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HomeMy WebLinkAboutPate, GayleCAMA / DREDGE & FILL 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 # ( ) ----- Authorized Agent Affected CW EW ❑ PTA ❑ ES - , PTS AEC(s): OEA HHF ❑ IH ❑ UBA L' N/A PWS: ❑ FC: ORW: yes / no PNA yes / no Crit.Hab. yes / no Type of Project/ Activity Pier (dock) length__ Platform(s) Finger pier(s) Groin length number - Bulkhead/ Riprap length avg distance offshore max distance offshore Basin, channel cubic yards-_ - Boat ramp Boathouse/ Boatlift Beach Bulldozing Other ti Shoreline Length �t (TTV�'� SAV: not sure yes no _ Sandbags: not sure yes no Moratorium: n/a yes no Photos: yes no D cm-mpcm Waiver Attached: yes no A building permit may be required by: Notes/ Special Conditions Agent or Applicant Printed Name Signature ** Please read compliance statement on back of permit Application Fee(s) Subdivision City - --- ----- -- ZIP -- Phone # (- - _ _) - - River Basin Adj. Wtr. Body -------------- _- nat /man /unkn Closest Maj. Wtr. Body- - - - - - - _-_ _ _- - - -- -- _ (Scale: ) ❑ See note on back regarding River Basin rules. Permit Officer's Signature Issuing Date Expiration Date Local PlanningJurisdiction Rover File Name 4 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 andvoid. 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 Neuse River Basin Buffer Rules 0 Other: 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 complywith 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/ 1-888-4RCOAST 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 •y k 1 .. 3 t n `F. ',�3 9759�G� •7 i :{�. �>hG iiFY�r�'.a i l Applicarit: Date: 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. (Appled 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 ❑ 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 El Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ . Fill ❑ Both ❑ Other [I Dredge ❑. Fill ❑ Both ❑ Other ❑ 1tCEIiD APR 2 2 2014 ]DICUMMMY I hereby certify that I own pr property located at 1 b(�, adjacent to CLll h (Address. Lot, in of Property Owner) I t..aan..,.,.,rt (Gltyrrown and/or County) The 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 ANDIOR DRAWING OF PROPOSED DEVELOPMENT (lndhddual proposing development must fill in description below or attach a site drawing) 1 WAIVER SECTION 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 �1 I do not wish to waive the 15' setback requirement Owner Information) r3WWK;-= Print or 1)pe Name Mailing Address �-��► ll� nl L ags5a City/State2l G I a- ,4ALt-a(,OQ Telephone Number /I3_/IL (Adjacent Property nformation) "��.-,� Sigh m� Print or T je4V. /7Z-�� n iling A� City/Stateop - ¢s--g �7 z Telephone Number' - / Z — J I - Date bate APR 2 2 2014 (Revised 6118)2012) D CM•MHD Cn Y