HomeMy WebLinkAboutTown of Atlantic Beach (4)�- A C
❑ (:AMA / ❑ DREDGE & FILL NQ 70452 A B C D
GENERAL PERMIT -TM Previous permit# —7'/
ONew El Modification El Complete Reissue ❑Partial Reissue Date previous permit issued /
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pur uant to I SA NCAC
Rules attached,,
Applicant Name
Address
i
City
State ZIP
Phone # ( )
E-Mail
Authorized Agent
❑ CW
❑ EW ❑ PTA ❑ ES ❑ PTS
Affected
AEC(s): ❑ OEA
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no
PNA yes / no
4I
Project Location: County g-----
Street Address/ State Road/ Lot #(s)
J )% V I �•
Subdivision
r
City r- ZIP
Phone # O River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Agent or Applicant Printed Name Permit Officer's Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check #
Signature /
�l off
Issuing bate Expiration DateC
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 I) 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:
❑ 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 comply with 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/ 1-888-4RCOAST 252-946-6481
Fax: 252-247-3330 Fax: 252-948-0478
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax: 252-264-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
(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)
Revised 7/06/ 17
❑LAMA / D ®RE®GE a FILL
GENEPAL PERMIT
gNew 0-Modification ❑Com lete Reissue Previous permit #' A B C D
P —"Partial Reissue
As authorized by the State of North Carolina, Department of Environment and Natural Resources Date previous permit issued
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Applicant Name 0 Rules attached.
Address
---- Project Location: County
City
Street Address/ State Road/ Lot #(s)
_:___'.---------- State ZIP —
Phone # — ---
(____._J-- - E-Mail _._
- - Subdivision
Authorized Agent ------
Aff
❑CW SEW PTA City — - _ ZIP
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