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Home My WebLink AboutTaylor, Tony 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 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 howto comply with these buffer rules. Division of Coastal Management Offices Morehead City Headquarters 400 Commerce Ave Morehead City, NC 28557 252-808-2808/ 1-8884RCOAST 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 CAiVIA/❑'DREDGE &FILL A B C NERALPERMIT Previous permit# ,� D evv ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued ,or zed by the State of North Carolina, Department of Environment and Natural Resources e'Coastal Resources Commission in awn area of envirpnmeq lconcern pursuant to 15A NCAC Rhles aft acMe^d. Name f ant Project Location: Coun ss'. !' {f , i- j f yr-�.. 9 Street Address/ ' State Road/ Lot #(s) ! State ZIP j t # -Mail Subdivi ion I` 1 i rued Agent a i City -- ZIP f ed EW . _ PTA ❑ ES ElPTS Phone # River Basin-ii EA HF ❑ IH ❑ UBA ❑ N/A ► Adj. Wtr. Body nat Iman unkn - El PWS: yes / ' PNA yes / Closest Maj. Wtr. Body• ,of Project/ Activity T� ■■■■■■■■G0'■■■■ ■ININ■I ■E ■■U■■H OMEMM■■■ ■I1■I .�.a.�CC� s1�� ■■■■■MMMIM■■R■■■■■ avgdistince offshore ■■■■■■■■IZlOM MEMO ■■■■■■■■M■■■■■■■ ■oil 0 a� NONE ■■■■ ■■■■■■■■M4■■■■■■ ■■■■■■■■■■■■■■■■ ;I■0 ■■■■■■■■■■ II■■■■■■■■■■■ II■■■■■■■■■■■ j AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS Nam of Property Owner Applying for Permit: (� Mailing address es �. 7/�- ye < Telepoone Number: I_ r I certiiy that I have authorized J�'V ��i�iG 4�(agent/contractor), to action my behalf, for the purpose of applying and obtaining all CAMA permits w nece4sary for the proposed development of 5 A kw i at myiproperty located at This 'ertification is valid through (date) (Propllerty Owner Information) Signature X-j-f 5` -,Prio N Type ar 0/- -A o Title, co. owner or truste Date XTie lephone Number i Email Address for property FEB 0 3 2017 ®CM- MHD CITY ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to 7noY may/ Y s G(Name of Property Owner) property located at IRA HM Q -NLe: C--F*b:- (Address, Lot, Block, Road, etc.) on ' ti'� �oLE G 1L , in $1 L�IANY(c 3;:::4 , R-E7 N.C. (Wate.rbody) (City/Town and/or County) LThe applic has described to me, as shown below, the development proposed at the above ation. 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 i description below or attach a site drawing) P -Prp .D WAIVER SECTION F I i I understan tat 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 RECEIVE ® 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. FEB 0 3 2017 (Property Owner Information) Ad' cent Prope Owner Informatio ) 1n Signatu Sigma ure JA2AI♦ Print or Type Name 1 ` Print or Type Name Mailing Address�"Maikn Ad r s �i✓i`lT�ss7//% �/ %� City/State2ip J� Cit /State ip 907A��ti C�eme.C®vy, Telephone Number/email address XTelepho e N tuber/email address �/� -3gce-ao�c D/ 31 , Date Date (Revised Aug. 2094) *Valid for one calendar year after signature` ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to —TD/�a-' 7°wf,,,4-- 's (Flame of Property Owner) property located at I 1:t0f I-4+oP ,�� c. Avme- (Address, Lot, Block►4, Road, etc.) on o � K , in nAPT Ic- -r',c0 . GflCTFMT� , N.C. (Wate.rbody) (Cityr/_ and/or C" -6unty) appli nt 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) 00 .�o ►d 'Ar' gwo L'b � 6 „ti � � a c, k •t-• GYr 1 �o •e 15 4- 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 Owne Information) (Adjacent Property Owner Information) tigpqture Signatur * D W /.v oWl Print or Type Name Pr' t or T pe a e Ql n Az&=ey IRZA s' ✓- `R EC E IVE ® MaX ng Address Mailing AcJdress �- /r City/W-6, p e�� city tee �'�CG FEB 0 3 2017 Telephone Numberlemail address Telephone Number/email address ®CM- M H D CITY 1 Date * _ [i Date (Revised Aug. 2094) *Valid for one calendar year after signature"