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Home My WebLink About51212_COOPER, A.B._20080808CI CAMA / ❑ DREDGE & FILL 1 12 1 2(—� 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 Environment and Natural Resources and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC i ❑ Rules attached. Applicant Name �, 1. 1l �_. a l _+ Project Location: County Address J Street Address/ State Road/ Lot #(s) City State ZIP Phone # ( ) T .'`iQ Fax # ( ) Subdivision Authorized Agent City ZIP ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Phone # ( ) Affected River Basin AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body (nat /man /unkn) ❑ PWS: ❑FC: ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body Type of Project/ Activity (Scale:; Pier (dock) lenq h `'~' Platf Fing Groff Bulk Basil Boat Boat Beac Othf Shor SAV: Sand Morrl Phot Waiv s ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■number length ■■■■■■■■■■■■■■■0■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ .-.length ■■■■■■■■■■ ®■■■■■■■■ 0■■■■■■■■■■■■■■■ avg IN ■■■■■�i■■■■■■■■■a■■■■�■■■■■■■■■n■■■■■■ a ■■■■■■■■■■■■■■■■■■n■■■■■■■■.■■■■■■■■■al cubic yards ■■■■■■■1••••"■■■i='MENEM ■■■■■■ramp ■■■■■■NINE ■■■■■■■■r�■v■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■ Line Length notsure yes no' ags: no not sure 0 ■■■■�tii�iri��►rim ��■■■■■■■■■■■■■■■■■■■ ■■■■■t��■■■■■■■■■■■■■■■■■■■■■■■■■■ s ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ yes no ON l /_ -; - P . )l. Agent or Applicant Printed Name i Permit Officer's Signature Signature "Please read compliance statement on back of permit" Issuing Date Application Fee(s) Check # Local PlanningJurisdiction 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 ])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, certify that this project is consistent with the North Carolina Coastal Management Program. River Basin Rules Applicable To Your Project: ❑ Tar - Pamlico River Basin Buffer Rules ❑ 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 (9 I 0-796-72 15) for more information on how to comply with these buffer rules. Division of Coastal Management Offices Raleigh Office Morehead City Headquarters Mailing Address: 400 Commerce Ave 1638 Mail Service Center Morehead City, NC 28557 Raleigh, NC 27699-1638 252-808-2808/ 1-888ARCOAST Location: Fax: 252-247-3330 2728 Capital Blvd. Raleigh, NC 27604 919-733-2293 Fax:919-733-1495 (Serves: Carteret, Craven, Onslow -above New River Inlet- and Pamlico Counties) 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) 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 08/09/06 " ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE) I hereby certify that I own property adjacent to 1'4:JtAr- (Name of Property Owner) property located at /0 6 /(164X eS or %e &e`I , (Lot, Block, Road, etc.) on A ^q in h2ai , N.C. ( terbody) (Town and/or County He has described to me, as shown below, the development he is proposing at that location, and, I have no objections to his 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 do not wish to waive the setback requirement.Fa I IF I w.? I do wish to waive that setback requirement. P1 ou JUL 3 I nm ------------------------------------------------------------------------------------------------------------------- DESCRIPTION AND/OR DRAWING OF PROPOSED D*fWF"6,ity DOM (To be filled in by individual proposing development) - / 0 _7 ' � / D 0 , 1 I ---------------------------------------------------- (Applicant Information) Mailing Address / o ff AJ or —ALWt- l 1 City/State/Zip A 2. � S'f 2 Telephone Number &-o?(-o9— Date -------------------------1 ---------------------------------- (Riparian Property Owner Information) Signature TIDY 4b wc-M Print or Type Name 1S-L % 2.3 ?�17 Telephone Number Date ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE) I hereby certify that I own property adjacent to d Q �9O 1,gfl (Name of Property Owner) property located at (Lot, Block, Road, etc.) on 20 o LL , in / ! C C a , N.C. ( terbody) (Town and/or County) He has described to me, as shown below, the development he is proposing at that location, and, I have no objections to his 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 do not wish to waive the setback requirement. I do wish to waive that setback requirement. JUL 3 1 2008 - - - - -- - - - -- - -- - - -- ----------------------------------------------Iftf w-c7ty [)(;m DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: r p (To be filled in by individual pryposing development) b S ----------------------------- I -------- (Applicant Information) Mailing Address /o(' 'k),"g City/State/Zip x, 3 NC, Telephone Number asrs.—ZzG- 2— 6S� 4 � (e dp A d+ L)CC�s ------------------------------------------------ (Riparian Property Owner Information) 9,X. —/, Signature /p..) ;]"S kie, Print or Type Name .� ql 3 (0 7 7 Telephone Number 4-aL- &F5-- Date Date c� \L I Front�eck WAI of I 1 JUL 3 1 2008 � 1 I MOM h 1 � ead City pc;IVI PROPERTY OWNER STSTEMENT Hereby certify that I own /or4ave authorization to sign for the property at /0 G �JdrI-A Z�Avrr- "br P4 4-14-& sc �egc�(� NC -1 / 1 Lessee M e PA rro jt has described to me, as shown below the development he is proposing at that location, and I have no objections to his proposal. I authorize Thomas Lawrence to act as agent to obtain all necessary permits to perform this work. DESCRIPTION AND DRAWING OF PROPOSED DEVELOPMENT: F03YE R9 JUL 31 2008 � ftAot Morehead City DCM Print name or type Telephone number Date THE FRONT OF THE DOCUMENT HAS A MICROPRINTAMOUNT BOX AND THERMOCHROMIC. ABSENCE OF THESE FEATURES WILL INDICATE A COPY. �7 75-i61B MvneyGYam INTERNATIONAL MONEY ORDER 919 Money Orders (\j cy) PAY TO THE ORDER OF:/ � PAGAR A LA ORDEN DE: /'� IM 0 TANT - SEE BACK BEFORE CASHING W ' ^ PURCHASER, SIGNER FOR DRAWER / COMPRADOR, FIRMA DEL LIBRADOR PURCHASER, BY SIGNING YOU AGREE TO THE SERVICE CHARGE AND OTHER TERMS ON THE REVERSE SIDE ADDRESS:/ Q DIRECCION mi ' ♦ PAY ONLY THIS AMOUNT E ' . --._ _. Payable Through -` '-' z _ i . Citizens State Bank ISSUER/DRAWER: •-r '7 .D .. fY - of Clara City MONEYGRAM PAYMENT SYSTEMS, INC. O 4-._., _ L LL Clara City, MN TO AUTHENTICATE RUB CIRCLE PARA AUTENTICAR RESTREGAR EL C(RCULO �:09L9i6187i:i0i6 787392T21I'-- 1