HomeMy WebLinkAboutChambers, Alan 77125C/ V LAMA / 1-1hT DREDGE & FILL ? 77125
r. • GENERAL PERMIT Previous permit# A B CC, D
6
ew ❑Modification El 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 15A NCAC
'Rules a tached.
Applicant Name �i Project Location: County
Address C C �� Street Address/ State Road/ Lot #(s)
1
City ii State � ZIP
Phone #) E-Mail Subdivision
Authorized Agent �t°� CityZIP
❑
Affected ,`w _,*TA ❑ TA ES PTS Phone # ( ) River Basin
AEC( ): ElOEA ❑ HHF ❑ IH ElUBA El N/A Adj. Wtr. Body �na�m/�unkn)
❑ Pws:
ng) PNA yes"/ n Closest Maj. Wtr. Body
ORW: yes /
Type of Project/ Activity 1�� %pD� --tI aq P (amyl IVL
Pier (dock) length
Fixed Platform(s) _ T_
Floating Platform(s) ln� L 1(0
Finger pier(s) .—'
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift I--
Beach Bulldozing_
Other
Shoreline Length
SAV: not sure yes
Moratorium: n/a yes
Waiver Attached:
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
<S;nl or Applicant Printed Name
Si nature **Please read compliance statement on back of permit
� 1L�
Application Fee(s) Check #
(Scale:
El See note on back regarding River Basin rules.
Permit Officer's Printed Name
Signat re I
n
Iss mg Da a xpirati n Date
Lt NT AUTHORIZATION FOR CAMA PERMIT APPLICATION
RECEIVED
Name of Property Owner Requesting Permit: 1 JUL 2 3 2020
Mailing Address: j 2(Y DCM-MHD CITY
�e� c
Phone Number: 2fe
Email Address:
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: �'x /(
L
at my property located at / L q Z -cN �,r)Z,
in CP"9il�6T County.
l 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:
Signature
Print or Type Name
C> -7 / G 7 l
Date
This certification is valid through I I
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Owner �(,eAV l,i'�/- Ci✓/'�:.'�f�S
address of Property./3 AnAXL
(Lot or Street #, Street or Road, City & County)
A
gent's Name # ,�/N.7.El !✓ / ' Mailing Address: ?0(/ g/,Q&92- 14"1
Agent's phone # i GS -��� "y3`�c�, �tJ&'Jv �c�jv /Vt6�-
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A descdotion or drawing with dimensions must tiff nE vl .with this Ietter-
�l. , / v �CL I have no objections to this proposal. 1 have objections to this proposal.
1 �+
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM} in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at htip://www.nccoastalmanaoementnet/web✓crn/staff4istJn4 or by calling 1-8884RCOAST.
No response is considered the same as no objection if you have been noted py Certified Mall.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15' from my area of riparian access unless waive "IVe1)
you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement. JUL 2 3 2020
I do not wish to waive the 15' setback requirement. ° CM'MFiD CITY
(Property Owner Information)
(- -1) 0
Sig Manure
Print or Type Name
Mailing Address
( parian pie Owner Information)
Signature F�
,Yov-sPrint or or Type Name
I o 4&A-vrV6� -Rktl.K
Mailing Address
City/StateMp City/State/Zip
Telephone Number / Email Address Telephone Number / Email Address
Dale
1202t,
Pale
(Revised Aug. 2014)
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER MOTIFICATION/WAIVER FORM
Name of Property Owner W/,,• ;;'/�,c t�✓/�r °:' f, S
Address of Property. 124' Erc%/�✓ J �,�'/Ll- tt (- u' «�
(Lot or Street #, Street or Reed, City & County)
Agent's Name #: /J�,Et I✓c=�
Agent's phone #: `irq
Mait' !gAddress: ,4o�r > '�
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing A description or drawing, with dimensions, must be provided with this letter.
I have no objections to this proposal I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at littp:, uAl"it,.r7ccoastafn:anaaemerlt.r)e✓webicrn/staff-listing orby calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been noted by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or must
be set back a minimum distance of 15' from my area of riparian access unless waive GGIM)
you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement. JUL 2 3 2020
I do not wish to waive the 15' setback requirement. DCM-MHD CITY
(Property Owner Information)
.S'i,s,Jrrawre
Print or Type Name
Mailing Address
City lStatelZip
Telephone Nur b r / Erfrail Adrfr&se— )-0)
�u1�•
(Riparian Property Owner Information)
.tr,.! � •%cam-•�,'i
,S'i�Jrral rrr¢
Print or Type Name
6(si z1AKi,r
Mailing Address
'�iE/a /Vt Z76bP
City/State2ip
Telephone Number / Email Address
i:>rrr.
(Revised Aug. 2014)