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Home My WebLink AboutHolley, Laura W.iD m '616REDGE & FILL CA A A B 'C D GENERAL PERMIT Previous permit # 9New ElModification ElComplete Reissue ElPartial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environment and Natural Resources 1. A and the Coastal Resources Commission in an.area of environmental concern pursuant to 15A NCAC h O.Rules attac ed. Applicant Name "A Project Location: County_' Address t Street Address/ State Road/ Lot #(s) J CityState &� 46-0 P I -1 Phone #ftIt-Mail Subdivision' yl) Authorized Agent City- ZIP Affected 0 Cw DEW 0 PTA DES 0 PTS Phone # A D_J FYIl River Basin 0 OEA 0 HHF 0 lH 0 USA 0 N/A AEC(s): Adj. Wtr. Body (nat Yman /unkn) El PWS: I f M I Closest Maj. Wtr. Body ORW: yes / !q j 1PNA yes /IV Type of Project/ Activity J1 AJS FloatPier Fixe Fin Groi Bul Basii Boat Boat Bea( Othi Shot SAV Mor Phoi Wai, I /I � -/ (Scale: ::--W ) ONE ON mom WREM"MMMMMMMMMMMMI max dii e offshor channel ININIMEN cubic yards MENOMONEE 0 ramp NONE MOMMINNOMMINE iouse/ Boatlift--�' I �� i Bulldozing-'i�i �s M MEN MMMMMMMMMMIMMMMM NONE -line Length not sure yes (9 9��mmmmm ME ! ME torium: n/a yes (no,'EMEMMENENIMMEMINMENJ Fs: yes !��MMEMMMMMIM 00 WE ME= 000011111 -rAtta6ed: yes no MENOMONEE A building permit may be required by: Note Local Planning jurisdiction? Notes/ Special Conditions 69en! or'Applicant Printed NarT;e Signature me read compliance statement on back of permit" Application Fee(s) Check# Ej See note on back regarding River Basin rules. PermitOfficer's Printed N4rne Signature issuing irate 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, 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 400 Commerce Ave Morehead City, NC 28557 252-808-2808/ 1-888-411COAST Fax: 252-247-3330 (Serves: Carteret, Craven, Onslow - North of 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 - South of New River Inlet - and Pender Counties) http://www.nccoastalmanagement.netl Revised 08/27/ 14 N.C. DIVISION. OF COASTAL MANAGEMENT AGENT AUTHORIZATION FORM Date Name of Property Owner Applying for Permit: RF JUl �NFo Mailing Address: a� �rne I certify that I have authorized (agent) to act on my Ke behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity) Rcplr� Exi5f,-3 A1196./ lee4lk . r�;sfi� oy da.� , at (my property located at) lit Ocx:�k Sf: /a1 bH�'�� . rt•C. RECEIVED This certification is valid thru (date) Property Owner l Date AUG 0 41015 ADJACENT RIPARIAN PROPS yap I hereby certify that. I own property adjacent to pro�?e11x lvctea t'..� (Address, Lot on , in Uffiaterbody) ,TY OWNER STATEMENT (Name of Property Oar :r) (City/Town and/or Cou The applicant has described to me, as shown below, the development proposed at the above location. - t/ I have no objection to this proposal. have objections to this proposal. DESCRIPTION AND/OR DRAINING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) i C« 144 j aif p sflµ Qoak • �cAi4 v �eill'svlrhe�.� P. 1P�4cc. +4pp.no-� of hCi a}rK9 ,B�Ik hsgy/. ✓ �Fce G 2, WAIVER SECTION 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.) RECEIVED I do wish to waive the 15' setback requirement. AUG p 4 2015 do not wish to waive the 15' setback requirement. (Pro -pert Owner Informs ion) (Adjacent Property Owner Information) I /lctgHb��- 1 Signature ture 's L i c rdeyt 0-:Y e Yes Print or Type Name Print or Type Name Mailing Address M�ling Address o2 `l sa Ci /State2ip CitylState/Zip Telephone Number Telephone Number l7 2a '71 �7 /aais Date Date (Revised 6/18/2012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I °4 - ► I hereby certify that.I own property adjacent to �Qu ra 1A` s (Name of Property Owner) �� - •.r-_---- - 5. (Address, Lot Block, Road, e OtJ- on tke C�:>ot-ko in Z+ 1(1u\7E� , N.C. aterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above cation. have no objection to this proposal. 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) �G �w �Ce�I�h 1= wsl-rrt� G(o�k • To HGt.� 16MIC3�� . &i kkeo-( gt p%oc e ' 4,Ppro)( j �o WAIVER SECTION l 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 ripari an, access unless waived by me. (If you j wish to waive the setback, you must initial the appropriate blank below.) RECEIVED do wish to.waive the 15' setback requirement. AUG 0 4 1015 ; do not wish to waive the 15' setback requirement. (Propert wrier Informatio) (Adjacent Propert Owner Information l G ct�G►b�� Signature /77 Si re 5; N's Print or T pe Name PrAt or Type N e r i4et c- a r tom( Mailing Adess Mailin Addre e r Y` City/State2ip CitylSta eIt e p n o Number Telephone Number - ��i8�is Date, Date (Revised 611 M012)