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Home My WebLink AboutNelsen, Nels 71697CA/ ❑ CAMA / ❑ DREDGE & FILL No 71697 A B 'C; - D GENERAL PERMIT Previous permit# ❑New ❑Modification ❑Complete Reissue El 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 0 Rules attached. Applicant Name_ Address City Phone # ( )_ Authorized Agent Affected ❑ Cw AEC(s): ❑ OEA ❑ PWS: ORW: yes / no State ZIP E-Mail ❑ EW ❑ PTA ❑ ES D PTS ❑ HHF ❑ IH ❑ UBA ❑ N/A PNA yes / no Type of Project/ Activity Pier (dock) length Fixed Platform(s) Floating Platform(s) Finger pier(s) Groin length number Bulkhead/ Riprap length avg distance offshore max distance offshore Basin, channel cubic yards Boat ramp Boathouse/ Boatlift Beach Bulldozing Other Shoreline Length SAV: not sure yes no Moratorium: n/a yes rho Photos: yes no Waiver Attached: yes no A building permit may be required by: ( Note Local Planning jurisdiction) Notes/ Special Conditions Agent or Applicant Printed Name Signature ** Please read compliance statement on back of permit Application Fee(s) Check # Project Location: County_ Street Address/ State Road/ Lot #(s) Subdivision CityZIP Phone # ( ) River Basin. Adj. Wtr. Body (nat /man /unkn) Closest Maj. Wtr. Body (Scale: ) _. ❑ See note on back regarding River Basin rules. Permit Officer's Printed Name j1( Signature -7 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: �I 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 howto complywith these buffer rules. Division of Coastal Management Offices Morehead City Headquarters 400 Commerce Ave Morehead City, NC 28557 252-808-2808/ 1-888-4RCOAST 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 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to K-e-1 Q ° of- �'s I �jj (Name of Property Owner) property located at h � :!;k4rck(t t4 iu I h r (Address, Lot, BI ck, Roa etc ) on 1��t��aG�S�c� 1 YVrn 1��i,cSt� n �C��e N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. 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) 6) ok-rM"v Rif,", Ooc 4 k(A Gbcj (t CC3--, �o 4- I WAIVER SECTION 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 dn not wish to waive the 15' setback requirement. (Property Owner Information) Mai ng `d�re Cit State/Zip 1 G -- Telephone)Vumbef Date (Adjacent Property Owner Information) i Signature -� /- /err Print or Type Name Mailing Address Jd Sr-t 5.41 T-io y Vl�t� J Gi City/StatelZip Telephone Amber 2_Cz- 6,�� Date /may//2 (Revised 611812012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to �Je is n - A'� fs'f 11 's (qa� off Property Owner) property located at /� JK —('C U.S ��ti� (Address, Lot, dock, R, on in E'CW - ) N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above locatiop� r✓ 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) � u 1� i`� � (� � i ►� Cam[ `� �-IFP�.�-- i�� 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.) IL 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 Information) Signature Signature Print or Type Name Print or Type Name 1 �C- �1= • �`i�S � �� /0'��i�ALG/3S�L ode, Ma"ing Ad res Ming Add ss City/State/Zip I City/StatelZip TelephorA N mber TelephT Umber vc '�'- Date Date (Revised 6/1&2012)