HomeMy WebLinkAbout54316_SMITH, RALPH_20090724CAMA / ❑ DREDGE & FILL\ q(
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 Res ces
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Rules attached.
Applicant
Address
City
State ZIPS
Phone # ( )
Fax # (`)
Authorized Agent
Affected ❑ CW
❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
❑ FC:
ORW: yes / no
PNA yes / no Crit.Hab. yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City ; r ., ZIP
Phone # (4r) r River Basin.``i { 1„
Adj. Wtr. Body i< ,,, f e ,a �(nar /man /unkn)
Closest Maj. Wtr. Body,,
Type of Project/ Activity
(Scale:
Pier g
Platf
Finge
Groi
Bulkl
Basir
Boat
Boat
Beac
Othc
Shor
SAV:
Sand
Mon
Phot
Wain
r pier(s)
length
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A building permit may be required by: i-+
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
Application Fee(s) Check #
❑ See note on back regarding River Basin rules.
Permit Officer's Signature
Issuing Date Expiration Date
Local Planning Jurisdiction Rover File Name
f
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 (252-946-648 I) or the Wilmington
Regional Office (9 I 0-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Raleigh Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293
Fax:919-733-1495
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ I-888-4RCOAST
Fax: 252-247-3330
(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 PIERIMOORING PILINGS/BOATLIFT/BOATHOUSE)
1 hereby certify that I own property adjacent to �`\ �J� ifs' ��% ` 1 's
(Name of Pr perty Owner or Applicant)
Mailing address if different from location address �, r
,
(town, state and zip)
phone numbers you can be reached at G .
property located at 9 / 21�fD V t= -��?'�,'F L�
(Lot, Block, Road, etc.)
on OFE 5a J Nb , in cam' r li-l.6 -�� , Cftlzrtf-r
(Waterbody) (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/bo
must be set back a minimum distance of fifteen feet (15) from my
waived by me. am.
o not wish to waive the setback requirement.
initial
y I do wish to waive that setback requirement.
JUN_ 2009
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
.�oQ� S•aJN41r>
I R1
JUL .I 4' 2009
rV UM"(012d Cif,► DOM
------------------------------------------------------ 1----I----
Print or Type Name
Telephone Number '
CM
I
ADJACENT RIPARIAN PROPERTY ONVNIER STATEMENT
(FOR A PIERIffOORIAIG FILINGSIBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to R4 CUP4 5YY1 JT-�V 's
(Name of Property Owner or Applicant)
Mailing address if different from location address -t;--�0Z
(town, state and zip) ,/0', /'/. _, /U. C -770
phone numbers you can be reached at / % 959 --- 7 / 71
property located at / 4 I -;k -L-) F-1y e Q-s
(Lot, Block, Road, etc.)
on V�e_ St�6 N In -11�fTer=A CA L.C.
aterbody) (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.
lal
I do wish to waive that setback requirement.
in(4Is
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DENIELOPMENT:
(To be filled in by individual proposing development)
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JUL 1 6 2009
INate"aad 01ty DOM
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Skt,,,
Print or Type Name
C)k�'� -g(�5
Telephone Number
� t Y
d
. s a'`A.
No Lh C.ar011re Department 01 Eavi uiil e it and Nratillul RQSOLirces
gqr
anagsrinent
Nlichze! !_. Easley, Governor
Charles S. Jones, Diractor William G. Ross Jr., Secret,ry
Date
j�, pplicant Janie- - r 9'1" s dII� .
Mailing Add n _ P � Ao ��
I eertii'y that I have aut>r prized (ages ,
P� �( to aci on inn
behalf, for the purpose cif applying for and obtab ing all CA'-'A� PerMW necessary to.
install or construe', (acthity) �..�� L 1 � � -
�� L -b s LF7
at (location)��--
This cer A�ication is � aj.-d 1-hru (date)
Siriaatiire _
P9 FaIVED
Morld 01ty QM
RALPH L SMITH JR
FARM ACCT
PH. 242-5235
PO BOX 26
FREMONT, NC 27830-9584
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