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Home My WebLink AboutTaft, Billk' 'Se4,4l_ 0 Q, j1) �►IVIA El DREDGE & FILL N" 675AIl A B C D ENERAL PERMIT Previous permit # ew ElModification ElComplete Reissue El Partial Reissue Date previous permit issued -0 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 Nam k Project Location: County Address— Street Address/ State Road/ Lot #(s) St City State ZI P r Phone �-Mail Subdivision Authorized Agent AA city ZIP ? [1,CW '14'EW J'PTA OES 0 PTS Phone # V! I k tr River Basin Affected 0 OEA 0 HHF DIH 0 USA 0 N/A k (fiat Iman JunknJ AEC(s): Adj. Wtr. Body 0 PWS: Closest Maj. Wtr. Body ORW: yes PNA yes n,6 rType of Project/ Activity Pier (dock) length Lr, )k e*}J.!' Fixed Platform(s) Floating Platform(s) Finger piers) _2" Groin length .,...- number"""'" Bulkhead/ Riprap length avg distance offshore—' max distance offshore Basin, channel cubic yards Boat ramp N---, Beach Bulldozing I I I L Other .... ... - - ------- ... ........ .. . ... ......... ........ Shoreline Length SAM not sure yes Moratorium: n/a yes Photos: yes no Waiver Attached: no A building permit may be required by: J Note Local Planning jurisdiction) Notes/ Special Conditions (Scale: FT T] , I U f-T . ........ ...... . . ...... L-i-J-1-1- th- L-1- I I El See note on ]back regarding River Basin rules. -A*iohnt Printed Name Permit Officer 's'PriR ted Name ac ... ......... iiignakire *#Please read compliane statementon c back of prmit e S11p, t ure V, 3 App, ication Fee(s) Check # Issuing DratJ Expiration Date r 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, certify that this project is consistent with the North Carolina Coastal Management Program. River Basin Rules Applicable To Your Project: 0 Tar - Pamlico River Basin Buffer Rules El Other: 0 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 400 Commerce Ave Morehead City, NC 28557 252-808-2808/ 1-888-4RCOAST 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.net/ Revised 08/27/ 14 AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS Name of Property Owner Applying for Permit: 131-// J� Mailing address: Telephone Number: _ _ 2,,,SZ-- 7I 7 - eS� 4!o,qi�6 13,a,45 I certify that I have authorized PeCek&—w1Y1 (agent/contractor), to act on my behalf, for the purpose of applying and obtaining all CAMA permits necessary for the proposed development of CMG I LIE at my property located at 2 This certification is valid through 1� 3 ® O 14 (date). (Property Owner Information) Signatur /Y Print or Type Name 1�10/1701*1— Title, co. owner or trustee for property RECEIVED 1015 Date G4 - 7 1-7 Telephone Number Email Address r ,. ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to G/ / 4 - is // ame of Propgg y Oyvner�/ 2- CU-3-7 property located at l /�� cC (Address, Lot, EI ck, R ad, tc.) on ��<iz C�c�e , in �� , N.C. (Waterbody) (City/Town and/or Countyy) The applicant has described to me, as shown below, the development proposed at the above locatiq 7� 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) /��i- 6vN RGl1 `Y WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, 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. {Prope . Owner Information) f Signature _ . i3t // 7-;W'- Pfint or Type Name M�ging Addres4 cftylstatemn 7,17 Telephone Number/ email address Ora 7,p-" 15— Date *Valid for one calendar year after signature* (Adj Owner Information) Signature's " Print or Type Name Mailing Address citylstatemp �� -.�-" - 05 � Telephone Iyumberl email address Date" (Revised Aug. 2474) RECEIVED �' JUL 0 8 2015 PQ"11.1V)N;� K;7v L F l`S k s4fcQi�j RECEIVED ja ® 8 2015 AD. ACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to y /Y 7 's � 0 q A l-v A? :I1 ,-e of� peg OV wnr}C, 4 -> / property located at (Address, Lot, Block, P,oa , etc.) on %� e- r Ca-e � , in 11/,l 1-' C� , 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 DRAINING OF PROPOSED DEVELOPMENT (individual proposing development must f!/I in description Abe/ow or attach a site drawing) See WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, 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 l ormation) (Ad' cent Property Owner Information) Signature Signature Print or Type Wame Pnnt 6r Type 41a(,e ,�0 7 /Ylcss L •1S or r� T� (9 1-irjzw a IL 1 ;k-•"P M 1 Addrve M rl Addr ss �,' l� CFi�'►`1V G 11 � �� r Z c Lrf ,j C �� RECEIVED CitylState)Tp Cray/Stafe/Zip / 7 s 21- - 7/7._(� 1 '72 A — msi —_ JUL 4 8 2015 Telephone Number/emailaddress TeTeph e um rleemail address Date Date" (Revised Aug. 20f4) *Valid for one calendar year after signature* M1 ` I �^ 7V-` J ,4q;tO,\j RECEIVED ja 0 8 2015 p,,'-AArl0 O�"