HomeMy WebLinkAboutSabiston, Walter R.0--
Nn 70446
❑CAMA / ❑ DREDGE & FILL _ A B C D
GENERAL PERMIT Previous permit#
ElNew ❑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 ❑ Rules attached.
Project Location: County
Applicant Name
Address Street Address/ State Road/ Lot #(s) ram%
k{f lrff!
City State ZIP �"2 X -
-�
Phone # O E-Mail Subdivision — ---
Authorized Agent
Affected ❑ CW ❑ EW � PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA [IHHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ARW vPc / no PNA Yes / no
Agent or Applicant Printed Name
Signature t* Please read compliance statement on back of permit
Application Fee(s)
r r 1 s
City I (iLj_ZIP --
Phone # (-'I'?,) �('( River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
Permit Officer's Printed Name
r ;a
Signature
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 (9 I 0-796-7215) for more information on how to complywith 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
AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Cit4 i 1� �r S rM)
Mailing Address: f ,SSl} R o�) C r +5
NCvo DV-t Nc
Phone Number: a3
Email Address: 5A81 STo N 0 C6R,5fW Ne+ • C 0)'1
I certify that I have authorized so ( to t.S r
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: e ))c4e�J51 at) Q f
at my property located at
in CArlere+ Cry County.
9 Live
r
I furthermore certify that I 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
J 2,41 � er R, S f4 B) STWI
Print or Type Name
Title
Date �O
This certification is valid through 3 lve- I
O�
�, ....,..... ,u� -
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property 9djacent to h� i i� t ✓ '� 13 s 15►=—
(Name of Property Owner) S 7 v
property located at
(Address, Lot, Block, Road, etc.) — N.C.
on _ Cad k k ein (City Town andlor County)
(Waterbody)
The applicant has described to me, as shown below; the development proposed at the above
/cation. i have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
A4+Azl ea mnP
WAIVES 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.)
`r I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
(Adjacent Property Owner mtormation)
Ly)
Signature
I,v, a!tcr
5015i U
Signature
Print or Type Name
t 5-o Robc'r fi ' t�.
Print or�T�e Name
`!7
Mailing Address
.�
Ma ing Address
City/State/Zip
7G
City/State 1,
y 3
Tele hone Number
p
Telephoneumb
�/
Date
Date
(Revised 6/1WO12)
Q�
PROPOSAL
WOR.KTC BE PERFORMED AT:
PROPOSAL SUBMITTED T C
NAME 0 h j �ey
NO. a
Respectfully submitted
Rny alteration.. or deviation from abb�'e SW'Wx-a5o s involving exn 'osts
Nq a executed only upon written order, and wil; become an extra gauge Per
are, and above t-e estmate An agreemems cont3^Gen_ ,ipor strikes, ac- Note - This proposal may be withdrawn
..,,,-"s Lr de'ays be}wd our cpn=cl.
by us if not accepted within J0—days.
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work
as specified. Payments will be madg as outlined above. ' % 17A r f �� rVAJL.Ol /3
RECFIVEDSlgnature
L�a_e
Y! �.�3 Signature ���
APR 3
��„t? URbr4RjQSAL
aAPR,26.2018e11:06AM 1252THE LITTLE BANK WALTER
ADJACENT RIPARIAN PROPERV OWNERt OTATEMEN
I hereby cerfifj that I own property adjacent tv _.�� e -s A 1 S
(Name Property
FxoperiY Iodated at 0 w yt-
(Address, Lot, Block, Row, etc.)
on r3oq SprJ� _ , in
(Waterbody) (Cltyrf c wn and/or
The apoli nt has described to rime; as shown below, the devel pm pro
I
I have no objection to this proposal. ,
' 1. have' objectPans to thisproposaL
l-isCRIPTION AND/dR DRAWING Ot PROPOS
(Indnridual proposing development must fill i6 description
WAIVER SECTION
• 1 understand that a pier, dock; .mooring pilings,, breakwater, boat
back a mini um distance of 15' from my area of 'riparian. accos
wish tow a the setback, you must Initial the appropriate blank
I do wish to waive the 15` setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Infarmati+on)
(Adjacent Pr
1A/ j
p 4
Si � Q'Y '� 1 S `r0 h/
5 re 4
Print or ),ipe Name
PHnf or Type f
Mali 9 Address
e n r k hl c- r� �6-7D
Mailing Andre
city/Stat ip
s . �3 67 00
CitylSf�t�tlZip
TelephooneNumber
Telephone. Nd
Dare I '� 0iV IREC_E1VE®
Dare
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weer)
ue �. M G
�osed at the above
�WNT ' '
Bch a sito drawing)
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lotuse; lift, r groin must be set
unless ived by me_ (It you
below_)
Information)
(Revised 0/18V2012)
N0.409 P. 16E 01/02
PR. 26, 2018E11:05AM 1252THE LITTLE BANK WALTER
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kny atterativn or dew imm g�a5�a sperrirrlotre avolHrg asmw
w'Rr be msmW 'p* •� wMm order, and 49 hSOWN an atp�e 'Per —
over 1
over arrd &9ve To gOWTO te, All Op eMOM aorr rQKd upon O oW- es•
aa«a& or bgmd Orly wftL Note - This proposal may be WjWrawn
by u i ff not accepted within days.
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as sod e�iCti- Payrr3ents. �►n�l t�i nn�i�:�s''o�lir+ed`a�oy� . '
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