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Home My WebLink About56889_FOSE, DON_20101014❑LAMA / ❑ DREDGE & FILL �l�J GENERAL PERMIT /IgPrevious permit# L'- NevW ❑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 E] Rules attached. Applicant Name Address City k State ZIP Phone # ( ) q- Wit: Fax # (i) Authorized Agent Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: ❑ FC: ORW: yes / no PNA (0 no Crit.Hab. yes / no Project Location: County Street Address/ State Road/ Lot #(s) Subdivision City ZIP Phone # O River Basin Adj. Wtr. Body (nat /man /unkn) Closest Maj. Wtr. Body ■■■■■!■!■■!A!!■■■■■■■■■■■!■�■!■■■■ - M. :!■!:!!:!!■!a■!:■■!■:l�:Nl:■:!■!!!■EN ■■■■■■■■■■■■■■■■■■■■■■■■!■!1■■■■■!■■■■■■ ■■■■■■■■■■■■■■■! ■■■■(!■■.N■■■■■■■■■■■■ ■■■■■■■■■■■■■■■lam■■■■■■■■■Il!■■■■■■■■■■■ ■■■!■■!!■■!■■!■�■��■■m■�■a�r.�■■!■!■■_■■■ ■!■■■■■■■■!■■■!�1■�■■fi■■tit ■!1■■■!f/!:\■■■■■ ■■■■■■■■■■■■■■■■■■■f1:1■■i■■!1■■■■l\►l�l■■■■■ MOME _■■■■■■■■■■■■■■■■t�■il�ilili■liliii�ilii■■■■■■■:�■■■■ Agent or Applicant Printed Name Permit Officer's Signature Signature "Please read compliance statement on back of permit Application Fee(s) Check # Issuing Date Expiration Date i.J j`1 1c, "e Local Planning Jurisdiction 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 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/ 1-888ARCOAST 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 NC Division of Coastal Mgt. Habitat Impact Computer Sheet Applicant: Don Fose Permit #: 56889C Date: 10/14/10 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 temp impacts) 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 Open Water Dredge 17 Fill ❑ Both ❑ Other ❑x 297 297 Dredge ❑ Fill O 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 ❑ 252-808-2808 :: 1-888-4RCOAST :: www.nccoastaImanagement.net revised:02/03/10 08:0:7- Frorn: To:91Gt c;c ;19' ADJACENT :RIPARIAN PROPERTY OWNER STATEMENT' (FOR A .PtER/M00RTNG Plr. INGSIBOA.TUFTZBOAT110USE) hereby certify that l own property adjacent to V-,)b-ro (Name of Property Owner) property located at (Lot, Block, Road, etc.) nn L -► i�b 0 13A in N.( (Waterbody) (Town and/or County) c� t Applicant's phone #:.2 0 / W _ Mailing Address: _..__... ---- He has described to me, as shown below, the development he is proposing at that locatior, Gmd, i have no objections to his proposal. I understand that a pier/mooring pilings / bontl ft / hoathouse- must be set back a minimum distance of fifteen feet (15') from niy area of riparian access unless waived by me. (ffyou wish to waive the setback, you must initial the appropriate blank below.) t�n I do not; wish to waive do wish to waive that setback requirement. ---------------------...._.......................----------................------------.....,...,.,......- -- - DESCRIPTION AND/OR Dl. AWING Or PROPOSED DES I LOP�TT;ti"l (To be f111ed In by ltrdlvldual proposing devokipmenr) IqAl o FT ------------------------------------------------------------------------- .....---------------......_......_.__._ .. (Ynformation for Property Owner Applying Oltiparian Property Own r Inforniation) for Permit) —'t iA- "'` i ` cO U S 0 to �ryrj- 7- Mailing Address -'L-'a� �— w �- Siena rr City/State/Zip 116 Telepho e b r Signature Date Sao V, i 1� / Print or 'C I Phone'�ur ��r -10'1� C_;: t=17 Fr ori: ADJACENT RYPAIIIAN P:ROPERT'Y OWNER STATEMENT (FOR A .P..t R/M. 00PJ1VC MIINGSIBOATLI TIBOATHOIJSE) L I hereby certify that. I own property adjacent to - (Name of Property Owner)T� property located at 13 � (Loi, Block, Road, etc.) ,o ;) n l `� in �ii I�,S b� ` N (Waterbody) (Town And/or County) Applicant's phone 4:3,947 26--N Mailing Address: /y�`fy` < - He has described to me, as shown below, the development he is proposing at that locaron, and, i have no objections to his proposal. I understand that a pier/mooring pilings / bontlif[ / ho�dlo ,sc must be setback a minimum distance of fifteen feet (15') from my area of riparian access unless waived by me. (1.f you wish to waive the setback, you must initial the appropriate blank: below.) , 1/1 do not: wish to waive 1. do wish to waive that setback requirement. ...................................................--------................------------...............----------- DESCRIPTION AND/OR DlLkWING OF PROPOSED DEVELWMT_TTf (To be filled In by lnrllvi(lual proposing development) to -7 (Information for Property Owner Applying for Permit) Mailing Addre s c i tyi ty/S tate/Z i p TelepI Signature Date (Riparian Property Owner 15fo�matinn) 13r1r.t or Type N:ii-r.e V� - Telephone's r ! cr DONALD G FOSE 2335 KATHLEEN D FOSE PH. 910-389-2030 8 BAYVIEW DR 66-112/531 JACKSONVILLE, NC 28540 �e(✓ �� — l s I y - LPt�J`8i L� I neieni om —classic— BRANCH BANKING AND TRUST COMPANY - BANKING 1-M-BANK BBT BBT.coom 1:0 5 3 10 1 1 2 11:000 5 2 9 3808 9 201120 2 3 3 5 y H.""la dcwxe