owner Information) Si .Si A. I, P 4-4-424- A . M Gpx.1 Print Tme Name Print or Type Name !Y h5' iI ir.Py CL5erd ,d ?O 6 S; Mf Ing Address c- Mailing Address 777'17— ti"---4— - * 1S S' S S S 4 S ' s' • it . i _ •‘_ -4--....44; "t., T ' ! ' --r----t— 1----'1"--, 1 ---, -±-4. , , . , \-'.. 4............4._ ..i 4 ,....,.....,,, 4.. ... ,....... 4„, . 4 . L. „.... ... f.4 4,-? .... i i SS S I 4 . i ; ; f-- 'i 4•11•=01.............. ".... Cf. (V I viit zi ', t I it i Lt ' e- i ' 1 , ; 1 - -.1 1 1 : i ".?. 4 lo• :t.- 4." I 1 .1, , . . ., ' i 4 !, '4,....,...... _ 1 , . . . . 4 ,i, ,, ,.., ...... . _4 i 4 ..:::t- ----v------ --T 1 I ' - I , f , i-- ,1 1 i ... ; .......----, t ( - , ' 0 -` • . 77 - 1 I / e , J i ' 1 . 1 .. . . JP I -'\Al..01.5c. Al/ p744 14 l'7C7 A . I 1 . . igifi/Zici X/ it,, 7 77,, Off'D'y "r7 1 .1-• t- 1 *-7747” - `'e'et.teet'etteeet"et'l'e— .t"'" ‘ ' t ' t--- i :.• , , , I ) - 4 i ..',.^...,- .-M-. .. , ; it, , Sr .1, •,,,— ia - y . ri I , 1 / 1 1 1 ',.. — . e 1. t' 1 . --L-4,-.J— ' i '*I—4 • ''si AN '." —A• —-1,—4 •