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Home My WebLink AboutHenderson, SteveD/V MA 0 DREDGE & FILL 0,0-, �A �C &1 6 Y' A B D GENERAL PERMIT Previous permit # Q0New ElModification E]Complete Reissue El 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, ursuant to 15A NCAC EJ Rules attached. Applicant Name Project Location: County Address Street Address/ State Road] Lot #(s) NT J uzlp' City State, Phone # E-Mail Subdivision 7 J Authorized Agent 1 1 I" _1V City� zip 0CW h kW PTA E3 ES El PTS Phone # River Basin Affected EJ AEC (s): OEA. ❑b HHF 61H El UBA 0 N/A Adj. Wtr. Body (nat /man /unkn 0 PWS: Closest Maj. Win Body ORW: yes / ��o PNA yes :nol,,L Type of Project/ Activity .i 1 \ "A (Scale: I '-" T- 0i 14 i __.1 Pier Fi.. Float' F ng! G rol , , Bulkl Basir Boat Boat Beac Oth( Shor SAV Mor Phot Wain SCK) 1-1yL I Platform(s'-1 Platform(s)—� ier(s) ngth Elm number ead/ Riprap length�____ 004 MINIMMINIBiENNEXPAr WOMEN MENEM avg distance offshord M - max distance offshore�� MEN M MIMMEMMUMEMENE SHONE MEN IFAM I ,channel",- cubic yards ramp NONE M MEMME MEN iouse/Boatlift' 1110111 CC INEWEENIN1111 :i Bulldozing----' ---ENKA= MENE MEMNON MENEEMELVANNIMEMENIMEMEMEMOMMOME a Mm=MNMMM MM�NUMMEMM UMEMEMEMEM Ma UNNNEEMOMME .Nlrmll MEMOMMEM ON MONOMER MMMUNMEMMEMEMMOMMOMMM FAMEMEN 0 22MM MENEM MIMMONMEEMEMEMMEEM MONEEME101114 Will MINEM MMMMMMEIP MEN A building permit may be required by: El see note on back regarding River Basin rules. Note Local Planning jurisdiction) - Notes/ Special Conditions or } Please read compliance statement on Application Fee(s) PermitOfficer's Printed Name ire Date Check # Issu Expiration 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 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 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 how to 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/ 1-8884RCOAST 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.nccoastaimanagement.net/ Revised 08/27/ 14 Y- Ju1.15. 2015 10:03AM No.0096 P. 1 AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS L� Name of Property Owner Applying for Permit: Mailing address: Telephone Number: I certify that I have authorized ()r1jS /44 ' ! "t (agentkontractor), to act on my behalf, for the purpose of applying and obtaining all CAMA permits necessary for the proposed development of fk:a?-''l & at my property located at This certification is valid through . (date). (Property Owner Information) L-,," Signature Print or Type Name RECEIVE � Wou JUL 15 2015 Title; co. owner or trustee for property 10 f7zl frl Date 2 s2-(!ZC 901 (��L_ Telephone Number Email Address RECEIVED JUL 2 3 2015 Ju1.15. 2015 10MAM No.0096 P. 2 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacentto 1ix Property located. at (Name of Property Owner) s on (Address, Lot 81ock, Road, (Waterbody) '' In ''7-- N.C, (City/iown and/or County) The applicant has descrlbed-to me, as shown below, the development proposed at the above location. I have no objection to this proposal. -�� I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (I.ndjVit�uaj:propQiiigielapil`erifi!"pst;ll'�ri;�iesc�lptl. - . o 10 on�itielolt -r.afta�ti';a:srte.grawrri ) .24 n---- l�y 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. I do not wish to waive the 15' setback requirement. (Property Owner Information) (AdJacent Property Owner Information) / Signature Si tore Print or T e Name Print orlm9 Name ailing Address Cily/Sfale2ip " C: S Teieph e NQQumber%email address~ 7- c D Dare 'Valid for one calendar year after signature' RCEYVE'- JUL 1 I C)CM-M'4,j -. " 91�57s'y RECEIVED JUL 2 3 2015 WUA&7W9 P N, (Revised Aug. 2014) Jul . 15. 2015 10 : 04AM No.0096 P. 3 ADJACENT RI A IqN PRO ERTY OWNER S A7f~MENT I hereby certify that I own property adjacent to Property located. at / (Name of Property Owner) `'S. on (Address, Lot lock, Road, etc.) (Waterbody) .____ __, in .,F.. , N.C. Th (City/Town and County) e applicant has described*to me, as shown below, the development proposed at the above location. I have no objection to this proposal. —�_ I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Micl dcrag:pY.Qposingdev�ldp ilerif'rri'Gsf ` ...�illliideserip�lo�r.:tie16%{r vr:atlach�.'$Tie� dr"awlrig) foa .rJ 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. I do not wish to waive the 15' setback requirement. .(Property Owner Information) Ad r✓ Signature IN 10' Print or T pe Name ailing Address T !3_:iPz_-0ew Te/eph ne Number/emetl eddfBSS o D Owner Information) RECEIVED JUL 15 2U15 RECEIVED JUL 2 3 1015 rC aW59Y 'Valid for one calendar year after signature - N, (Revised Aug. 2014)