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Home My WebLink AboutBurnett, William Jr.CAMA / 0 DREDGE & FILL GENERAL PERMIT E New DModification Ll Complete Reissue D Partial Reissue N270407 A B 'C !D Previous permit # 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 pursuant to Applicant Name Ad; "k 7Address City — State ZIP -7 4's Phone # (—) , — /19 E-Mail Authorized Agent k ", �. - >cz I � -)In ' 41, Affected AEC(s): ORW: El CW 0 EW 1-1 PTA El ES 0 PTS Ll OEA El HHF L1 lH D PWS: yes / no PNA yes 15A NCAC EqRules attac�hep. Project Location: County 'A - :'- Street Address/ State Road/ Lot #(s) Subdivision City zip Phone # River asin EJ USA 0 N/A n a unkn Adj. Wtr. Body Closest Maj. Wtr. Body no MEN IN MEN IN ME NNE M N■■■I■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■o 0 M. M. M. OEM■MEMO■M ■ .■■■■■■■■■1 0 Now Ec ��+ ��ii l� Im ON Bra %Is 7_261AA.22 EME IMMUNE rl 7> - Agent or Applicant Printed Name Signature ** Please read compliance statement on back of permit Application Fee(s) Check # V,11'0 4-�` � ;1)/ 1 C, f� Permit Officer's Printed Name Signature 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 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 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 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) Revised 7/06/ 17 AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS Name of Property Owner Applying for Permit: Wa-'-IA-ni Mailing address: Z� �'� 11161" D✓' 2- Zef Telephone Number: L- %I % 2 %! I certify that I have authorized %Cq1/ �`��5: Cei% (agent/contractor), to act on my behalf, for the purpose of applying and obtaining all CAMA permits necessary for the proposed development of &'aL ay` og2A ' (/-iPi at my property located at 10/n%E k,&aLr ��b) ' /y, 12q This certification is valid through (Property Owner Information) Signature Print or Type Name (date). D�vtit� Title, co. owner or trustee for property Date Telephone Number RECEIVED Email Address APR 16 2018 DCMI- NIHD CITY ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to Avezr s za"O —VE- - 's (Name of Property Owner) property located at 12 [ - j (Address, Lol, Block, Road, etc.) on 14&- &M I Kt2 LLB' in P// �'d�C SI�D�� N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above �lQcation. �� 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) C�I�NSTiiJc% X l(� hoc 32 X 6 1 BU T/i�G DOCK . ant t ! Jj boCkv� I.)6Ck (,,at�i iS f)T%s%CHED i-o I-/X6A k0UN-TOw,41,) l lol Doo /b �d' f � WAIVER SECTION I understand that a pier, dock, mooring pilings, 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.) 1 do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) Si nature Print or Type Name Mailing Address City/State2i S 7/ % ZZ/, Thone Number 1�• 147 REC-GI V G® Date APR 16 2018 (Adjacent Property Owner Information) �1 Signature 1✓Z P-1 Q %yEAL Print or Type Name .12Z JVAG ui c�ruLc Mailing Address Yilve— �L L NC LYSl Z City/State2ip 1ft ny- qql Z�3� Telephone Number Q� 7 Date CCm- MH® CITY (Revised 611812012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to 61& �ZE'i�><7T , j/' 's (Name of Property Owner) property located at /zit "4-1-A)U7- Cl 116!' , k-wou Jk'�5, — (Address, Lot, Block, Road, etc.) on 14e2r'fli r fl x in Pi��' e kit.-c. ! kCA' e� N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above IbFation. ��,, 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) 1-�h''at �= X I %irr� � �<- �ri) / pLf}�� l��1 % Ct b D" I�- ry 6X%4} 1"'ds .ev Gir t_ : /NSTau. It)/ '0' /� 6,qi WAIVER SECTION I understand that a pier, dock, mooring pilings, 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) ( 'scent Pr erty caner Information) Signature Signature tV1LL/&- E4&62 Z-V441571- t/JUGLAS T 9e-0 U) /Jr Print or Type Name , Print or Type Name Mailing Addre"s Malls g Address risen vt NC 27�� i�E 164)d �Q�AX-21!!5��Z City/State/Zip City/StatelZip 2�Y_ 7/ % 2 %/�' C� Z (o ql� Telephone Num er eoplephone Number ►� ry ��eV Date Date APR 16 2018 (Revised 611812012) 1� C*®V1® CITY