HomeMy WebLinkAbout57104_TALBERT, JERRY_20110207'�-A /S
❑CAMA / ❑ DREDGE & FILL
GENERAL PERMIT 6CtyPrevious 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
Applicant Name
Address
City
State ZIP
Phone # ( ) Fax # (_)
Authorized Agent
❑ CW ❑ EW ❑ PTA
Affected
AEC(s):
❑ OEA ❑ HHF ❑ IH
❑ PWS: ❑ FC:
ORW:
yes / no PNA yes / no
Rules attached.
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
❑ ES ❑ PTS Phone # (_) 'River Basin
❑ UBA ❑ N/A
Adj. Wtr. Body fat /man /unkn)
Crit.Hab. yes / no Closest Maj. Wtr. Body
IN
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Agent or Applicant Printed Name
')�i�
n\�'V
Permit Officer's Signature
Signature ** Please read compliance statement on back of permit **
Issuing Date Expiration Date
Application Fee(s) Check # Local Planning)urisdiction 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, 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 (910-796-7215) for more information on how to complywith 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 Cit r�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
nQF Iicant:
Date:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
tem im acts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
1
Dredge Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
.. I-;5S,3--;RG,OAS ..,r•.;a�;r.rcr_a��:a1:,��..,,.....,A _Ma+ �:,»,x.....t:, nor :t :���
PECEIVED
ADJACENT REPARLAN PROPFRTY OWNER STATUMMIiT JAN 31 2011
,MoieheudCih,DCM
c I hereby ertify that I own property adjacent to Tc-1
(Nalwe of PMW-Fty Owner)
property located at— 10 FAG r d do-r
(fit, B%dL, Road, etc.)
on lad Urrae e-Aci in Muxtritfap Cirf N-C.
I (Wady) (Town am"r ebunty)
Applicant's phone #.- 72 4 - )X'e 2 Ding Address: 2-v3 6-Fv,1(-t4 AliF
ML&Af Pfjf 0 6/., Al 2
He has described to me, as shown below, the development he is proposing, at that location, and,. I
have no objectiom to his proposal-
. A I Y -tr- 14,4 W C j)Afb6,,w6
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(Tohejilted in by property owner proposing development)
0
eft IT FR CP F,-, (,.,"
(1nf1DrM21b0U for Property Owner Applying
for Pew)
lu-3 FGta Ave
Mailing Address
144"ef o'E'4 P
owstatezip
TeICAIDne Number
Si a L,AS
Date
(Riparian Ptvp" Owner lw&nuation)
l/,-7 -44,-,11� 1 /
Signaltze
PriuFo; Type Name
Telephone Number
[DIM.,
AWACENT RJUP�N PROPERTY OWNER. ' TFUMEN
i�ECCIVE'r'
to `" BAN 3 1 2011
(Nsde arpmperty (lw=erj
property l+o►:awd a£ 2c'3 6 L-c*Lt a iyi
. ek--)
on & Z LE-rt Ele 4COL IE * in MUxCYE4,0 C r-q I NrC.
Appliemrs pie #: 72 4 - X' k 7 Kzifimg A&hvsL- - 2-U 3 / a
!yl ,W EAP L-Lu _ AL 2kSl2
;—
He has described to me, as .shmm below, the development he is proposing at that location, and. I
have n a objoatiums to his proposal_
NAI yF,V,44Cr Frk -.FL&t do t
DESCRIPTION ANDfOR DRAWMG OF PROPOSED DEVELOPMENT:
(To befiZW is -by property owner Propos*gpit)
6
,A&L'Ilt-e (Ar., "
• v 3
Lam_`„, �'•� `.,� V � _� i - .�
ohs
(Inforffiati(d for PropertyOwnerApplying (RiparianPropmly Owner Is tion)
for Permit)
�U� (,NE=rdifrta �G�
Mailing Address
CitylStatewip
724- 2U �-7
Telep pne Sigfigur
nM Jo c� cy) ,J i, 1,
r(-A `j
Prhtt or jW Name
TelcPhone Number
IM
0
JERRY W TOL13ERT 12-06
203 GEORGIA AVE.
MOREHEAD Crry, NC 28,%7 1325
66-1259/531_
SW .
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WOODFOREST - n�G, y N A T f O N A
B A N e o
2t HaR err tnc e.cw.�: o"
J v W-Wo,odf,. ark 226-6724) ,
053112,921:
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