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Home My WebLink About58165_CHAMBLEE, NEIL_20110926IJc—.,AMA / ❑ DREDGE & FILL GENERAL PERMIT 7�]Nevv ❑Modification ❑Complete Reissue []Partial Reissue 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 ❑ OEA ❑ HHF ❑ IH AEC(s): ❑ PWS: ❑FC: ORW: yes / no PNA yes / no ❑ ES ❑ PTS ❑ UBA ❑ N/A Crit.Hab. yes / no V Previous permit # Date previous permit issued Rules attached. 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 e of Project/ Activity ■■��%tom ■■n■■�wna�u■w�■ � �� rEll7■[h�Yi1,1■i11[r:�■r�e,�`�//tL� lr®CI■■!■�J ■�/■�■ �t■�■�r�lfitl�il/!!l�III!��►dl■■1�4illll■� Ali tlltll�l�lt.. . i�iil�iliyi�it��■■■1�4NtL�I��l1■■■■■� - - {� ■■■■rM■■■■■ i1�Ml�Ar�Ai►�i■ il■'1L!ZN■"Iman■i MEN �1�1�;®�i118�i��E�','�i�■rifY�rJ1�NL'I��■■■■■■■■■■■■■■■■■ C:f�l�■llil:S:�i11il1;Lift■■■■■C�ri[�1i1�■■■■■■■■■■■■■■■■■■ MENEM >P r � ■■■■■■■■■�I�Z�.... ■MEN mom ■■■ii�iiliiiiiii"�iiiiiiiiiiiliiil�ii'ii.:IC:I�C�=■■■■■om ...:■■■■■■■■■■■■■■■■■■■■■It■■■w■■■■■■■■■■■ ■■■■■■■■■■■■■■ ■■■■■■�■■■■■i■■�!■➢■■ err r��t��■■■■■■■■■■■■■■�■ ■■■■M1■■■wwl�l■■ft�i�■■■■■■■■■■■■■[!� ■■■■\Il11llli�wwiliii�l■■/llli■■■■■■■■■■■■■■MMM ■IVW■■■■��■■■®M Agent or Applicant Printed Name s Y Signature ** Please read compliance statement on back of permit Perm' IssuiniDale Expiration Date Application Fee(s) Check # 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 RECEIVED JUN 2 7 2011 DCM-MHD CITY North Carolina Depa meet of Environment and Natural Resources Division f13f Coos-1-1 Managemmen tvlichze! F. Easley: Governor Gha�l�sS. Jones, Director William G, Ross Jr., Secret j-/ Date �-�� .— AppDicant Naaaae -jo 1c--C-f— L15E (ailing Address � I r- ."� i�17"1 C--r'-f to act On In - certify tbat I have a-0thorized (a-eant) �r behalf, foa- tlae purpose eia applying for and obtaining all CANU PerMits necessary to install or construct (activii.0 at (location) 1 i -7 f9btb This cer -Mication is v ali'd khru (slate) f--1 I 81,gn a tSure ADJACENT RIPARIAN PROPERTY OWNER STATEMENT &ti % I hereby certify that I own property adjacent to Ni::-i I— C- $1- 1:- 9� is 27 (Name of Property Owner) c4 �OJJ property located at 11 `% 1 'Qt1JD X->R (Lot, Block, Road, etc.) on ij ( MADE C Acl`IA4-- , in Ar��--N1�1T (Waterbody) (Town and/or Coun ) Applicant's phoneb�I��' 97 -�Tailing Address: 117 f�Nb ZA 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) c.1c - (Information for Property Owner Applyin for Permit) i (Riparian Property Owner Information) Mailing Address Signature � SSA� City/State/Zip Print o ype Name Telephone Number Telephone Number 6--26-j( Signature Date Date ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to. N4 I�}� A11 FLFC- is 6, 2� O (Name of Property Owner) �y,>> `mac property located at D (Lot, Block, Road, etc.) on MAH AOD �=AH .L , in ATLAffrt C SCA eAiRTeZET , N.C. (Waterbody) (Town and or ounty) q �— Applicant's phone�#:� �� l " �? Mailing Address: 1177 �1'D D� C -2:3 S He has described to me, as shown below, the development he is proposing at that location, and, 1 have no objections to his proposal. ----------------------------------------------------------------------------------------------- DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT To be filled in by property owner proposing development) CR v l L'U fyt; Y-7st- MAKE � i�� (Inflar>rnfion for Property Owner Applying for Permit) (� a I ------ Mailing Address City/State/Zip Telephone Number Signature y-c -b r 5.r 6"r— rve IC �3 �_P� � 1-'A ------------------- �`-=----- (Riparian Property Owner Information) d7Z:��Signatu Print or Type Name Telephone Number Date Date SAMMIE E. TURNER MARINE CONSTRUCTION ACCT 252-725-3415 P-0. BOX MOREI lEAD CITY1885, NC 28557 PAY TO THE _A.p _ice S t I a Q"BRANCH BANKING G AND !RUST 11 NK 88T 813T..2M,ANY Jffi� FOR 000/ V) 533C .... ....... 11 J.1:(3-53..10"211:000521OSiilop 'Its Applicant: Date: 'P) '-6) / 6 T- / a-11Qk 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 amo t) 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 Dredge ❑ Fill ❑ Both ❑ Olher Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Dolh ❑ 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 ❑ 24r., �.: t..-UAS>1