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Home My WebLink About45255_SIMPSON, CHRIS_20060504-o(Q i6b ❑CAMA / L DREDGE & FILL �j- Al5?,55 GENEkAL PERMIT Previous permit # [-]New [-]Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environment and Natural Resources and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ❑ Rules attached. Applicant Name Project Location: County '' 11 Address City Phone # ( )_ Authorized Agent Affected ❑ CW AEC(s): ❑ OEA ❑ PWS: ORW: yes / no State ZIP . Fax # (i ) ❑ EW ❑ PTA ❑ HHF ❑ IH ❑ FC: PNA yes / no ❑ ES ❑ PTS ❑ UBA ❑ N/A Crit. Hab. yes / no Street Address/ State Road/ Lot #(s) Subdivision City ZIP Phone # ( ) River Basin Adj. Wtr. Body �' (nat /man /unkn) Closest Maj. Wtr. Body Type of Project/ Activity f -`- (Scale: ) Pier (dock) length Platf Finge Groin Bulkl Basir Boat Boat Beac OthE Shore SAM Sand Mo Phot Waiv ormr (s) ratorium: _ —t L 77 --T TII- �L �— r pier(s) lengthI numberiead/ P length_ P gt avdstanceoffshore offshore � _ _ _ —.maxdistance s HT!, 1 - - channel I - I i —I— r 1� —i - I —I— cubic yards ram i -'- I-- — — �--1--�--I— louse/ Boatlift I • — i Bulldozing r K_ --.—_ -- -- — line Length not sure yes no bags: not sure yes no n/a yes no os: yes no e Attached: yes no j - - — -- — A building permit may be required by: Notes/ Special Conditions See note on back regarding River Basin rules. Agent or Applicant Printed Name 'Y'006 Permit Officer's Signature Signature "Please read compliancestatementon i`Y i)& agDate Expiration Date t, Application Fee(s) Check# Local Planning Jurisdiction Rover File Name Statement of Compliance and Consistency This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void. This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The applicant certifies by signing this permit that 1) prior to undertaking any activities authorized by this permit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian landowner(s) . The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available information and belief, certifythat this project is consistent with the North Carolina Coastal Management Program. River Basin Rules Applicable To Your Project: L! Tar - Pamlico River Basin Buffer Rules L_ Other: ❑ Neuse River Basin Buffer Rules If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of Water Quality. Contact the Division of Water Quality at the Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215) for more information on how to comply with these buffer rules. Division of Coastal Management Offices Central Office Mailing Address: 1638 Mail Service Center Raleigh, NC 27699-1638 Location: Parker -Lincoln Building 2728 Capital Blvd. Raleigh, NC 27604 919-733-2293 Fax: 919-733-1495 Elizabeth City District 1367 U.S. 17 South Elizabeth City, NC 27909 252-264-3901 Fax: 252-264-3723 (Serves: Camden, Chowan, Currituck, Dare, Gates, Pasquotank and Perquimans Counties) Morehead City District 400 Commerce Ave Morehead City, NC 28557 202-808-2808/ 1-888-4RCOAST Fax: 252-247-3330 (Serves: Carteret, Craven, Onslow -above New River Inlet- and Pamlico Counties) Washington District 943 Washington Square Mall Washington, NC 27889 252-946-6481 Fax: 252-948-0478 (Serves: Beaufort, Bertie, Hertford, Hyde, Tyrrell and Washington Counties) Wilmington District 127 Cardinal Drive Ext. Wilmington, NC 28405-3845 910-796-7215 Fax: 910-395-3964 (Serves: Brunswick, New Hanover, Onslow -below New River Inlet- and Pender Counties) Revised 06/29/05 ' ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE) I hereby certify that I own property adjacent tofio5-,, _'s property located at Y13 S. . si (Name of Property Owner) L (Street Address, Lot, Block, Road, ``etc.) rr on , in �ii�GC/ I�YJd ld /v L , N.C. (Waterbody) (Town and/or County) He/she has described to me, as shown below, the development he/she is proposing at that location and I have no objections to this proposal. I understand that a pier/mooring pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless waived by me. I have indicated my intentions by initialing below: (initials) I' do not agree to waive the 15' setback requirement. I do agree to waive the 15' setback requirement. kmivats) ------------------------------------------------------------------------------------------------------------ DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: (To be filled in by individual proposing development) • iT SAo ------------------------------------------------------------------------------------------------------------------ yA,� 0 Signature Print or Type Name `i i - 3 :L Telephone Number Date: ' ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER/MOORING PILINGSIBOATLIFTIBOATHOIISE) I hereby certify that I own property adjacent to I US5 f �5�,� �m/�Dr n 4 's (Name of Property Owner) property located at tj i -s 5, C h e- ou-4i (Street Address, Lot, Block, Road, etc.) on , in SGLyu bozo , N.C. (Waterbody) (Town and/or County) He/she has described to me, as shown below, the development he/she is proposing at that location and I have no objections to this proposal. I understand that a pier/mooring pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (1 T) from my area of riparian access unless waived by me. I have indicated my intentions by initialing below: (initials) . I do not agree to waive the 15' setback requirement. I do agree to waive the 15' setback requirement. (initials) ------------------------------------------------------------------------------------------------------------------- DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: (To be filled in by individual proposing development) r Sigria4ire " IV Print or Type Name Telephone Number Date: (�J o��•z�� --bib G2l �eQ1 e V (9 f BOSS J. SIMPSON, M.D. CHRISTINE B. SIMPSON 102 FOXRIDGE D, 27614 CHAPEL HILL, _ n 16-771 2531 08631370952 DATE � J StatemEoyees'Credit Union® Cary' North 43 MEMO �:253L77049is08635370952112 ^�9*183L. 4984 6 S F=