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HomeMy WebLinkAboutHall, Jon 76768C.'CAMA / ❑ DREDGE & FILL V�f GENERAL PERMIT JN(New ❑Modification ❑Complete Reissue ❑Partial Reissue Previous permit # 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 J2 Lxj Rules attached. Applicant Name ® 011 Project Location: County(_i p� Ire-n Address j Street Address/ State Road/ Lot #(s) Z City N , (� f % State—�X21p 9m2 ` / Phone # ' -Mail Subdivision 1 V �� Authorized Agent (,��f i A 0� 'Sry City ZIP Affected ElCW Ll EW PTA ElES ❑ PTS Phone # () � River Basin J AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body v t m /unkn ❑ PWS: Closest Maj. Wtr. Body ORW: ves/1"'no i PNA yes no Type of Project/ Activity Pier (dock) length Fixed Platform(s) Floating Platform(s) / Finger pier(s) Groin length -ell number Bulkhead/ Riprap length avg distance offshore max distance offshore — Basin, channel ,� cubic yards Boatliftl", Beach Bull ozing CC Other ( V P Shoreline Length u SAV: not sure yes rno Moratorium: n/a yes Waiver Attached: yes r� (Scale: A building permit may be required by: OlV CL/l r %See note on back regarding River Basin rules. ( Note Local Planning Jurisdiction) —� Notes/ Special Conditions Fc�Dr)�A �� � OLCI [1 � � n f .j A,46A-�cvi gro­rApplicart Printed Name ature ** Please read compliance statement on back of permit t2� 20 q� Application Fee(s) Check # v R �-IA coa Permit Officer's Printed Name S M7�0 - /0 ��0 Is ing ate E pir ion Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: -fS/Z -,0k4 L Mailing Address: 1Z)5- F-dl &yjd2 b:5L2 Phone Number: Z Z t-P 6 $C 5 54 4- Email Address: �o A) -Lo S ovpe- P J L-1a1(a ► I certify that I have authorized, TDR Vi D 14ij&r!-(sv�, Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: /w Slit ?,,aerf- LF-r at my property located at c D S* beocrr L/KJr- "Q in -jnA t ;,---AlCounty. I furthermore certify that I 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: Signa ure Joa Print or Type Name ; h\c n 1,L) M2.� Title Date This certification is valid through cr--� It JUN 0 2 2020 DCM-MHD CITY • GomplOte items 1, 2, and 3. ■ Print your name and address on the reverse so that we can return the card to you. ® Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: IIIIIIIII11111111111111111111I IIIIIit IIIII111II 9590 9402 4999 9063 5249 67 2.-Article Number (Transfer from service label) [j1,9-- U�u 2869 1387 PS Form 3811, JUly Gu to roiv A, Sig ature X O"Agent ❑ Addressee B. Aeceived byfPfin ed Name) C. D to of Delivery (- Q - t� 5 �-i 1 Z� D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No 3. Service Type ❑ Priority Mail Express@ Cl Adult Signature ❑ Registered Mal"' ❑ Adult Signature Restricted Delivery ❑ Registered Mail Restricted ❑ Certified Mail@ Delivery ❑ Certified Mail Restricted Delivery ❑ Return Receipt for ❑ Collect on Delivery Merchandise ❑ Collect on Delivery Restricted Delivery ❑ Signature Confirmations" ❑ Insured Mail ❑ Signature Confirmation ❑ Insured Mail Restricted Delivery Restricted Delivery (over $500) Domestic Return Receipt RECEIVE® JUN 0 2 2020 ®CM-MH® CITY CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Owner: Address of Property: \L)S Q.6 , QV--UJ ,C12-A\JUJ (Lot or Street #, Street or Road, City & County) Agents Name* Mailing Address: Agent's phone #: I hereby certify that I own property adjacent to the above referenced property. The individual 5 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. 01 I have no objections to this proposal. I have objections to this proposal. z if you have objections to what is being proposed, you must notify the Division of Coastal Management is (DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices availableathtio.-I/vrlrtr.nccoastaimanagement.net/v✓eb/cm/staff-fistinaorby calling1-888-4RCOAST. No by Certified Mail. response is considered the same as no objection if you have been notified ! �t WAIVER SECTION � I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must P 9 P g ,.� 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.) )d I do wish to waive the 15 setback requirement. I do not wish to waive the 15' setback requirement. ' (property Owner Information) �SI�71Ut2lY8 Print or Type Name Mailing Address 11i-tit)%lam k�'3 i \-�L ,2-rJ City/StatelZip Telephone Number/Email Address Date (Riparian property Owner Information) �'- \ b. u G � PO4 Icv JAt Si a ure Ajalvy 14 400e115e- i) JtJew or Print or ype Name iP Mailing Address - - -- 7�c�rrl � ]VI O 6 CitylStatelLip Telephone Number/E ail Address Dat _» IDCM-MHD CITY LI-1-4 I ASMIVED 15 1IJI I �1 �� LI II I1II r4I QyI^9AI.o