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Szczygiel, Jacob 77185C
V U -. ,�CAFE / ❑DREDGE & FILL 9 77185 A B cc", D G RAL PERMIT Previous permit # f lewModification 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 (97.9 r IC ..--��++�� i � Rules attached. Applicant Name ; :JMCD C I e 1 Project Location: County K�Col,IAE4 Addres�rs�� Street Address/ State Road/ Lot #(s) /V City P/iil/ State_N/ZIP_ Phone # E-Mail Subdivision Foci fy-ed Authorized Agent 60b6 y /'LGY� a /!S City ZIP Affected El CW , 414A ES" ❑ PTS Phone # ( ) River Basin S ElOEA ❑ HHF ❑ IH ❑ UBA El N/A AEC(s): Adj. Wtr. Body n nat unkn ❑ PWS: ORW: yes e,� PNA yes Type of Project/ Activity Pier (dock) length Fixed Platform(s) 55k to Floating Platform(s) Finger pier(s) Groin length number Bulkhead/ Riprap length avg distance offshore max distance offshore Basin, channel cubic yards__ Boat ramp i Boathouse/ Boatlift / Beach Bulldozing Other _ Shoreline Length SAV: not sure yes no Moratorium: n/a ye no Photos: ye no Waiver Attached: ves o4 A building permit may be required by: ( Note Local Planning jurisdiction) Notes/ Special Conditions Z n \ 0 Cik, A e r Applicant Printed Name Closest Maj. Wtr. Body rf (Scale: 1 !© See note on back regarding River Basin rules. Signature ** P12kse read compliance statement on back of permit Signatur ^ ` ApplicationFee(s) Check# Issui Datf Expi ation Vate Description and Drawing of Proposed Work Property Owner: Section Number: 000 0 Owners Name: Address: � 06 Telephone Number: Lot Number: S-uzIs►e� 5 9"w" l4 e, r E-mail Address: \cam Contractor: Company Name: 1�y�J�� G L�Va. Contact Person: l Ip 4, Address: Telephone Number: Z� Z'L 14 C1_ E-mail Address: b;; �y U1 %o o ci iy)-A Detailed description of proposed work: 14 Xis j; d JL .��'�' �l u� d� r�"�'s: a's ��j e,rPPf I�� ct n 1e4v "To -scale" drawing of proposed work: Adjacent Riparian Property Owner's Statement Adjacent Riparian Property Owner: Section Number: Lot Number: W1 Name: 1�3�� C�JsAC\ Address: ( Q 0 Telephone Number: ou Z— C, 8•— E-mail Address: % ,� '��,v,5 &K6L L Ait--k, COA^ I hereby certify that I own the property adjacent to: Section Number: G � Lot Number: o L �, Owners Name: 1 A ct& "ZL 2.i (,v Address:CLJ so")'�ft4(Uv� Telephone Number:; E-mail Address: J 92 L 2 xh % el & f1�i cvvo , (o.',N The individual applying for this permit has described to me the scope of work as shown on the attached copy of the "Description and Drawing of Proposed Work" form and have no objections to the proposed work. I understand that docks, pilings, tie poles or any other marine structure must be set back a minimum of fifteen feet (15'-0") from my riparian line unless waived by me. I do not wish to waive the setback requirement. I do wish to waive the setback requirement. Adjacent Riparian Property Owner: Signature '\:�, -J�. C Print Name R �� � CC)S_�A Date Adjacent Riparian Property Owner's Notification by Certified Mail - Return Receipt Requested Adjacent Riparian Property Owner: Section Number: a t Lot Number: ©ks_ Name: Address: ��) ®� CGiS�C`sv41'�a✓� l✓� f' Telephone Number: Z .S 2— �J 3 q(P 7 1 E-mail Address: tip C k3 K24�^CL4, I r CJAn I hereby certify that I own the property adjacent to: Section Number: Lot Number: ©l (v Owners Name: ro " 1 fiul _� ZC 244 i e i Address: Telephone Number: Z .S-2 — Z 1 Lj E-mail Address: ZL2,) 5%� ©%c Kp (:ra,&-. The individual applying for this permit has described to me the scope of work as shown on the attached copy of the "Description and Drawing of Proposed Work" form. I have no objections to the proposed work. If you have objections to the work being proposed, please write the Division of Coastal Management, 400 Commerce Ave., Morehead City, NC 28557, or call 252-808-2808 within ten (10) days of receipt of this notice. No response is considered the same as "no objection" if you have been notified by certified mail. I understand that docks, pilings, tie poles or any other marine structure must be set back a minimum of fifteen feet (15'-0") from my riparian line unless waived by me. I do not wish to waive the setback requirement. I do wish to waive the setback requirement. Adjacent Riparian Prope y Owner: Signature �. / �t/�G�1 Date: Print Name E � 1 CK S C* .r—,\ O *-f = =o E i J v O O U 0 � = N c� 3oG =N aM C/J N a N -00 cu L a 0 C a) = U Q (0 r O) Q C C Q 00 . C Fu cn E E 0 C_ _ X W CL O X .a � Q U a N > X X 0 0 a) n3 r O - U-)