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Home My WebLink AboutTereshko, StephencAMA DRGE & FIL N'111 66923 A B D GENERAL PERMIT Previous permit # New El Modification 0 Complete Reissue El Partial Reissue Date previous permit issued 6� 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 bulges attached. Applicant Name Project Location: County Address Street Address/ State Road/ Lot #(s) City I i Ot, State AJ zip Phone # E-Mail Subdivision Authorized Agent j City- zip Ja Affected El CW ";E'FW ffPTA :,EJES El PTS Phone # River Basin 0 OEA 0 HHF El 1H 0 UBA 0 N/A Adj. Wtr. Body AEC(s): El PWS: =r (nat hau /unkn Closest Maj. Win Body 01RW: yes /5!, '4, PNA yes no Type of Project/ Activity (Scale: Pier (dock) length Fixed Platform(s) J_ Floating Platform(s) Finger pier(s)_ . . . . . . .. ....... . . .... ... .. ............... .... .... .... . .................... .. ... .... . ... ..... ... ..... . .... ..... ... . . .. ....... .... ...... . .... ..... .... .. . ... .. ........ . . ... Groin length nu ber . ... . . ...... .......... ......... .......... ... ... . ...... ... ........... .. ... . ..... . ........ ...... - - ... .... ... . . .. ......... . ....... .. ...... . ....... .... .... (E U'lkhead�/lprap length avg"clistance offshore . .. ......... . .. ... ... ........ .... . . .. .... ........... max distance offshore Basin, channel . .. . .... ... . f I - + ..... .... ........ ..... . t t t I .. .. ...... ......... .... . ... ... . cubic yards Boat ramp Boathouse/ Boatlift Beach Bulldozing Other— Agent or Applicant Printed Name Permit Signs **Pleas'eread compliance statement on back of permit Signat Ap Fee(s) Check# pliqa;1on. Issuing T WNW& "101M MAMMON icer ? inted Name r ate Exiliration6ate ' I • ^ s 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: 21 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 howto complywith these buffer rules. Division of Coastal Management Offices Morehead City Headquarters 400 Commerce Ave Morehead City, NC 28557 252-808-2808/ 1-888-411COAST 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 t:,. . CAMA / ❑ Di EDGE & PILL" A g D �NERAL PERMIT Previous permit# New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued' As authorized by the State of North Carolina, Department of Environment and Natural Resources and the Coastal Resources Comnlission in an area of environmental concern pursuant to 15A NCAC Iles attached. Applicant Nam , P' Project Location: County, Address' ` v't < , Street Address/ State Road/ Lot #(s) City tlawV-e"'5 � / State ZIP .. / 1 ��""' G $�/' ,�' . Phone # O 1 E-Mail Subdivision ~'�� Authoriied Age nt 1 eo&10,,uj City c-in ( :ZIP Affected ` ❑ CW `VIEW . ETA eES ❑ PTS Phone # ( ) River$asin ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ' AEC(s) r Adj. Wtr. Body €r1.��J}UUj `% (nit a /unk ❑ PWS: �^ CO � � n ORW: yes / no PNA yes no Closest Maj. Win Body 3 LA in Type of Project/ Activity 1 6e (Scale. ) �.-. Pier (dock) length - Fixed Platform'(s) Floating:Platform(s Finger piers) Groin length n ber. "Bulkhead/ 'pray length r »+� - - - - - - - avgdistance offshore_ max distance offshore_ �— Basin, channel cubic yards , r � Boat ramp Boathouse/ Boatlift W C Beach Bulldozing ZZ Other Shoreline:Length i SAV- not sure yes no Moratorium: n/a yes no 1 — I -- - -- -- Photos: yes I�—t— -- - Waiver Attached: yes I ++ A building permit may be required by: ❑ See note on back regarding River Basin rules. Note Local Planning jurisdiction)4 Notes/ Special Conditions tc' .gyp j'"'0'' Agent or. Applicant Printed Name PermitOffi s rated Name SignPleasereadcompliancestatementonbackofpermit Signatur App4cationFee(s) Check# ,x !s umg ate Ex ration ate: i N.C. DIVISION OF COASTAL MANAGEMENT AGENT AUTHORIZATION FORM Date Name of Property Owner Applying for Permit: Mailing Address: I certify that I have authorized (agent) *.,:!A qkjrt,4 to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity)c��gcQ . �Nee�.�..�.�� , at (my property located at) This certification is valid thru (date) % JAN 21 2016 Owner Signature C�_ MHp CITY JAN 11 2016 DCM- MHD CITY ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to �,,�g��,�, 's %, Name of Property Owner) property located at (Addreds, Lot Block, Road, etc.) on pia ti , in �� c`�,s t'X� , N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above to aon.% I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must rill in description below or attach a site drawing) RECEIVED JAN 11 2016 WAIVER SECTION ®CM- MH® CITY 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 waiveed® by me. (If &Y;71 ish to waive the setback, you must initial the appropriate blank below.) N NED do wish to waive the 15' setback requirement. Jo 21 2016 I do not wish to waive the 15' setback requirement. HD CVTY (Property Owner Info ation) (AqVeen7roperty �� Owner Inf a/wn) Sig ture X Si ure* 4 f Print or Type Name Prir.pr Type Nam 9 Mailing Addr ss M f i g Address NNE)�.�3� ,/L�7�-�S CSC 6 /Vr City/State/zip City/State/Zip gy';z-- 7 2 Telephone Number/email address Telephone Number/email address .5� -nayx 2-- 3 Date \� a� _ \'S Date* (Revised Aug. 2014) *Valid for one calendar year after signature* ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to �� \� S1r�1 I (Name of Property Owner) property located at \\�1 S�lc . (Address, Lot Block, Road, etc.) on �.> a _ , in ri -"x ;� ' , N.C. (Wa erbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above 'e.-�— 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) ��-��►.��,�•�� '`lit . \��=�,�` j�`I� �.h . WAIVER SECTION RECEIVED BAN Y 12016 DCA4_ MHD C►Ty 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.)RECIVE® I do wish to waive the 15' setback requirement. JAN 21 2016 I do not wish to waive the 15' setback requirement. (Pro erty Owner Info mation) Sign ure Print or Type Name Mailing Address Ci /State/Zip - Telephone Number/email address Date 1�1-1, \S G, I( .® CITY (Ad' cent Propl!jy Owppr In MAllony xg� Sk,rnature * , ) , g q Printor TACt'�ame Z� lam`/cf�.�l G!Z • / 1C� , Cit / yl 11 p� �--6 1-7 Telephone Number/email address s 11611 Date* (Revised Aug. 2014) *Valid for one calendar year after signature*