HomeMy WebLinkAboutGodfrey, SteveLJCA VIA / ❑ Al DREDGE & FILL No 70930 A B C `. D
GENERAL PERMIT Previous permit #
QNew []Modification El Complete Reissue El 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 pursuant to 15A NCAC ` - / r
[mules attached.
I
Pro ect Location: County ' - f
Applicant Name 1
w Road/ Lot #(s) t / St Add Street ressae � f 1
Address �,� V •�
City � 1 State
Phone # ( E-Mail Subdivision r f ("i'?iL• f
r i f f``y'? I Pi P_.
Authorized Agent City' ZI
� ^+ C C `/ � � 'f f�-�
❑ CW PTA ❑ ES ❑ PTS Phone # O _ River Basin',
Affected ElOEA ElHHF ❑ IH ❑ USA ❑ N/A
AEC(s): Adj. Wtr. Body f ;r ^r`1 ( { +�•� (at man /unkn)
❑ PWS:
Closest Maj. Wtr. Body'
ORW: yes / no PNA yes / na- o
Type of Project/ Activity
/
i (Scale:
Pier (dock) length
I
Fixed Platform(s)
Floating Platform(s)
Finger pier(s) .a
Groin length
number
Bulkhead/ Riprap length
avg distance offshore y
max distance offshore „-
Basin, channel
cubic yards '
Boat ramp
Boathouse/ Boatlift f
Beach Bulldozing]
Other
Shoreline Length
SAV: not sure yes Po -
r I
T
Moratorium: n/a yes f t no
Photos: yes j no
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions,
�1 &210)
Agent or Applicant Printed Name
a
sF
Signature Please read compliance statement on back of permit"
Application Fee(s) Check #
❑ See note on back regarding River Basin rules.
l .Y�.
Permit Officer's Printed Name
T�h -�;e
n'
Issuin Dat 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/ 1-888ARCOAST
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
S
.... * AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:�e1 Ip t1C�[�2�c,1
Mailing Address:
. E 0�7
Phone Number: 919-'1 1 �29
Email Address: An gozd 1,
I certify that I have authorized LacrV t1-t4cn4 Arnoij
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: I-E p tc�,Ce_ l:5
J) o c K::-k nc� D Sc�Ae
at my property located at a049k VAA �ec,,rl 4it
in A CO County.
I furthermore certify that 1 am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Title
Date
This certification is valid through ! /
;S.
.4 .
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to '51C- LT. G o ,. rzecl 's
(Name of Property Owner)
property located at 30 3( 'L�-
(Address, Lo Bloch, Roa etc.))
on JJYI C , ►n ( F�1EJd`[�,(f etc.
on N.C.
(Waterbody) (CitylTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
� a
I have no objection to this proposal.
_ I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
ReOce' u"LOvA Pita, i4 1,11r",F. - F00 P P6 Of
6W�
Qn 1
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 Owner Information)
a
S��i.ggn�at
Print or T pe Nam
C'ANIrL� a
(Adjacent Property Owner Information)
�JR� �. ,�y,Qas Taawc�cs �-Kfa�'isn�i'
Signature*
Print or Tyre me
Mailing Address
City/StatelZip
Nam* 1:—P �2-z¢9-e91SR
Teleph e Number/email address
!B
Da e *
*Valid for one calendar year after signature*
(Revised Aug. 2014)
Y♦
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _5�'ere- &Oct -�?/ 's
(Game of Property Owner)
property located at b(Q `�
(Address, Lot, Block Road etc.)//
on sl'� % f� CfP e K- —,in ref� N.C.
(Waterbody) (Citylown and/or County)
The applicant 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
1 � f to 1)-f
k kAPgj
WldQ
rP Pace C- v r fe r't i e? --
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 Owner Information)
Signature
Prii}# ype N me'
% J C jc n
M ilid e n Ass
City/Stat&Z
Te/epone
umber/email address
*Valid for one calendar year after signature*
(Adjacent Property Owner Information)
Signature*___ _
Print or Type Name , ,
Mailing Address �r
,�J-2 ? t,►l�c DNr.,r�
City/State2ip ,-„ r
Tel e phony l�Kpnb�rI email address
Da4, *
(Revised Aug. 2014)
Q,CAMA / ❑ DREDGE & FILL INN 7093 A B D
ERAL PERMIT Previous permit #
Chew ❑Modification ❑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 pursuant to I SA NCAC
E106-les attached.
Location: County_ Applicant Name - ' ''- Project 1CtY
Address Street Address/ State Road/ Lot #(s)�C �.
City y State tliZIP
Phone # (?'� E-Mail Subdivision r
Authorized Agent _ , f, C;� *_ )_ ` - City l` L 1 ZIP
❑ CW p'rVV A ❑ ES ❑ PTS Phone # ( ) River Basin t L't ,frl C
Affected ❑ El ❑ UBA ❑ N/A µ
AEC(s): OEA ❑ HHF Adj. Wtr. Body � tt/1Rt { � -��' � (at/man /unknl
❑ PWS:
�'�
Closest Maj. Wtr. Body V6X
ORW: yes / no PNA yes /
Type of Project/ Activity
Pier
Fixed
Floati
Finge
Groir
Bulkr
Basin
Boat
Boat
Beac
Oth(
Shor
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A building permit may be required by: ( + tt El see note on back regarding River Basin rules.
—s— —r-r— —� i= /-�—'
( Note Local Planning jurisdiction)
Notes/ Special Conditions'''
compliance statement on back of permit'
Application Fee(s)
Permit Officer's Prjo'red Name
Signatur
�Vi s-Y
Issuin Dat E pirati n bate