68400_Uncovered boatlift_20171009

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;'N GENERAL PERMIT
Previous permit# " A i D
New ❑Modification ❑Complete Reissue ❑ Partial' Reissue : ,• Date' previous issued
permit,
Asrauthor.zed by the State of North Carolina, Department of Environment and Natural Resources
" and the Coastal Resources Commission in an area of enJironmental concern pursuant to,15A NCAC
"
Rules aftached. .
. Applicant -Name
Project Location: County'
- Address ` `1�z� 7 j
Street Address/,State Road/ Lot #(s) e�;T- :. `, i >'?' 1'
City`�Ca t= L_ Stateh� C ZIP "? 7`� 1 7Z.
Phone #'( r`)S?i /r7 y(®E-Mail :
Subdivision 01..0 R--v C S�-;�-��L� S
Authorized Agent 0
City L � ���vw �� � � � -, ZIP
Affected ❑ CW Pa EW J PTA n ES ❑ PTS
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Phone # ( ) River Basin AT�_- R�M w e b
- AEC s : ❑ IDEA ❑ HHF IH ❑ UBA ❑ N/A
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❑ PWS:
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Closest Maj. Wtr. BodyA"
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Agent or Applicant Printed Name-^-P`e�m,"'bff cep s,Printed
Signature .**Please read'compliance statement on ba&8f permit's Si nature'
Application'Fee(s) Check# Issuing Date
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:Expiration Date

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Applicant L a t 9 IF -Pe- .r15 Date: Penntt
q ! , � �" � '. ' .
Descrrba belowthe HABITAT disfur6ances for the applicadon.: All value-s should match the nave, and units of measuramen�
fourtd in your Habitat code sheet
TOTAL 5q. Ft
Al-F)NSq_ Ft
TOTAL Feet
Fit lAL Feet
(Applied far_
Ona pated final
(Applied fort
(Anflcf aced 6w
Habitat came
DISTURB -TYPE
Disturbance total
dstwrbance.
Dlstdr'bance
' disturbance.
Choose One
includes any
Excludes aryl
total includes -
Excludes any
anticipated
restoration•
any anffdpated
restoration andlar
restoration or
andfar temp
restoration or
temp impact
tamp impacts)
fnt act amount)
temp impacts)
amount)
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Dredge Q ' FIR El Both. Q Others[
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I] dge (3. Fill Q Both Q Other Q
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•f]redge-Q• FIR Q Path Q Other Q
t]redge Q Fill Q Path C7 Qther Q
Oredde Q Fill Q. Boar L7 Other [j---------------------------
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O*ge*Q'. of C4 Bath t�i Other Q
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Dredge FM aaPh 'Et -Oth er
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Dredge Q- 'F f Q goat iT Other Q
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Oredg' a Q F7•t l Q ' Pattr' C1' Other [j
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Oredge Q . MI I CI Bdtil Q. Ofher'Q

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ADJACENT RIPARIAN PROPERTY INNER STATEMENT
C3
I hereby certify that 1 own property adjacent to 15 CP r
3 �e Sh 6 dame o Property
property located at b I' 6 GG w i /Y
p� (Address, Lot, Blodk, Road; etc.)
on PO 1h f 1 G 0 i e j" , inclo c i i , N.C.
(Waterbody) (City/To and/or County). s
The applicant has described to e, as shown below, the development proposed at the above
O I ti n. -'
I have no objectio to this proposal. o
I have objections to this proposal.
DESCRIPTION AND/O DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing deveiopme is varast M in.-eJesct'lpfi®nJLer 11a aci� a site a�rin� a o F -
f3 e71,
�CP;�
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 16 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) d acent Pro a Owner Information)
Signature �, ` M, Si tune*
- Q (go)( -7 5 m7pt Or Pe Name P21 Type -Z�
Name e � G w
Ma"ng Mailingdr s
�
cityistar NC 2 7 $)p�a�-s��k
Telephone Number/email address Telephone N mber/ ail ad ress
a S31 17 ?el eo — o 2
Date Date*
I (Revised Aug. 2o14)
*Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that 1 own property adjacent to L 1 S �f ge r A � ` is
((Nerrte Property Owne.r). .
property located at %- o r 5 A !ter
1 (Address,
on l 4 rri / " C d y e)^ , in
(Waterbody)
The applicant has described to me, as ,
loca io .
I have no objection to this
I have objections to this
Q1 DESCRIPTION ANDIOR DRA
{Individual proposing development mus
r> C'0 w / Art n , N.C.
(Cityliown add/or County)
below, the development proposed
IING OF PROPOSED
fell in description bel
1.zs A_
or Mach a
the above
rn
4 /- j. s gei
�® WAIVER SECTION
I understan that a p , k,-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 [rust 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). (Adjacent Properly Owner Information)
Signatt4re
Printor Tyne Nx e7 7 5
o %�o
Mailing Address z %6 1 Z
Ci"tataOp
Telephone ,Number/email address
25�2 3/ / ?Ifs
Date
*Valid for one calendar year after signature*
er
Print CAS e - ­ 7 N ---
Telephone Number/email address
a 0 r1
Date's /fll b - /
(Revised Aug. 2014)

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Donald R. van der Vaart
Governor Secretary
BUFFER AUTHORIZATION CERTIFICATE
FOR PIER.AND DOCKING FACILITIES ACCESS WAY
A riparian buffer authorization is required for pier and docking facilities access ways through the Tar -Pamlico &
.Neuse River Riparian buffer per Division of Water Resources (DWR) regulations 15A NCAC 02B.0233 & .0259. The
Division of 'Coastal Management (DCM), through a Memorandum of Understanding with the Division of Water
Resources (DWR) has reviewed your project proposal and has determined that the project as proposed complies
with the aforementioned regulations.
Those activities covered by your Coastal Area Management Act (CAMA) permit have received Buffer Authorization
as long as the project is constructed in a manner that continues to meet all of the'conditions listed below. Failure to
comply with this Buffer Authorization may subject the property owner & the party (contractor) performing the
construction Wor land clearing to a civil penalty by DWR of up to,$25,000 per day per violation.
i. Crossing is Perpendicular: Pier and docking facility access way must cross the 50 ft. riparian buffer
perpendicularly (which is defined as between 75 and 105 degrees) unless otherwise approved'by DCM. The
alignment shall minimize the -removal of woody vegetation to the greatest extent practicable.
2. Pervious Materials: All reasonable measures shall be taken to ensure the access way is made of pervious
materials like open -slatted wood or composite, mulch, or grass to meet the intent of the rules to the
maximum extent practicable.
3. Access Width: The width of the pier or docking facility access way shall be limited to six (6) feet.
4. Project Drawing: The drawing on the CAMA General Permit is considered the project drawing of your
property indicating the relative location of the pier or docking facility and any requested access. way. This
drawing will be used to aid in compliance and monitoring efforts.
a Pre -project site conditions:
By your signature below you agree to be held responsible for meeting all of the conditions listed above and verify
that all information provided is complete and accurate.
Agent or Applicant Printed Name
Agent or Applicant Signature
CAMA GENERAL PERMIT #: Zoe 41vo " 5
Permit Office s Signature
Issue Date
Washington Office Morehead City Office Wilmington Office
943 Washington Square Mall 400 Commerce Avenue 127 Cardinal Drive Ext.
Washington, NC 27889 Morehead City, NC 28557 Wilmington, NC 28405 3845
Phone [phone] Phone [phone] Phone [phone]B
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