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Home My WebLink About69873C - Hales, BerniceType of Project/ Activity, Pier (dock) length Fixed Platform(s) Floating Platform(s) Fingerpier(s) -" Groin length !,B.Ilt df Liprap lengt Q y avg distance offshore max distance offshore e1 Basin, channel cubic yards --^ " Boat ramp Boathouse/ Boatlifa-^� Beach Bulldozing"' Other 1: Shoreline: Length SAV not sure yes, no Moratorium: n/a yes Photos: yes Waiver Attached: yes n F1 1 A building permit may be required by: ( Note Local Planning Jurisdiction) Notes/ Saecial Conditions U LIL (Scale: ) ,NEIIIIII INEEN 1■®Ni 1®®N® IMMEN 310 ❑ See ote on back regarding River Basin r I'es. r i lamejoFPermrc•Officer's Prin ame . icompliancestatement'onbackofpermit* '' Signatu"re ' Check# - IssumgDate E p Date 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, certifythat 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 Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215) for more information on howto complywith these buffer rules. Division of Coastal Management Offices Morehead City Headquarters Washington District 400 Commerce Ave 943 Washington Square Mall Morehead City, NC 28557 Washington, NC 27889 252-808-2808/ 1-888ARCOAST 252-946-6481 Fax: 252-247-3330 Fax: 252-948-0478 (Serves: Carteret, Craven, Onslow - (Serves: Beaufort, Bertie, Hertford, Hyde, North of New River Inlet- and Pamlico Tyrrell and Washington Counties) 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) Wilmington District 127 Cardinal Drive Ext. Wilmington, NC 28405-3845 910-796-7215 Fax: 910-395-3964 (Serves: Brunswick, New Hanover, Onslow - South of New River Inlet - and Pender Counties) http://www.nccoastalmanagement.net/ Revised 08/27/ 14 t CAMA �,DIREDGE & FILLENEL PERMIT A BCC D Previous permit # --^- New ❑Modification ❑'Complete Reissue ❑Partial Reissue Date previous permit issued u�lad by the State-of-Nopte-Gar-ohrra, Departmentef Environment -and Natural- Resources the Coastal. Resources Commission in an area of environmental concern pursuant to 15A NCAC ^� Rules attglhed. licart Name - C�f, Project Location: Count 1 1 ress Street Address/ State Road/ Lot #(s) AJ f State ZIPI 2) - ne # C E-Mail Subdivision iori ed Agent zip-- Cted O CW ❑ EW ❑ AfiA ES ❑ PTS Phone # (�) ;63, River asin L ' ❑OEA ❑HHF ❑IH ❑UBA ❑N/A �. "- (s)'' ❑ MS. Adj. Wtr, Body r ` ` a ,,,,�: a lhtd ' unkn V. ( es Closest Maj. Win Body y no PNA yes nO ype of Project/ Activit& Pier (dock) length -- Fixed Platforms) Floating Platform(s) Finger pier(s)- -:-•^" Groin length----' ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent tom (Name of Property Owner) property located at I (Address, Lot,fflock Road, etc.) on - OE> , in E 560 , N.C. (Waterbody) ( ity/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. /c'if _ I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT Ii4 idc/al pro�os%ng d ve enf m sf' I/' in descr/pfion ,tielo� ar attach a s/;e mWing) C� tv 141.4. ell d`1 NS '` 1vi'Y '� ✓ �..r r t. WAIVER SECTION 1 understand that a pier, dock, mooring pilings, boat ramp, 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 bi2iciffW 6'i �V �-.. I do wish to waive the 15' setback requirement. FEB 2 4 2017 1 do not wish to waive the 15' setback requirement. artYOwner Information) TYPro (Adjacent Property O n r nfoMb n) 1-;5e.� C.� 6 t L� S SITM P Prrye-i Print or Typ�Name Print or y Name `) (') (o N CJ w oo c Ct n '2 IN Address Nc a 9 67 0 Mai i g Ask ddre C) tylstat ip 1s�L- r7').3-- a 5 3 7 City/State ip dsa- 8-, 8'6 7 Telephone Number/email address 0-- �t- / Telephone Nu�b_er% �mall address 7 C ECE-1 V Date Date* < I *Valid for one calendar year after signature* (ReVlSedQ. Yg 14) ®CM- MHD CITY 'r• ADJACENT RIPARIAN PROPERTY OWNERSTATEMENT I hereby certify that I own property adjacent to5a�� `,N� 'S I Name of Property Owner) property located at 2.0(c> (Address, Lot,J�lock Road, etc.) on "�9 t > , in P560, N.C. (Waterbody) (ity/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above o I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT �t»d�i�ua/ propasmg afev�lorr�e[�t�c�s `f//l in �CCescriptioi� b�loia� oar ai��cl� a s�t� tlrawin9l 01 1 rV A— WAIVER SECTION ,.� I understand that a pier, dock, mooring pilings, boat ramp, 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. RECEIVED I do not wish to waive the 15' setback requirement. MAR 0 3 2017 (Property Owner Information) (Adjacent Property Own in m ??b CITY A ) ture LSign r rrti 2 q01--S T�&A 7, Print or Type Name Print or Type Name Qk `�ogwoecC )'Cin z/ 2 Q,wovd LA) Mailing Address Mailing Addre City/S fe ip City/State/Zip : ::L- 7a3- 9,6 2�2 - 5-03-0 ZY7 Telephone Number/email address Telephone Number/email address 2 - a3- r 7 2 2-3 / Date R E I i/ D *Valid for one calendar year after signature* FEB 2 4 2017 (Revised Aug. 2014) DCM- MHD CITY AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting PermitV>�U' Mailing Address: Phone Number: Email Address: all �e-s 3 C. CIQ- r -, C o M certify that I have authorized N�eS Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: at my property located at �� - �`� � L pygV ' �jb�'3 in County. I furthermore certify that 1 am authorized to grant, and do in fact grant permission to Division of Coastal Management staff, the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating jinformation related to this permit application. Property Owner Information: a r � ALQ2 Signature :iE9f`f\iC Q- \AG�)e..s Print or Type Name Title OS Date This certification is valid through 03 / 03 / �� MAR 0 3 ZW7