68364_L-Head Platform_20171011

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IBC iW$lon of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: FP,fit
Date: C7
General Permit #:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
P0#1-
'
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
r
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill,❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
252-808-2808 :: 1-888-4RC®AST :: w►ww.nccoastaimanagement.net revised:02/03/10

Authorized Agent Consent Agreement
1, lod ®®� flaerrb authorize Tobin Jay Tetterton of
9
(Property Owner(s) )
TJ's Marine Construction, LLC to act on my behalf in obtaining CAMA permits for
the location listed below.
PROPERTY ADDRESS:
10
le.
f
'S MAILING ADDRESS:
Phone No. /,% 7L
PROPERTY OWNER'S SIGNATURE:
AUTHORIZED AGENT SIGNATURE:
DATE: 20
W/Authorized Agent Consent Agree.

Adjamnt
pmpfirtv
ovim
Chm* ante
AUACENT RBEMNSMAN PROPERTY OWNER STATEMENT -
I hereby certify that l own property adjacent toQ,",
(9affie Of PB0f0QdV OW8413
property
an
The applicant has described to me, as shown below, the development proposed at the above
locatio
! have- nq- Objection to thls� proposal:
I have objections to this proposal.
®ESCROPTIOM ANDIOiR DRAlMNO OF PROPOSED DEVELOPMENT?Ind&Id?uaI prcpos ft development must fill in descsipflon �beaow ur attach a sate drawiOW
-- ---� �IiC�'0 aOA
U
prapadyI understand that a pier, dock, mooring pilings, boar ramp, breakwater, boathouse, lift, or groin
o::=r must be set back a minimum distance of 15' from my area of riparian access unless waived by
:hit me. {if you wish to waive the setback, you mugstt in',t'ia8i the appropriate blank below.)
Gam? 1 do wish_ to waive the 15' setback requirement.
-- 1 do not wish to -waive the 151-setback requirement. - -
QAd,�ace^P®�e��wner �rrni��at8®nD
0
Wdress� 41 ���o�ip
Telephone um erf email address
©'Q , 4 t .'7
Date*
(Revised Aug 2074)
Walid for one calendar year after signature ,

AM.CENT PJPI E&TY OWNER STATEIli3ENT-
I hereby certify that I own property adjacent to A /zn--.s
prc
on
- The applicant has described to me, as shown below, the development proposed at the above
location.
adjacent I have -no. objection to this proposal:
I have objections to this proposal.
�eeknste
DESCPHPTION ANDI®R ®RA1meNe OF PR®po
SE® DEVELOPMENT
{Individual proposincg develapment must fill in description below or aftch a sift drat im),
- ----- --- - -
a
stiz a WAMR SECTIOM
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, life, or groin
0-Mla must be set back a minimum distance of 15' from my area of riparian access unless waived- by
z
me. (If you wish to waive the setback, you mue�t'al tide appropriate blank below.)'
1 do wish -to waive the 15' setback requirement
1 do not wish to -waive the 15'-setback requirement.
(Adjacent Proped y
jer U nformatidn)
CD7')'\ .
Tet hone Afu berf email address .
Ye'
- �1/aiid for one calendar year after signature' , - . (RevfsedAug 2014)

Aj
HCDENR
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.
• 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 vrovided/1's complete and accurate.
5
licant Printed Name
or Applicant
CAMA GENERAL PERMIT #:
Permit Officer'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]
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