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HomeMy WebLinkAboutSabiston, Anne9 3� �Agt -.. �a' �"^t�+iu Ig ,i r ... ... - ff •__ 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 El Other: El 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 how to 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 N.C. DIVISION OF COASTAL MANAGEMENT AGENT AUTHORIZATION FORM Name of Property Owner Applying for Permit: Mailing Address: 1t03 --nL- kts Drove Roc8 III v7sm ,. I certify that I have authorized (agent) ; Il jo to act on my iDeviR6 k Sons Kko-rirnc Cons}rcLc+, on, LL - behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity) o9 53' p Woo6p n .hul 6 ea6 , at (my property located at) 1\03 TtAks Lroy e- I wA vac uL614 ; M C a8s I b This certification is valid thru (date) W 1� 1 / 20) 4 Property Owner Signature Date CERTIFIED MAIL . RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner. ('Y1Jrll� Cj� Address of Property: I lb-3 'Tx4l -es Lcov e�i oad ZecuA (Lot or Street #, Street or Road, City & County) Applicant phone#: Mailing Address: 1)03T44ReS 6roue- (2,4 rJcJ a gsr I hereby certify that I 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 descriobon or drawing. with dimensions, must be, 2rovided 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 of Coastal Management (DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is available at www.nccoastaimangement.net/contact dcm.htm or by calling 1-888-4RCOAST. No response is considered the same as no objection if you have been notified by Certified Mail. WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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) Signature Ann-e- S ,b 'i ss 4-on Print or Type Name Mailing Address &CtU4 4 i 'QC a rl5 1 City/State2ip d5a -?,,I 8- L147/ Telephone Number Date (Riparian Property Owner Information) Signature Print or orr Te Name l J 0 4616do 1,206k Mailing Address l-«11e-Ld-6L City/State2ip /'�s - g y' Telephone Number /1- i1-13 Date CERTIFIED MAIL - RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Owner: GSbcSJ-, Address of Property: 1 i 6?5 (Lot or Street #, Street or Road, City & County) Applicant phone #: 6169. $- p-7 Cfl Mailing Address: [ U � es (-ro u e I& I hereby certify that I 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,_Mah 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 of Coastal Management (DCM) In wrYing within 10 days of receipt of this notice. Contact information for DCM offices is available at www.nccoastalmangementnet/contact dcm.htm or by calling 1-888-4RCOAST. No response is considered the same as no objection if you have been notified by Certified Mail. WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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) Signature Anne- Sabis�00 Print or Type Name 110-�) (Drove Mailing Address '6eU'Uf"r+ , iJC- a851(o City/State/Zip a5a- 7a8- qo-A0 Telephone Number ks0V. Date (Riparian Property Owner Information) ignature /, Xonu1� /- AC�Ce"%aild Print or Type Name / /// % l/�ory- l/� _ r cec lc t01 Mailing Address 03 iev C' &V�OL // L A City/StatelZip A5-1- 34-.1 - 7d q 2-- Telephone Number i1-- 9 113 Date