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Home My WebLink About40314_BALARA, RANDOLPH_20041103_ LiCAMA / L_i DREDGE & FILL) GENERAL PERMIT Previous permit # CNew EModification JComplete 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 j J i ' ®-Rules attached. Applicant - t ,i'', �.. pp Name { `"' Project Location: County Addresses Street Address/ State Road/ Lot #(s) ~ ? CityState ZIP Phone # 13 Fax # ( ) — Subdivision Authorized Agent''` "`" City `' - ZIP Affected E CW ❑ EW C�PTA ❑ ES ❑ PTS Phone # ( ) _ River Basin ' J OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A AEC s : O Ad'. Wtr. Body___nat man 1- �_��_�? r unkn i _ PWS: ❑ FC: ORW: yes / no PNA yes / no, Crit. Hab. yes / no Body Closest Maj. - -- y Type of Project/ Activity Pier (dock) length Platform(s) _ Finger pier(s) Groin length number Bulkhead/ Riprap length avg distance offshore max distance offshore Basin, channel cubic yards 1-7 Boat ramp Boathouse/ Boatlift Beach Bulldozing _ Other Shoreline Length SAV: not sure yes no _ Sandbags: not sure yes no Moratorium: n/a yes no Photos: yes no; Waiver Attached: yes no A building permit may be required by: Notes/ Special Conditions Agent or Applicant Printed Nam � e � Signature" Please read compliance statement on back of permit ** r ' Application Fee(s) Check # (Scale: ) See note on back regarding River Basin rules. Permit Officer's Signature 1� J Issuing Date Expiration Date ( 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 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, certifythatthis project is consistentwith 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 (910-395-3900) for more information on how to comply with thesebuffer 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 / 1-888-4RCOAST 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 151-B Hwy. 24 Hestron Plaza II Morehead City, NC 28557 202-808-2808 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 910-395-3900 Fax: 910-350-2004 (Serves: Brunswick, New Hanover, Onslow -below New River Inlet- and Pender Counties) www.nccoastalmanagement.net Revised 10/05/01 R. S. Balara 0695 �f G �e)51zl 66-30/531 8016 Mary Dee Balam 133 Ph Be 252-24 - 133 BeuDrive huwod Drive Pine Knoll Shares, NC 28512 DATE - _— O PAY TO THE tw —_ J $ ORDER OF -- --- - --DOLLARS - - — Look for; Micro Print si ure line. gray type and ine ork. First Cii iicns R11 !ogo en +ack. If not present. do not c:ah. e FIRST CITIZENS 133 ][,� 7�Tip First -Citizens Bank & Trmt Comparry �(-1lr j� Mlantic Beach, N.C. 28512 / �www.11ntdtlxons.eom NP i:0 5 3 L00 300':00 2 78 7909 508ii' 080 L 6 wm Z445)- v 7V Llit,L C) 6' fir/ EIN 4, bQMF,06 15 c'eml - _ I ice— 0-0 _ r 15 ---� 4 DOCK DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Individual applying for Permit: Address of Property: (Lot or Street #, Street or Road, City & County) I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit has described to me as shown on the attached drawing the development they are proposing. A description or drawing, with dimensions, should be provided with this letter. I have no objections to this proposal. If you have objections to ►vltat is being proposed, please write the Division of Coastal Management, Hestron Plaza H, 151-B, Hwy. 24, Morehead City, NC, 28557 or call (252) 808- 2808 ►vithirz 10 days of receipt of this notice. No response is considered the same as no objection if you have been notified by Certified Mail. WAI'V'ER SECTION I understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags must be set back a minimum distance of 15' from my area of riparian access unless �,%aived by me (If you wish to waive the setback, you must initial the appropriate blank below.) V I do %vish'to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement l / Sicynature Date Print Na e C�'S� q-i -0 Telephone Number With Area C de DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Individual applying for Permit: A �� Address of Property: (Lot or Street a, Street or Road, City & County) I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit has described to me as shown on the attached drawing the development they are proposing. A description or drawing, with dimensions, should be provided with this letter. II have no objections to this proposal. If you have objections to ►vhal is being proposers, please tivrite the Division of Coastal Management, Hestron Plaza II, 151-B, Hwy. 24, Morehead City, A'C, 28557 or call (252) 808- 2808 within 10 days of receipt of this notice. No response is considered the same as no objection if you have been notified by Certified Mail. WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boat house, lift or sandbags must be set back a minimum distance of 15' from my area of riparian access unless valved by me. (If you wish to waive the setback, you must initial the appropriate blank below, ) i do wish to waive the 15' setback requirement. I do not wish to waive the 15- setback requirement Signa�e / Date / J �lV)/VAarl Print Name 07 -5- ?- ` Z S10) -- Telephone Number %Vith Area Code - ow)