HomeMy WebLinkAboutEthridge, Bruce/ Beaufort Innr�
CAMS I DREDGE & FILL NO. 61144
~� GENERAL PERMIT Previous permit #
New 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
Rules attached.
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
City State _ ------ ZIP
Phone # ( ) Fax # ( ) Subdivision
Authorized Agent City _ - _ ZIP
Affected CW EW PTA ES PTS Phone # ( ) River Basin
AEC(s): OEA HHF IH UBA N/A Adj. Wtr. Body —_ (nat /man /unkn
PWS: FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock) length_---,_--
Platform(s)
Finger pier(s)
Groin length - -
number
T f
Bulkhead/ Riprap length
avg distance offshore _
max distance offshore-
- IBasin, channel t
cubic yards
Boat ramp -
.__
4111.
Boathouse/ Boatlift - - —
-
R .,
-
Beach Bulldozing
-
Other _- s.-
i .
— -
-
- —
Shoreline Length f
SAV: not sure yes no
Sandbags: not sure yes no
}
Moratorium: n/a yes no
N
y
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature *x Please read compliance statement on back of permit
Application Fee(s) Check #
C
in'
(Scale: j
C See note on back regarding River Basin rules.
Permit Officers Signature
Issuing Date
Local Planning jurisdiction
Expiration Date
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 I) 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 CarolinaCoastal 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 Headauarters
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)
N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 12 — Ila — [ Z
Name of Property Owner Applying for Permit:
FRUCC- E-T4RV-D (E
Mailing Address:
lot Air sr.
�kV�'ofZT. YI C. z951L
I certify that I have authorized (agent) gl"5 Mae. Ile" iuc 'T's f ft. (411I"If"to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) T lzx-k lab),
at (my property located at) 1
This certification is valid thru (date) G - 18 -1 Z
2--IS-12-
Property Owner Signature Date
g` RECEIVED
4:
y JAN 0 9 2013
DCMMHD CITY
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ,DGAUfO tk-T Tip 0 's
�1 Na of Property Owner
property located at (f� Aw • �jl� fl I $SWO
(Address, Lort3 Block, Road, etc.
on GRL�-ANTS G�-P�1rC�L_ , in ��Actr�ol?.'Z" , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatio
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
RECEIVED
WAIVER SECTION JAN 0 9 Z013
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me-D(4 DCTiY
wish to waive the setback, you must initial the appropriate blank below.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pro(p�erty Owner Information)
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Wa
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Print or Tyn�e N"ame
lot ! r4t4 ST
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Telephone Number L
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(Adjacent Property Owner Information)
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Print or Type
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Cit /�te
Telephone Number
Date
(Revised 6/1 S/2012)
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to U j" F RT ILA t- s
(Name of Property Owner)
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property located at ` O ( A v N ST -- , 8U&—V� , �fC 2g s l
(Address, Lot lock, Rbad, etc.)
on C *p(t4c-L , in wepe'� N.C.
(Waterbody) (City/Town and/or County)
The applic nt has described to me, as shown below, the development proposed at the above
locatio
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
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READ
JAN 0 9 2013
WAIVER SECTION Dcm-"47�!"'.
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived 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.
(Prope Owner I orm on)
(Adjac nt Property Owner Information)
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Aoplicant:
Date:
Ir q__ Nni $sof measurement
Describe below the HABITAT disturbances for the application. All values should match the name, alnl�
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)
Dredge [I Fill ❑ Both El Other V
Dredge [I Fill El Both El Other El
Dredge El Fill [I Both El Other E]
Dredge ❑ Fill ❑ Both [I Other ❑
Dredge Fill [3 Both [] -Other El
Dredge El Fill 0 Both [I Other [I
Dredge El Fill [I. Both El 'Other [I
Dredge El Fill [I Both [I - Other [I
Dredge [I Fill ❑ Both [I Other ❑
Dredge 0 Fill [I Both [I Other [I
Dredge ❑ Fill ❑ Both ❑ Other 0
Dredge ❑ Fill ❑ Both [I Other ❑
Dredge [j Fill El Both D Other' 0
Dredge C] Fill El Both [I Other [I
Dredge [] Fill [] Both [I. Other Cl
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