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HomeMy WebLinkAboutBennett, Harry 76325C.•. cAMA /�REDGE & FILL No. 76325 A B ENE L PERMIT Previous permit# New ❑Modifcation ❑Complete Reissue [-]Partial Reissue Date r ioKermit' ed As auth ruedby the State of North Carolina, Department of Environmental Quality1and the Coastal Resources Commission in an area of environ en I concern pursuant to 15A NCACach Applicant Na Project Location: County Address Jk An bn 1 i 1 0 Street Addressl State Read/ Lot #(s) / Cityi��'/.R�V0'Vlfi_Lr l�l ��iltlill ��l�it�P.T•►�11� .Phone -Mail SubdivisioAl law A!F Authorized Ajzent City �WFJOZHAAAHULWFWA rN El CW glqwl Jr Basin Affecte ■. ■ ■ ■ [I N/A�' fORW: ye Closest Maj. Wtr. .. ► ,�51-. El rr:,'"ilAl�t1� Type of Project/ Activity E)t 1 4�/A, (Scale: Pier (dock) length Fixed Platform(s) - : -- Floating Platform(s) Finger pier(s) Ll — Groin length er Bul head/ prap length avg distance offshore f max distance offshoreBasin, channelcubic 7V"V yardsBoat ramp Boathouse/ Boadift -- -— Beach Bulldozing Other - ! Shoreline Length _ SAV: not sure yes o - Moratorium: n/a yes o Photos: yes no Waiver Attached: yes o A building permit may be required by: ( Note Local Planning Jurisdiction) Notes/ Special Conditions n % h a . r1 Agent or Applicant Printed Name Dy t tre Signature *•PI eadcompliance statement onback ofpermit *'* SignDAppliFee(s) Check# lZ ❑ See note on back River Basin rules. Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: ar r// v le NNf'-t Mailing Address: %o c,.o,%.< I rg ; / AlF oN c a ej-:�-d Phone Number: r '7 90 a Email Address: 1 certify that I have authorized /4r Agent I Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: �1ii N7v '4 at my propertylocated at /� % a S"f. in Gar4fre- 4 County. I furthermore certify that 1 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 Information: i f - i�r ` / i 9FNN rint or Type Name vot'rr, Title RECEIVED 3 / `,S- / �2 �� Date MAR 17 2020 OCM-MHD CITY This certification is valid through -3 / /S / :� i ADJACENT RIPARIAN PROPERTY OWNER STATEMENT � 's I hereby certify that I own property adjacent to r-r(Name of Property Owner) property located at 1 �o �� Sf- (Address, Lot, Block, Road, etc.) C c / in on N.C. (Waterbody) (CitylTown and/or County} The applicant has described to me, as shown below, the development proposed at the above location. have no objection to this proposal. I have gTzjQctionto 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 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) nA Mailing Address A/E,-� RFrd NC a 8 Telephone umb 3� Date (Adjacent Property jOw�nnee_r—information) Signature ZZ&dn �✓�- FIE ! -- Print or Type Name ,-kr- 1 NZ al'sra d"-/0 RECEIVED (ReviseA408/049zo DCM-MHD CITY ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to property located at �FN�f7� s ( am e of Property Owner) /So u1 F,✓ Y -t (Address, Lot, on �'eL r✓ '. / , in (Waterbody) etc.) r. R-.'f 4 , N.C. own and/or County) The applicant has described to me, as shown below, the development proposed at the above location. L,-" I have no objection to this proposal. -- DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill in description below or attach a site drawing) 7�r t o Y Cc 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 t aive t setback, you must initial the appropriate blank below.) Ul I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement - (Property Owner Information) Print or Igpe Name .� ��� %, +tea ��� •('f5- /r9 � / Mailing Address p (/C a8s� Al_ _ :J L1F(FJ /V Telephone Nupber Date T (Adjacent Property Owner information) Sionature S�F✓F WiJSoJ� Print or Type Name n / 7 /tea iJE,,/ Sf Mailiyn� ddress1 aBSJa rl �il' f� 7 i L �E/1 � City/StatelLip Telepon n� Number 3 //s/3o -----RECEIVED Date (RevisedW/fM020