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
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(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
!
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WAIVER SECTION
�
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
P 9 P g
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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.)
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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
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ASMIVED
15
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