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HomeMy WebLinkAboutBrown, Anthony 76765CXCAMA /, DREDGE & FILL N9 76765 A B OD GENERAL PERMIT Previous permit# XNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality 07H, � / j� j 1' I and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC , / + N Rules at ached. Applicant Name A ���/1% Project Location: County Address St SC Street Addre s/ State Road/ Lot #(s) 1 \ �� A7 City State NGZIP* — Phone # () E-Mail Subdivision / Authorized Agent f City �� ZIP/ Affected ElCW ..N�FW i TA ❑ PTS Phone # (_) River Basin Wrl l onk AEC(s): ElOEA ElHHF ElIH ElUBA ❑ N/A Adj. Wtr. Body /man unkn ❑ PWS: c_ ORW: yes / no) PNA yes /(9)Closest Maj. Wtr. Body J� Type of Project/ Activity Pier (dock) length Fixed Platform(s) Floating Platform(s) Finger pier(s) Groin length C Bulkhead/. iprap length_ 42o avg distance offshore max distance offshore Basin, channel cubic yards r Boat ramp / Boathou e/ Boatli)_=J Beach B dozing Other 5 ` Shoreline Length SAV: not sure yes nc Moratorium: n/a yes Waiver Attached: yel nol i A building permit may be required by: ( Note Local Planning Jurisdiction) Notes/ Special Conditions A�+_ � (fX C-LA Agent or A lica t Printe Name Si nature Please read compliance statement on back of permit" pplication Fee(s) Check # (Scale: ❑ See note on back regarding River Basin rules. Permit Officer's PH ted Nam f Sign ture -57 �ZZ 9 "ht I wing ate xpirat n Date ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to property located at ��� of Property Owner) I (Address, Lot, Bloch, RoPd, ) on uc, t�L.� , in <5c�(+� N.C. (Waterbody) (City/Town and/or County) The a t has described to me, as shown below, the development proposed at the above to ion I have no objection to this proposal. ell I have obiections to this nrogosal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site obi, 46 /�c rIL 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) (Adjacent Property Owner formati Sig tobAll %e / Si mature �I \ Print or Type Na e Print or Type Name p //l`f �7c. !T Mailing Address 0 Ma ng dre A City/St te/Zip City/State/Zi r�V �QL� Doi 02 3 Telephone Number Telephone Number P� Date Date° (Revised 6/18/212) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to property located at -5a N� ?fib of Property Owner) I (Address, Lot, Block, Road, etc.) on��,®c , in N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the ar tot*! . I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRA&ING (Individual proposing development mus fill in ud J ED DEVELOPMENT below or attach a site drawing) 4 j�.i,!oC.'a-j 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 ri arian 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 Information) '-Br-,)") rJ Print or T p� q'm�e Ma Fjng A ress� City/Sta 2i Telephone Number 5--17--20 Date Q rl,-,4n C l'r. � n 1r s ("' r-" (Adjacent Property Owner Information) ignature >�, I Print for TCype Name Mailing Address ,,e' Sa 14 kik, .26 5-7 �r City/State/Zip Te�le�p ne Number S-- l .10 Date A (Revised 611812012) �vz�C�, 4r, ll-�atv�c 1,