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Home My WebLink About71110A_Phillip & Robin Delpierre_20180906CAMA / DREDGE & FILL N 71110 (S� B C D GENERAL PERMIT Previous permit# XNew ❑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 15A NCAC Rules attached. Applicant Name phi k�o�„� IJ Address ISO "Talk CIAO C+ City S,,,,' V. , -\ :5 „J t State N c ZIP ,��5 ti`t Phone # ) 4:13—\-' E-Mail Authorized Agent N I, Mc .. - u Affected ❑ CW ❑ EW K PTA ❑ ES �kPTS AEC(s): ❑ OEA ❑ HHF ❑ lH ❑ UBA ❑ N/A ❑ PWS: ORW: yes / 05) PNA es / no Project Location: County t), r e Street Address/ State Road/ Lot #(s) IS o "fa 11 C 1 A{ Subdivision City S,:.s'%l.A rVA St-)oI < ZIP S.—+ri Phone # ( ) River Basin Adj. Wtr. Body cl, l +o 3Ccr. &—,V, C.K (nat � /unkn) Closest Maj. Wtr. Body Cvr � a Type of Project/ Activity N�c K 40, ( 0x 1✓ . iry^ 1 c ci (Scale: I = ;1 0 , ) Pier v� Fix Float Fing Groff Bulk Basin Boat Boat Beac h Shor, SAV: Mo Phot Waiv ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ng Platform(s) length number ■■iti■■■■■■■■■■■■■®■■■■■■■■■®■■■■!�■ avg distance offshore max distance offshore:�� ■■■■■■■■■■■1i�1■■■■■■■■■■■■■■■■■■■■■■■■■■, ■■■■■■■■■■■■■■■■■■■■■■■G7■■■■■■■■■■■■■' ■■■■■■■■■i■■■p■■� NON.■■■ramp ■■■■■�■■�■c■�■■■ cubic yards ■■■■■■■■ ■■■■■�rer■!n�■■■■■■■■®■■■■■■■ ■■■ �� ■■■■■�►.■■■a■■■■■■��■■■■■■■■■■■ ■■ ■■■U.1101. � ■■�Ty■■■■■■■ ■�■■■■■■■ Bulldozing ��e��■■■ ��c�� ■■■■■■■®■■■■ ■■■■mow■.�=, lineLength ■fit■■■■■■■■■■■■■■■■■®■■■ ■■■■■■■■■� 1■■■■ • ■r■■■■■■■■■■■■r•�r.��■■■■■■■■■®■■In■■■ no ■C■ ■■■■■■■■■■■■■■Y■■�■■■■■■■■■■■■1�■■■ A building permit may be required by: ha 5 In 4,( < ( Note Local Planning jurisdiction) Notes/ Special Conditions Uy- Agent or Applicant Printed Name Signat re "Please read compliance statement on ack of permit" � i o \ 00 . U(t440 u Application Fee(s) Check # ❑ See note on back regarding River Basin rules. Permit Office ' t me Si e /t.,/.-�aI� 1 A.Wli Issuing Date Expiration Date NC Division of Coastal Mgt. Habitat Impact Computer Sheet Applicant: Liz ` }),t V t t I*'Njj.I I, ) Date: I (&�f S Permit #: 7 I I 10 A Describe belo'V 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) w Dredge ❑ Fill ❑ Both ❑ Otherf (I ' 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 ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ 252-808-2808 :: 1-888-4RCOAST :: www.nccoastalmanagement.net revised: 02/03/10 N.C. DIVISION OF COASTAL MANAGEMENT AGENT AUTHORIZATION FORM Date Name of Property Owner Applying for Permit: V�li \�\, (-) , k)(�� i)l-PY-re- Mailing Address: "C, 211 Cl I certify that I have authorized (agent) N E--� Ma1'ne to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to 1 nI install or construct (activity) at (my property located at) This certification is valid thru (date) 9, Property Owner Signature Date ■ Complete items,1, 2 7 and 3. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. Article Addressed to: -)eRkS C-nAok,ousk�` Lond, CA �) ao 9590 9402 2521 6306 6108 06 2. Article Numhar frmnefar frnm mrviro /nhon 7017 0660 0000 7242 A. X U.1-Al `40 B. Received by (Printed Name) ❑ Agent C. Date of Delivery D. Is delivery address different from item 17 ❑ Yes If YES, enter delivery address below: ❑ No 3. Service Type ❑ Priority Mail Express® ❑ Adult Signature ❑ Registered MaiITM ❑ Adult Signature Restricted Delivery ❑ Registered Mail Restricted Certified Mail® Delivery Certified Mail Restricted Del" ❑ Return Receipt for ❑ Collect on Delivery Merchandise ❑ Collect on Delivery Restricted Delivery ❑ Signature ConfinnationTM 5133 ❑ Signature Confirmation Delivery Restricted Delivery Restricted i Ps Form 3811, July 2015 PSN 7530-02-000-9053r Domestic Return Receipt USPS TRACKING # First -Class Mail Postage & Fees Paid USPS Permit No. G-10 9590 9402 2521 6306 6107 90 United States Postal Service • Sender: Please print your name, address, and ZIP+4® in this box* NORTHEASTERN MARINE CNSTR P.O. Box 42 Kitty Hawk, NC 27949 CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM PI I Name of Property Owner!1 t ' Address of Property: i �- `-)T«D (Lot or Street #, Street or Road, City & County) t� Agent's Name #: 1 I Ln rl t7 a Mailing Address:? Agent's phone #:��- I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit has described to rye as shown, or, Lhe attached drawing the development _they are proposing. A description or drawing,with dimensions must be iovided with this letter. .-�lt'Zc �- `�(�� :c. __ w'0. It `� � 4 c_►-c-��e`k��'1 I ha e no objections to this proposal. I have objections to this proposal. If you have objections to what is being proposed, you rust notify the Division of Coastal Management (DCM) In writing within 10 days of receipt of this notice. Correspondence should be mailed to 1367 US 17 South, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-3901. No response is considered the same as no objection if you have been notfffed by Certified Mail. WAIVER SECTION I understand that a pier, dock, mooing pilings, breakwater, boathouse, or lift must be set back a minimum distance of 15' from my area of riparian access unless waived by me. (ff you wish to waive the setback, you must Initial the appropriate blank below.) I do wish to waive the 15' setback requirement. I do notwish to waive the 15' setback requirement. (Property Owner Information) Signature � Print or Type Rame CA . Mailing Address a 51e, ��L 29 cly-'1 Citylstate/Zip 9 S a - (4 13 - TI1211 Telephone Number Dace Telephone Number �L Dare CZ r CERTIFIED MAIL . RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Property Own Address of Property. (Lot or Street #, Street or Road, City & county) Agent's Name #: m-� n—vi 1'1 c)e Mailing Address: f L) 0 L l " Agent's hone # I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit has described to me as shown on the attached drawing the development they are proposing. A description or drawing. with dimensions must be orovided with this letter_ �Z`�, cL I I t ��C_I �+= 0-110 `�3 6YVP ��-` 0.3f T'have no objections to this proposal. I have objections to this proposal. if you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writing within 10 days of receipt of this notice. Corre,4pondence should be mailed to 1367 US 17 South, Bizabeth City, NC, 27W9. DCM'representatives can also be contacted at (252) 264-3901. No response Is considered the same as no objection K you have been notified by Certified Mail. WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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 notwish to waive the 15' setback requirement (Property Owner Information) Signature Phi 1IDe l ) e-vn-- Print or Type Nhme Malting Address Citylstatel0p Telephone Number Dwe ( 'parlan P rty Owner Information) \ � - x � Signature ��,yIS (�uLAK�Iti.��l Print or Type Name t p L/ t4 C'T bvoe�� V zits �� Telephone Number Date Oct s�Ktx 'I r Asp A.4 7 - £ f .