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)
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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: