HomeMy WebLinkAboutRoyer, Jack 78803C�kbAMA / ffiDREDGE & FILL N( %fiii�) �r
�G,ENERAL PERMIT Previous permit# A B C °
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit Issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC_��
l Rules attar ed.
Applicant Name t ! Project Location: County v
Address_ I%2�J (�r iy� Street Address/ State Road/ Lot #(s)�.
City-- (� -- State ZIP
Phone # "y' 93E-Mail Subdivision__ �.�- � �,
Authorized Agent _ ( G-C t J I n t city—.----- ZIP
Affected UCW _L�LW 'ETA .bES ❑PTS Phone # (_)_ River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body
an unkn
ORW: yes /(6o) PNA yes Closest Mal. Wtr. Body 0GtC3
Type of Project/ Activity
Pier (dock) length_
(Scale: i I F I )
(''4
Fixed Platfonn(s)
__.
Floating Platform(s) _
-
Fingerpier(s)
Groin length
�,uber•
Ipvlkhj Riprap length fl -,..
ag distance offshore
max distance offshore_
_
-I
j
Basin, channel _
_
Y
I --'
-f=.
cubic yards
Boat ramp
—L
Boathouse/ Boatlift..--
i
J
Beach Bulldozing_
Other,___
s..
{t I ri:-1.;.<:�--,.--:-�I- � r
_L�ts:
!_ l I
. �
..t•GS
i, C�1' n., C.` � f�- ._ ; I
Shoreline Length
$AV: not sure yes no
�t
Moratorium: n/a yes no -- --- -
Photos. yes no
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/Special Conditions PccnPft'
A'l C 1f�t4
t or Apph nted Name — —"
CSignature I readcompi cestatement onback ofpermit**
Application Fee(s) Check #
t' tt.fy F\ig({{ .
❑ See note on back regarding River Basin rules.
AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: S� tarn -Li 41��'TH �Q` G-2
Mailing address:
SJ(�
K)C 2ZV)o
Telephone Number: Q3`1 - 5 �3 - CAS 3 1
I certify that I have authorized C q-W06- (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of INy 1 w � t k 2ol )
at my property located at S pu SLA- C8T'6-
This certification is valid through
Owner Information)
�T err
Print or Type Name
(DU(N 62 S
Title, co. owner or trustee for property
( / I `i / 1-0
Dates
G3")-� 33-CAS 31
Telephone Number
(date).
I hereby certify that I own property adjacent to :TN('1C -t- C a-Z4&i N 'RQ4, ? s
(Name of Property Owner)
property located at 5 to 564- (;' �- DQI' 1 r':7-
(Address, Lot, Block, Road, etc.)
on TCL-) in wrt '27%7 ILL
(Waterbody) (City/Town and/or County)
N.C.
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)
t
WOPp5c o
P'Wzo,< ► z0,
-:5 (-\C Y'-
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.
Owner
0\ 5
Print or Type Name
td? SGA anrrr fi2�1lG
/M�a�iling Address f
1 \/�jL�t71irL\ l�
City/State2ip
rl 4. (Z—rl O
Type Namer
Mailing Address
S�il� Pori cJ .L .
City/State2ip
') -Z)
Telephone Number Telephone Number
Information)
I hereby certify that I own property adjacent to \Nor. + rLT7A L,ctN 1�2J`:GQ 's
(Name of Property Owner)
property located at S 06 _S6a e- n-r4- 7R. d
(Address, Lot, Block, Road, etc.)
on TCW in__N %)=,ya2T tit N.C.
(Waterbody) (CltyiTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
_L,If� 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)
�1�JPG5(.n t,J 4.11,
ppvaw
WAIVER SECTION
understand that a pier, dock, mooring pilings, 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.
M67 1 do not wish to waive the 15' setback requirement.
Owner
f/
Name ' Print or
Information)
Marling Address Malting Address _
�t J?o2T rJL �(w>ctr s�c—lo
Iftat iip Cdy/Stateop
-ISS' / O l`T<''r'l U
Tele hone Number Telephone Number--�—
_
I
IAIWO-u 12
04 VI.,
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