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Home My WebLink AboutGoodman, JimmyN ❑.CAMA / ❑ DREDGE & FILL Na 72074 A g C D GENERAL PERMIT Previous permit # L, New ❑'Modification El Complete Reissue El Partial Reissue Date previou7.ermit issued As authorized by the State of North Carolina, Department of Environmental Quality f and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC Rules attached. " Proi1ect Location: County Applicant Name Address J' 4 City _ _ State _ ZIP s ' Phone # () E-Mail Authorized Agent ❑ CW ElEW ❑ PTA ElES ElPTS Affected ❑ OEA ElHHF ❑ IH ❑ UBA ElN/A AEC(s): ❑ PWS: ORW: yes / no PNA yes / no Agent or Applicant Printed Name Signature ** Please read compliance statement on back of permit ** Application Fee(s) Check # Street Address/ State Road/ Lot #(s) ! t Subdivision City ZIP. Phone # ( ) ' °'d W, `River Basin Adj. Wtr. Body __gnat /man /unkn) Closest Maj. Wtr. Body 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/ 1-888ARCOAST 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) 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://portal.ncdenr.org/web/cm/dcm-home Revised 7/06/ 17 LAMA / ❑ DREDGE & FILL N2 i 2074 A B C D GENERAL PERMIT Previous permit # New ❑Modification ❑Complete Reissue El Partial Reissue Date previous ermit issued As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of envir nmental concern pursuant to I SA NCAC �KI Rules attaqfied. Applicant Name !', t 1 Project Location: County :�, ;14, -- -� Address I Street Address'/jState Road/ Lot #k(s) City State 1 ZIP;'- �/ a Phone # _ -Mail Subdivision j � j , j City I ;`l ,i 1 , ZIP:^ Authorized Agent r ❑ CW 41EW '< PTA ❑ ES ❑ PTS Phone # ver Basin Affected ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A AEC(s): Adj. Wtr. Body: nat an unkn ❑ PWS: Closest Maj. Wtr. Body ORW: :*`yes,%/ no PNA yes) no e of Pr ect/ Activity . M■ ■■■ ,iat'.M O.PEMEMNON Er■■■.:......M■s ■■■■■■■■ VIM IBM! ■�ll�l:■■■■■A;��fl■■■■■■■■■■■■■■/E■MM�■■■■■■ ■■■■■■■■■��ilSri■■■■■■■M■w■■■■■E�.a■■■■■■■■■■ . . ■■■I■■■■■■�11�1�■■■■■a�►r�c■■Erg■■��■■!�■■■■■■■■ ■■■!■■■ lE�ll1llM ■M■■!�■Mtll■■ ■�lO;�'1I�■■■■EEO■ ■■■■■■■■El 111111!■■■■■■■■■■■■■MINNEI/1M■■■■■■■ ■■■■■■■■11 111.41� ■MMMi!"r71f1'1 /!l■■■■L' rli�■■■■■■■■ M. .1....�. i■■■■■■■■ ■■■■■■■■■IG■■■■■■■■M■■■■■�1■■■■■MEN ■■■■■■�O'PJ.r\■■■■■■■■■■■■■■■1■■■■■■■■■MEMO ■mom ■(!■EE■l'i'11��■■E■■■M■E■■■■■■�1■■■■■■OM■O■■ ME Ems MEM■►■EE■ ME■■■111EE■inflim■■■■■■■M■■E■■■ME■■MME■EEME■ I■ J■ I■■MMMM■■MM■■MMENNO■■EMMME■E l 'r` :r.��l�Qa'�IJ11�!/1■MM■M■MMMUM■MOM■M■■■■■M■MM■ M■■RMIE■W'",NONE ��!■MMMM■■MOM■■MM�IO■M■■MMMM■■M■ • ■EEO■MEMMM■MO iMM■NE EliMENMNINON MO■EE read compliance statement on back of permit *'* Fee(s) Check # PermitbTfOer's Print ' me 1 Signature Issuing Date Expiration Date Dec. 15. 2017 1 ; 5 5 P M No. 3003 I hereby certify that I own property adjacent to properly (Nate'of Prop located at � Q r( o� (Address, t�=C_42- , etc.) on in _ (Waterbody) (Cityffown an ENT 7 S _ Owner) N.G. The applicant has described to me, as shown below, the development pr�posed at the above locatior� I have no objection to this proposal. ' I have objections to thi9 proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing developmertmust fill in description below or at414ch a site drawing) P/�� i9 am r� Fo a / . p'_5 D 4- O �_J f WAIVER SECTION l 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 I do wish to waive the 1 5' setback requirement_ I do not -wish to waive the 15' setback requirement. (Pr erry Owner l ormation) (Adjacent Property Owner Information) e Si ire Z-G L e- w Print or Typa Name Print or We am M,ay'1�n Add r s `� Msili Add s c, rerzip Z- D Telephone Number - Dale J :j K - 3 !a 8� �i- 1 Talophono Number r / Date (Revised 6l1W2012) g8'Xs"� yqo A �� _ ;/Nye j i z = 2 gig H"t Dec 15, 2017 1:56PM No 3004�P 1 ` 45 33SD AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: I Y-Yl QUA 900dMG Mailing Address: 147 L4urtQ N10tU4r1r�. 1J% 4- (� Phone Number: 92 0 2- Email Address: I certify that I have authorized rriOY 1.3 O►%I sent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: rllmdryt O�_Ca.� lacVOjAh rl" Qnc l at my property located at in CAr�X J 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: Signature � Mm ki(�02-beYIOIYI Print or Type Name Title )a / ) 1 i7 Date This certification is valid through _ I I Dec, 15. 2011 1.56PM No 3004 P. 2 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to s. propertylocated at (Na e of Property Owner) � Q (Address, t, BI c l etc.) 011 in N-C. (Wateribody) (City/Town and/o,r C nty) The applicant has described to me, as shown below, the development proposed at the above locaiiork I have no objection to this proposal_ I have objections, to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELdPMENT (Individual proposing deve/opmerrtmust fill in description below or a0ch a site drawing) D 0 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_ (Pro erty Owner -Information) (Adjacent Property Owner Information) 7e Sigr e 7 ?or) y J e O_r� .9 Print or Type Name Print or Type erne LN Ma'ing Addre s T G 2. �S'� dam, Mal* Add ss S CTip —z- g �t 2 --23a� clty/statelzi �5 a_- 34� g C) _ Telephone Number Telephone Number Date Date (Revised 6/1 a/2012) Dec. 15, 2017 1,56PM � �� No; 3004 P. 3 2 �i y ti Eyy � Pigi� De �, 15. 2017 1,55PM �No, 300�3 ,VIP 1 AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: J i m 90cdac Mailing Address: Phone Number: Email Address: I certify that I have authorized 11 �xmrol l r to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: dyeC )CL at my property located at in IrIO 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: Signature Print or Type Name n l&� Title la 1 ): 1 /7 Date This certification is valid through -1 I