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Home My WebLink AboutBrock, Lee❑CAMA / D DREDGE & FILL �r GENE_RAL PERMIT ❑New ❑Modification El Complete Reissue ❑'Partial Reissue, As authorizeU bathe State of North Carolina, Department of Environment and Natural Resources and the Coastal Resources Commissio*kl an area of environmental concern pursuant to 15A NCAC A B C D Previous permit # Date previous permit issued Applicant Name Project Location: County _ Address f`� " Street Address/ State Road/ Lot #(s) City State ZIP' Phone # �-Mail � Subdivision ( ), Authorized Agent "^ City _ Rules attached. ZIP Affected ❑ CW ❑ EW q PTA ❑ ES ❑ PTS Phone # ( ) _ _ River Basin _ AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body _[nat /man /unkn) ❑ PWS: ORW: yes / no PNA yes / no Closest Maj. Wtr. Body_ - - ■ ■■■Biil�.■ ■1♦ �i■■EN ■■ ■■■ M ON IN MINIM ME SI 1■■:■■■■ ■ ■■��■■■� ■■�■■■ WEE E NNE .. IN ■ �.■■■ ■■■■■■ .■■■..■--■■t..®...■■!■.■■ .■■■ ®■■■!1■■:�i■■ ■■■■■■t�■�■■■�■[#1 MEN ■■MEN ME M Erb FJZ ON N—ME 0 IS NOME VA41 _ ■ ■■■G7■■■® ■■■II■1 ■�■■E�i■■■■■■ ■�■■��®■■�■■lli.'ri.�■!I■�i■lid■■■■■H�■■■■ • - ME IS ■ilili■ ■■■l`1S■E■�1■�'ifM1111■■�>llll0�� FARM tilll/■■■�■■N■■■■■ ■■■■■N■■■i i■■ ■■ H■■■ ON ■■■■1t1►�'J■fir.:■11�"''•• "WM on ::�4�ii�■�■■� ■N ■®�■ MEt�ll�11�9It 01K1 Mi so • .. ■ won OP3 mo■■■■■�■ii■iil��' ■■■H MEN ■■■■■■■■o MEM ■MN Agent or Applicant Printed Name Permit Officer's Printed Name Signature ** Please read compliance statement on back of permit ** Signature Application Fee(s) Check# Issuing Date Expiration Date 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: 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/ I-888-4RCOAST 252-946-6481 Fax: 252-247-3330 Fax: 252-948-0478 (Serves: Carteret, Craven, Onslow - (Serves: Beaufort, Bertie, Hertford, Hyde, North of New River Inlet- and Pamlico Tyrrell and Washington Counties) 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) http://www.nccoastalmanagement.net/ 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 08/27/14 • Jun 01-1 T OT.38a p.1 ram 31, 2W 0939AM BM-ck Faint CoffWy j Z5&35411 Z gage PA 1 Fte�reby certithat !OM�OwfiY ad?alien t t0 . i on -`=2 (At!dcloe;l,;otx 910 1. x wa a{yatrr�rAnd(or c►�uniyj n ; ; •• xv►i b GrN,'tti� alt afogrngnt p6p6w a4 the above. � haVE! noLti'?j�fiprl to tlttti (�t': � • . - ' t ovi�. �a Ii a dot rY r �r b /iO tV r �. ,h7d} #t l' i A% - tuhda am�m .c 15 i-ruse;li or groln irtust be set WOW ft.s� Y, �` pp3tiari.a�cess unjeSs waived by me (t# Y� 4 , tlt9th� prOpridte blank bea*111 rsqt4remant- VsdY Dwnerinto 1'oc � Si�rirrtitr� .� �'liritar rya# Hama A.�'tg ,+} u r.•G . yeas =J004. ' ...,� .-�7___ �o � .. Mfg Aadr"--...-_..._ • � ,�•. ON. ar M MO AN ��F�T* ��fP ��AN ��OPJER�TY LM— PROPtRTY OWjl HSTATEMENT hereby certify that FoVAj- PtOPerty adjacent to e e- 1 8 OrVOTtY located at IV,01, AMO of Property, O rt�msr) lvl� on Wdi6s*, -Likt, 610C* 'Road RAW fhO.d The applicant has descrlbMtb location. bftW,'Ova!Ow9nt propoW at tho above. I have rro p jgt i to thts_p Posa 1 have,€ens tiffs M ,. 1 0 � , -oEse Afoir, I WOW or attach a'she drawing) Ad A, #tH 7A t F4 lift, or groin must be t Aerst un and- that a pier 0 r,,boath4use, OCC. back Qrn dii5to M- o Oet oor wish to miatvti-the T unless waived by me. (R yOjj set W blank t,016w) YOU 5f Setback te4oirernsnt. I do,riot wS h w4)" �0. tft$ 1,5 setback reCIVIrOrWrIt. v 7it OW" tAdjgkcent Property OWn , er Information) Signature PrinT t 09r -�' ji lk4-54� ry Prin 11 4)f Tips Name 7W. 4- 9-� Z qw (Revised 611"OY2) ❑CAMA / 0-DREDGE & FILL WGENERAL PERMIT Previous permit # A B 1,C D ❑flew ❑Modification ❑Complete Reissue ❑Partial Reissueq , Date previous permit issued As authorize"y'ie State of North Carolina, Department of Environment and Natural Resources and the Coastal Resources Commission-.ip an area of environmental concern pursuant to 15A NCAC N�{ I -;l£ : ,, Rules att4ched. If Applicant Name ' ' Project Location: County Address . #:.' _ Street Address/ Stat-e-�Road/ Lot #(s) CityJ� State ZIP Phone # (�'! X E_Mail Subdivision Authorized Agent Affected ❑ CW ❑ EW I_y PTA ❑ ES ❑ PTS AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: ORW: yes / no ` PNA yes /.no City yI I JI ZIP. Phone # (-"1. River Basir r Adj. Wtr. Body "A! Closest Maj. Wtr. Body �7 ■■■M■■■■■ ■■■■■■■M■■E■■■■■mMM.■■■■ ■ ONE ■■■■■■■■■■■■■■■■■■■■■ MEN ■■ ■■■■M■ES OM■■■■�■ ■■■■■■■■■■■■■■■ MEMO NI ■MOENO� �■i IIIIMN■ MENOM MO■A■■N■MINI M ■■ME ■■MM■■■O■■E■■■■M■■■■EEM■MMM■■■MEMO E■M■■■ E■E■■■E■■EE■ ■E■■■ EM■■ . • ... ®■■■■■■■O�■■■■■NONE NNE NONE ■NE■■ ■■■ N■■O:O■NN■■■N■■■NEM ■■■EEO NEI ■WE■■OEME■■■E■ OMEN OMEMO ■MEM■M■■M■M■■■O ME • mm ■E■N■=■■■■■N■■■■■ 1 ■■■■■. MEN ■■■■■.■■■■■[.■■..■O■■■■■■■.■■. . ■■■■■■■■■.■■■■■■■..i.E■.. NNE M■■..■■.■■ ■■■.■MONFi O■EOOWN EOO■E■■EO M■OMM■M NNE ■EMMUM ■■ ■■EM M■■■■■■MEE■E■ME DI ... • •■■M■■L1E EMEE■■M■■E■r�■■■■.■■ .. OM■■MM■ME®E■MEMMUMMEi1 MEMO MMM=MMMMM ■■..■■MM®.■■■l�Mi>M.MEUMi��iEl■■.■■■■■■■■ • ■■.■■DOE■■Or"IO■E.�It■M�YO■■■■■■■...... ■■■■�■Oir1■■I■■ ■■-12 M■■ ■■■E■■E■■O ■■■O■■IMEEE■MOT�M®■■ O■■■E■■■O■ O■■OOI��1EOMOiMi11hi�■■■■■ ■■■■au% . OOOMOI ... M■E■LIML*EIO■Oil':C"1:�IEM�O■■■■ MM■l ■OMEW 17Mi'� MEMt�l ■■ME■■OMME M■■EM■■■ ��.1n MEEO■OOMOONMMMME MEN EO■O■O■ ■■ME��MN■■�� .■®■O■■■■E■■E■■MME■■EEO■■■■■■OEOOM■O■■ �I■NMENNM■■�� Agent or Applicant Printed Name Signature Please read compliance statement on back of permit Application Fee(s) Check # Permit Officer's printed Name Signature Issuing Date Expiration Date