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Home My WebLink About58136_SOKOLOSKY, JOHNNY_20110629-C e ❑CAMA / ❑ DREDGE & FILL GENERAL PERMIT Previous permit # CINew ❑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 concerngpa yt t Z NCAC i ❑ Rules attached. Applicant Name Project Location: County Address__ _ Street Address/ State Road/ Lot #(s) CityState ZIP Phone # (_) Fax # (_ ) Authorized Agent ❑ Cw ❑ EW ❑ PTA Affected AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ PWS: ❑FC: ORW: yes / no PNA yes / no ZIP_ ❑ ES ❑ PTS Phone # O River Basin ❑ USA ❑ N/A Adj. Wtr. Body (nat /man /unkn) Crit.Hab. yes / no Closest Maj. Wtr. Body Subdivision City MM■■■■■�■■■■■■�■■�■■■■■■■■■� ■■■■ ■■■■■■■ ME • C■■ME■::: ■:■■::■::■:EMM:I: 0 No No momm:■mmmmsm® NON:`:■�:�:::::::::::■ ■■■■ .. ■■■.. .Dr■ ■N■■■■.■■■■■■■ .■■ .■■■.■■■....■..............■........... ■■■■ n®i■■■■■ ■■■■■■■N■M■■■MU■MEN ■■��i�i.��.�'"iri®I'�i�ii��""�"..��I��lia��laa:®�i r:%ram■■■■■■■ Agent or Applicant Printed Name Signature ** Please read compliance statement on back of permit ** PermitOfficer's Signature ) IssuingDate Expiration Date Application Fee(s) Check# Local Plan ningJurisdiction 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 landowners). 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 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 ;j v',..::'. r rti Aoplicam: Oate: 1 r� Describe below the HABITAT disturbances for the application. All values should match t found in your Habitat code sheet. u� ment Habitat (`Jame a DISTURB TYPE Choose One TOTAL Sq. Ft. (Applied for. Disturbance total includes any anticipated restoration or temp impactsimpact FINAL Sq. Ft. (Anticipated final disturbance. Excludes any restoration and/or temp 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 (/W/J* Dredge ❑ Fill ❑ Both ❑ Other 'Vf7 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 ❑ �_r.2•i3v;w• it:: .. `� '.. 4 > ?t'f3A'ai .. +a.—•:u'.r.�c* .n,.a]:,u f i. r.'r.,::ayr..nsat NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary Date Zl- ApplicantName �� ►��► yz� Kv (a� k� S.% Mailing Address 1 7-7 6— SA tad e Or L° � Lai r I I certify that I have authorized (agent) �- 6 �' to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity) r' /�X�Lt� Z! at (location) ; 7 !i �f-� I-- � L/ 1,-Y' ' C- This certification is valid thru (date) Signature 400 Commerce Avenue, Morehead City, North Carolina 28557 Phone: 252-808-28081 FAX: 252-247-33301 Internet: www.nccoastalmanagement.net An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to �;,�,,,,,� jam_ r, 5 �Cv �oskti �s (Name of Property Owner) property located at # c p ,- ; v r /1 (Lot, Block, Road, etc.) on in ��:�� ..�� , N.C. (Waterbody) (Town and/or County) Applicant's phone #:3557 3 Mailing Address: /dam L' He has described to me, as shown below, the development he is proposing at that location, and, I have no objections to his proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: (To be filled in by property owner proposing development) (Information for Property Owner Applying for Permit) Mailing Address Ale- City/State/Zip 6 Y4, -Sys Telephone Number �- y7.7j�d°l! Pat re Date (Riparian Property Owner Information) gnature Print or Type Name Z-,C 2, _ Telephone T<u ber Date nI 5 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIERIA100RING PILI_NGSIBOATLIFT/BOATHOUSE) I hereby certify that I own property adjacent to 1;-0 n,7x J!v �o lay s (Name of Property Owner) property located at 510 (Lot, Block, Road, etc.) on � r''7t/� /��1pC!' in tw7ce1 �� ,N.C. (Waterbody) (Town and or County) Applicant's phone #:Ws,2 `16- '-5"f3-3Mailing Address: % 74 He has described to me, as shown below, the development he is proposing at that location, and, I lbelow.) ctions to his proposal. I understand that a pier/moo.ri.ng pilings / boatlift / boathouse ack a minimum distance of fifteen. feet (15') from my area of riparian access unless e. (If you wish to waive the setback, you must initial the appropriate blank Trdo not wish to waive I do wishto waive that setback requirement. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: (To be filled in by individual proposing development) (Information for Property Owner Applying for Permit) 17 5 5hae- Drive - Mailing Address 6Ccto - s/4/ /V(� A-YS 14- City/State/Zip (asapsss3- Telephone N -Z r ture Date ------------------------- (Riparian Property Owner Information) II Signature Print or Type Name Telephone Number Date 0� v d w� b Lol 0 ►i � t t �a 6 f 1� E �G INTRACOASTAL MARINE CONSTRUCTION 3515 WHITE DR. MOREHEAD CITY, INC 28557 Pay to the Order of` Date $ e' BRANCH BANKING AND TRUST COMPANY 1-800-BANK BBT BBT.com FOR MP "'0000259011m l:053 10 1 12 11:0DOS 19831,994 life 2590 66-112/531 k7 wp 7 1_1 a