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Home My WebLink AboutPerdue, GeraldLiCAMA El DREDGE & FILL "GENERAL PERMIT Previous permit # 1d_=7New ElModification ElComplete Reissue El Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environment and Natural Resources 7 an 1-� and the Coastal Resources Commission in area of environmental concern pursuant to I SA NCAC , UL"'L/ EJ Rules attached. �pplicant Name L Project Location: County 'Addr(issf Street Address/ State Road/ Lot #(s) State, ll "Zip `,i hone # Fax # Authorized Affected 0 Cw EW PTA OES E) PTS AEC(s): 0 OEA El HHF El IH El UBA 0 N/A 0 PWS: OFQ OIRW: yes PNA yes /,no Crit.Hab. yes no City ZIP Phone # LRiver Basin i Adj. Wtr. Body f na Closest Maj. Wtr. Body X-i junkn MEMO ■■■:■■■■■■■■■■■■■■■■■■■■�■■■m■■■■■ M." ■■■■■■■■■■■■■M■■■■■■MEMO■■ E■■■■■■■■■■■ ■■■■■■■■■■■■■M■■2ii■OMEMNA�■■■ MOM■MMEM ME■M ■■■■■■■■■■■■■�i ■`■■■■■■■ EMEMMEMEEME nwifflwm 04� Agent or Applicant Printed Name PermitC 'Signature. "Please read compliance statement on back of permit" IssuingC Application Feels) local Pla Check# 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 [)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 consistentwith the North Carolina Coastal Management Program. River Basin Rules Applicable To Your Project: Tar - Pamlico River Basin Buffer Rules F� 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 howto 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 Headquarters. 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) Revised 08/09/06 i�7"� �t)7�J39'7�•'�x� �� .^•`;��5 �� I�� Applicant: C ' "" �(2� Date: 1 � �(17 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. (Applied for. Disturbance• total includes any anticipated restoration or temD 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 D edge ❑ Fill ❑ Both ❑ Other 9 16q 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 ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ _ Fill ❑ Both ❑ Other ❑ Dredge ❑. Fill ❑ Both ❑ Other ❑ revised; 02JL / 3 N.C. DIVISION OF COASTAL MANAGEMENT AGENT AUTHORIZATION FORM Date I)•z2• r3 Name of Property Owner Applying for Permit: Mailing Address: I certify that I have authorized (agent) M L, fl �� 5` `-� ►� to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity) L, Ar+ at (my property located at) S� nDz�� K•�a, ,� This certification is valid thru (date) -_ � �� u • 22 • !� Property Owner Signature - Date ADJACENT RIPARIAN PROPERTY OWNER STATEMENT hereby certify that I own property adjacent to G cr' n I cl Pa a oa-z- 's (Name of Property Owner) property located at IS)-) k i iis4- /ti A (Address, L Block, Road, etc.) on efxj".0 / , in 7-I'r:� �-I ; c � B c h , N.C. (Waterbody) (City/Town 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 AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) D T�7 kc o�.,, r- o i � t_ � �� >'/5-� r 3 is�INS Z.ti+Sia II lvaw L� '70rn6 1v o 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. I do not wish to waive the 15' setback requirement. (Property Owner Information) (Adjacent Property Owner Information) G-D-e/'oL0Dozd L, 6— Sigganature PPrintr T peJN,ame b `�o JAI le 70'130 ailing Address W. C-. 'Z 0 50 �t �� 3g Telephone Number U-2z • r3 Date &;A� U S gnature ::YaS¢P ti w Print or Type Name S�- Mailing Address A-, 1, b Urn CitylSota3 ip�2� Telephone Number i i.2,2. i'k Date (Revised 6(18/2012) • ADJACENT RIPARIAN PROPERTY Q'Ii;i.NER ATE110EIN' r -'i ii 1 .`r�l', i �r'3 +? 1" •a��; =" `.��_� , �jlme of Property 0AJY-nfn'-) r�r�cerY; ;catti�l at (Address, Lot, Block, Road, atc.) o i i in i (11vaterbody) anchorCountyj The applicant has described to me, as shown below, the development proposed at the above. location 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) "TO kC c71_-D L i � + Li_4 b 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. I do not wish to waive the 15' setback requirement. (Property Owner Information) CG-e" ,, L0 ?AV-o Si nature Print or T pe Name 4300 0h4Uo.'-1 I le Quo d Mailing Address ►nhe4o��Ie %(e.27aS0 City/S ate2i Telephone Number t/• 2Z- 13 Date (face t Property Owner Information) Sign re Print or Te Name _I1 0,,Z-/1, ktM<,� n&B__1V ddress 4 " 2252 Ci S te/Zip 4 2a-?S Telephone Number IZ • R, /_.� II . (Revised 611812012)