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Lesan, Doug 77194C
KICAMA / ❑ DREDGE & FILL N9 7719A "GENERAL PERMIT Previous permit # New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality f� ,�y� and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC n7Z7 I i �o,� -07 ules attached. Applicant Name Project Location: County 0) s fD �/✓ B n D Address Street Address/ State Road/ Lot #(s) City �y`_o11 U� f /(� Stated ZI4-R6�-- Phone # ( -Mail V1 Authorized Agent ❑ CW AES ❑ PTS Affected AEC(s): ❑ OEA ElHHF ❑ IH ElUBA ElN/A ❑ PWs: ORW: yes / n% PNA eD/ no Type of Project/ Activity Pier (dock) length Fixed Platform(s) f(_W6 Floating Platform(s) Finger pier(s) X Groin length number Bulkhead/ Riprap length avg distance offshore max distance offshore Basin, channel cubic yards Boat ramp Boathous Boatlif Beach Bu dozing -� Other �l f Shoreline Length t% ! SAV: not sure yes no --.......... ----._....-.... --= ---1 Moratorium: n/a yes Photos: yes n .......... _.. .. i Waiver Attached: es no --� A building permit may be required by: ( Note Local Planning jurisdiction) �j, Notes/ Special Conditions / 04— `b Subdivision !A.V City `ZIP Phone # ?10() River Basin 4�� Adj. Wtr. Body ^46�J, I V10 nat a unkn Closest Maj. Wtr. Body .e (Scale: ❑ See note on back regarding River Basin rules. j�y I 6/1 1 V ® In )(A+0V UJAJ el f� LA&p t or Applicant Printed Name Permit Officer's Printed Signature ** Please read compliance statement on back of permit Signat -re Issui g Dat Application Fee(s) Check # I hereby certify that I own property 'nt to ProPelrtY located at =d r ie- "SS L1310 08CI etc', '0 on it I N Lot, "t in (Waterbody) (Cltylfown andlor Cou"M The applicant has described to me, as shown below, the deV01OPMOrIt proposed at the above locat on. I have no objection to this proposal. fix W—A—IM911 SECJJQN I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin must be set back a minimum distance of 15' from my area of riparian access urdess waived by me, (if you wish to waive the setback, you must Initial the appropriate blank below.) -1 +"q I I do wish to waive the 15' setback requirement. to waive the 15' setback requirement, -0-roerty nor I n) G/ e 1 b Pdnfor TY�16Name n M !=% Ut Ile Al City Telephone ail address (Adjacent Property Owner Information) Signature tk Print or 7�,p�, Ime Mailing V A res 0 Y%zp)t C CitylSfatelZlp fj Telephone Number / email address Dare DatO *Valid for one calendar year after Signature* (Revised Aug. 2014) AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION Name of Property Owner Requesting Mailing Address: Phone Number: Email Address: I certify that I have authorized tAyen[ r contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: It �C I ,;t 1 at my property located a � t Lc4 l in 0CUcounty. l furthermore certify that l 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 Own! f Information: Signature P,jht or Type Name Title Date This certification is valid through t / f to ?ccated r-o .11 9 t i 'e�d4. A'ca�2 do vAsh to waive the 15` setback requirement. ;t,.. do not wis to waive the g 5` setback requirement. Pam address ' V80d for one calendar year after signature* (AdJacent Property Owner InfOrnation) ,�'ionnturm � _ > r— Telephone Number / email address .Date* 4X 5;eQ�- 0 (Revised Aug, 2014) DJACENT RIPARIAN PROPERTY ®WNER SATE_ MENT I hereby certify that I own property adjacent to s L. c �f,�--f —� - (Nam of Propetiy ©wner)l property located at _,v1.:� ,_' — ddress, Lot, Colo oad, etc.) an t Flu K 11%L� �' in ,c r`1 1 t.' r F, N.C. (Waterbo yd) (CityPTown andtor County) The p nt has described to me, as shown below, the development proposed at the above to io I have no objection to this proposal. 1�E I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Indlv/duat proposing development must fill in description below or attach a site"drawing) &- _ ,P,r�� 33