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HomeMy WebLinkAboutBain, Michael 76790C®'X CAMA J DREDGE & FILL Nn 76790 A 6 �c U GENERAL PERMIT Rw4k%4pern"M "` •('New _. Modification Complete Ret s L "PartW Reissue tau pnaotm pernw wued As a ha.xed by the Sun of North Cwohrw Department of Eft-OnrnenW Quaaty . d the Cosa Rtaa.na CamraronC_� r ar a d. neo tnentl ca c.rn pun'ur t toIsA NCAC_Q 7N 1 / ame p AppkcwK NOd ...L20`r n------- Prgecc location: Cwmr -_ ac'"�7�C $A St. en Address/ State Roa4r La N(s) 7�L_ 4r. (*J)- ca%seeNC v4�0 Phone Subdivitlon� Atrthomed Agent -- --------._ Cam'._-I�=tt CC. \7 ZIP--�g7��� .. LW <PTA ES C RS Phone . ( _.) ——__.._.._ Rnw Bak, wh t L1 k Affected OEA ' ;.-HW 1 *1 _ usA "'A AEC(%): r . Adj. Wtr. Body_],,,pr�—� kt•i-C/tCnx _/w>kn) oaw: rm � PNA yea )C;�) Closest Mal. Wtr. Body __I+lewc-i-._.iZi✓'._____-- Type o/ Project/ Acth4ty P.ar (d"i,) length 7' IKW�j , \ _...._ Fledledor Pm(tl �}r �O Fwtw Gran length marber B1Ah"W Rprap length..- rag detanct olMnre 1 _ � - - bun. dunwl cubs prda Boat ramp Btxh- Other N- f (scaw J r r r ) SAM na wn ra ro - -- f �—+ I J 4 1 1_ ( l 14"Orkan: Na ,w ro Pharr: pa no Warty Attached Yet no A btaMmg perms may be m wed bl• l n ( f n� Y u See rote on back neprdMR Ww Basra m WL ( Note Local K&ANIN g j WUOCeon) /� ► oteW SpecW Condkilo a A, ± f jr /J� boat s f 1 h� s � h1; Ise l _ga►n._-----_--- Agert • Pleas read carnPkw" ltaemve on beck of pert[ ^ H a,,,or,tee(rl OWA0 .erl.etO�c✓. ��° e,��_ i Slput f N MA / ElDREDGE & FILL NO 76790 A B O D G NERAL PERMIT Previous permit# ew ❑Modification [-]Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality —7 �) / and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 0 / P n ! /�,�` -I-_-j les attache . Applicant Name M� AI d'l Project Location: County (�'1'P a / Address �//�� � Street Address/ State Road/ Lot #(s) r �<9 btlj- J City State-Nf. ZIP J Phone # (AA 5 1_5 E-Mail I --Subdivision Authorized Agent El CW *W <PTA ❑ ES ❑ PTS Affected AEC(s): OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWs: ORW: yes no PNA yes /(P Type of Project/ Activity Pier (dock) length Fixed Platform(s) yid az Floating Platfor (s)/) Finger pier(s)_x�� Groin length number Bulkhead/ Ripmp length avg distance offshore max distance offshore Basin, channel I cubic yards i Boat ramp 7 Boathouse/ oatl'/ I %G Beach Bu in Other S f S i N Shoreline Length SAV: notsure yes Cno Moratorium: n/a yes Photos: yes Waiver Attached: yes A building permit may be required by: ( Note Local Planning Jurisdiction) , , Notes/ Special Conditions I/Ibl l'%C6P'l bcr w Agent Appl'ee�nt Printed Name City 0 ZIP Phone # O r River Basin / ' Adj. Wtr. Bodya� (li`p =Clt�at /g/unkn) Closest Maj. Wtr. Body tye—r 'r �r (Scale: ::__ ) ❑ See note on back regarding River Basin rules. Sigppture** Please read compliance statement onbackofpermit" Signat reOgAzo v /QjX o/Cl (!tom/J�� Application Fee(s) Check# Iss ng ate Ex ration Date ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to i 1 I c'yl am'% 6 G1 ) `I I I ( ame of Pro erty Ow er) / property located at 2 i%Q /% r t ct i An_ -ect11 /r'%: ✓// C, L (Address, Lot, Block, Rd' ad, etc.,) on GJreP Gy'e"'P- in C.rnr'ta-rri Cd• N.C. (Waterbody) ' (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. 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.) I do wish to waive the 15' setback requirement. y I do not wish to waive the 15' setback requirement. (Property Owner Information) Signature Print or Type Name Mailing Address City/state/Zip Telephone Number/email address Date (Adjacentrty�ner Information) '11-4' atu e�* I Loc-® A FfitLG�R✓�/�S Date 2 «S^ IV/ nber/email address *Valid for one calendar year after signature* (Revised Aug. 2014) ADJACENT RIPARIAN PROPERTY/OWNER STATEMENT I hereby certify that I own property adjacent to / / /CJ�(�e�/ � a / Gj 's AA M L (Name o rf p t Owner) property located at �y / /cl r/I S dI Nc�b i1u� A4G Z y (Address, Lot, Blpk, Road etc. on L19 Ire- ci;-e-"i in t�f,,'- . ) , N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. 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.) I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) �Sig aryre t�a�� Nc/l h Print or Type Al me MaTng Add ess -K, h.cTot, , N Zes 0 Clty/State/Zip p� 2.-�_2—S'2-1 Telephone Number/email address Date (Adjacent Property Owner Information) or 2q,26y Telephone Number/email address Date's *Valid for one calendar year after signature* (Revised Aug. 2014) �e "orf Ci t i '` 1. 111 M;J�/ Ida;� 100 Z�Au� i 2_�-2-s2/--Sid NC Division of Coastal Management Cashier's Official Receipt Received From: YV`t r,�apd &I n Permit No.: C1 2 Applicant's Name: &a" • Project Address: RECEIVED Jul- 01 291,8 DCM-MHD CITY 12027 A B OD Date: Tr r 20 Qh $ aBO 7C Check No.: // `"1 5 L3 a County: Please retain receipt for your records as proof of payment for permit issued. Signature of Agent or Applicant: Signature of Field Representative: Date: Date: