Rosado, Kelly

A
ZICAMA f 1❑ DREDGE &FILL
A
67851: NO & I 9 S) D
GENERAL PERMIT GPrevious permit #
New ElModification ElComplete Reissue ElPartial Reissue Date previous permit issued
As authorized by°'ihe State of North Carolina, Department of Environment and Natural Resources
and the Cdastal.4tesources Commission in an area of nvironmental concern pursuant to I SA NCAC
bO Niles attakhed.
Applicant Name Project Location: County
Address Street Address/ State Rqkd/ Lot #(s)
City Ci -V1 State IP C"
r
Phone # IF -Mail Subdivision r--
Authorized Agent ,
'V A City Y
zip I
Affected '$CW W )��'TA DES 1:1 PTS Phone # River Basin
D OEA ACHIF /D 1H El UIBA El N/A man /unkn)
0 PWS:
AEC(s): Adj. Wtr. Body.
yes /(
00 Closest Maj. Wtr. Body 4
1RW: no PHA yes /( o
Type of Project/ Activity I
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number—�
iead/ Riprap length
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avg distance offshore_ ---
max diitance offshore. —
:,channel
cubic yards
ramp
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not sure
ye
rtorium: n/a yes
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21
-er Attached: yes
A building permit may be required by:
Note Local Planning Juri 's"' clict*4�
pecial Conditions Note S )ns
r
Agent or Applicant Printed -Name
Signature e read compliance statement on back ofpermit
V&
lickion Fees)"Ch
�T
El See note on back regarding River Basin rules.
C, 17 0, f (VJ
PennitOfficer'k.1
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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 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/ 1-888-411COAST
252-946-6481
Fax: [phone]
Fax: [phone]
(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: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://www.nccoastaimanagement.net/
Revised 08/27/ 14

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IL
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL, MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFIGATIONIWAIVER FORM
Name of Property Owner:
AY ASS 7
Address of Property: -� rT u • - .- .. , -
(Lot or Street #, Street or Road, tty &County)
Agent's Name #: ��`� Mailing Address:
Agent's phone*
I hereby certify that l own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letter
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division or Coasts/.Management
(DCU) In writing within 10 days of receipt of this notice.. Correspondence.should be mailed to 400
commerce Give., Morehead City, NC, 2855T. DCU representaflves can also_ be contacted at (252) 808-
2808 No response is considered the same as no oblecfioh Kyou have been notified by Cerfiried Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse; lift or grain must be set
backa minimum distance of 16 from my area of riparian access unless waived by me. (if you
wish to waive the setback, you rnusm 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)
,�agnar�cr�
�,�1 saoC rs
Print or Typ6 Name
1503, SrrWs LA�r�<�►
Mailing Address
�BSS7
Gift'/Stateaip -
gi��-'13I�_371f,g
Telephone Number
Date
(Adjacent Property Owner Information)
Signature
MA►J era �i2 C-i2.
Print or Type Name E-k 2CJA-�
sQ5• 4-3ce / -8 -t, -%)L 56
Marling Address
Cify/StateMp
.25 3 &90 33 3 �
Telephone Number
'q /0/i -
Date .
evlsed 611WCR
SEP 0 8.2016
DCM- MHD CITY

ADJACENT RPARiAN PRop—; --;s aR ST T�M�i i T
i hereby certify that I own property adjacent to
Property located at j 5 me of PropeE.�ni owner 's
3
on Vf„/ ddFessr Lot, BiacicI R oad, et ..j
{ifltaterbodu} in�I. G.
(Gityl, own an ' �• �ount-y)
The applicant has described to me, as shown below, the development proposed at the abov
location.
e
1e I have no objection to this proposal.
- '� 1 have objections to this proposal.
i IeSGRII✓' l�f h{t3/� DRAWING 0- faR�P©Slwl? i3�V)�L�P1��Ni'
(inclivioruai proposi�s�. -- de�relop�eng _��.{s; fill f� descrfPfaon below or affac;� a site drawing)
fl I \''
!©I x
3
RECEIVED
_. SEP 08 2016
DCM- MHD CITY
understand that a pier, dock, mo ring pilingr.,boat ramp, breakwater, boathouse, tiff, or groin
must be set back. a minimum dista ce of 15, y area of riparian access unless waived by
me. Of you wish to waive the setba�k, , VDU MU z initial the appropriate blank below.)
I do wish to waive the 15` etback requirement.
X I do ;lot wish to waiv�[,thep 5' se lback requirement.
(Froper€y Owner ing ration) {Adiacent RroperEy o%.n4r information}
Rio a •e Sianaita-e
S 4A
Pant or T ((►►Iam Print or Type Name {
1 D � �C.O La+iir•b, � __ q - e3 PL 5
ll� fling Address - l
G� � � � S S 7 Mailing Address
Crt,�/Slatel i - -- -- �4 r � ar. W R2�-
_ q1� _�3��_ ��! ,C�rv/staisrp
�---_ �53 C936 �- 333Ca
r elephone rVu ber!emaff address elephone Numbertemail address
s Ins.'« *n
Dart
Date*
Valid for one calendar year after signature* (Revised Aug. 2014)

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i11+3�iER a'"
r �.ii13�
rsixy ceI L that f d' ti'i rdi3erb� afi' n = .
r lacen° to ado
• i}iQut L located atk4�'�)__ �' Iu ii`t.' "
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fr
on M {fit V
t iiiargs d»i,F T ;n "
1.oad,
•+`as`•.��f .��ri?i1'� L�'i;:o:?i i ' -,t l:'i:M :?If , tF.l,..
11aS described i0 :i1e, a:!s sid�wn beloy.j. the te}l8jd?iiCil
i 18V~ np o7j8GitOn .de'!s i''QrDPrO OS G at lns above
S@. ----.� alre objections to this oroposell.
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`.•.........-_..---......... a w4-1 r+.. ..'�,. LIV 1(f J. w�... .. i... ... �t..� rl. 4�/{C'� •'
derstanc ti,at a pier, ddcx, mo rtn piling:,,, boat ramp, b;e2k%-rater, boathouse, fit, or groin
Cs set back a minimum dista ca Of !Q or, , i"i_r r8E i, '• � a Of r �ariari e'tCGE5S ,.Sr:l855 tylai�J$[j `z,iV
Me. (( You wish to �ryraive ; ne se
k � —
be appropriate blank �ic:r•
; do i11ish ro waive the
"Valid for one calendar year altar sigrawi e ,
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r 7
Ott fJo; ,=;T�a,�te
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'ci n�llCf^ tf�r17berlwa# adc}r9.�,.s
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AGENT AUTHORgATION FORMA FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: t�&, �U gcs� 0
Mailing address:
Telephone Number "t G �' I-,3 i 1 G
I certify that I have authorized A(ageht/contractor),
to act on my behalf, for the purpose of appiring and obtaining all LAMA permits
necessary for the proposed development of
, . )*0 f .
at my property located at 66a, C W .s t�,CA-d Ch ,-/'V c Ss �7
This certification is valid through (date).
(Property Owner Information)
or Type Name
ritte, co. owner or trustee for property
%as 1/�
Date
Telephone Number
AA (' Y Q S d)
-mail Address