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Home My WebLink About73213❑' CAMA / ❑ DREDGE & FILL V NO. 73213 A B C D GENERAL PERMIT Previous permit# ❑New ❑Modification El 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 D Rules attached. Applicant Name Project Location: County Address Street Address/ State Road/ Lot #(s) City- _ -_ Stag i? ZIP Phone # ( ) E-Mail Subdivision Authorized Agent . f,*' '4CityZIP ❑ CW - EW ❑PTA ❑ ES ElPTS Phone # ( ) River Basin Affected OEA HHF ❑ IH El El AEC(s): ❑ Adj. Wtr. Body (nat /man /unkn) ❑ PWS: ORW: yes / no PNA yes / no Closest Maj. Wtr. Body 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 "r Basin, channel cubic yards e ` Boat ramp f ! Boathouse/ Boatlift w 1 / Beach Bulldo,zing. j Other . I! V A Shoreline Length SAV: not sure yes o - --- Moratorium: n/a yes Photos: yes n Waiver Attached: a no FFF' A building permit may be required by: ( Note Local Planning jurisdiction) Notes/ Special Conditions Agent or Applicant Printed Name (Scale: ) r00 _f fSee note on back regarding River Basin rules. Signature "Please read compliance statement on back of permit" Application Fee(s) Check # Permit Officer's Printed Name Signature f Issui Date ' Expi tion 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, certifythat this project is consistent with the North Carolina Coastal Management Program. River Basin Rules Applicable To Your Project: El 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 (910-796-7215) for more information on howto complywith these buffer rules. Division of Coastal Management Offices Morehead City Headquarters Washington District 400 Commerce Ave 943 Washington Square Mall Morehead City, NC 28557 Washington, NC 27889 252-808-2808/ I-888-4RCOAST 252-946-6481 Fax: 252-247-3330 Fax: 252-948-0478 (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 (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 CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Mailing Address: 2 - r) l� � Phone Number: Email Address: o 5_,3 / - Coj I certify that I have authorized Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: _ &k o at my property located at G . Z 6, O 14- k— LQ 4 � 'D) r- ► ` 1�, 5 1, , in 4f A- County. / furthermore certify that l 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 0 iM 13e__ � Sat) � Print or Type Name Title C /_)—/ U F Date This certification is valid through / / ADJACENT RIPARIAN PROPERTY OWNER STATEMENT i hereby certify that I own property adjacent to r1-7 h � K,1 a I/ =S' Game of Proper Owner) property boated at = ? L= > 13 'v C ,� (Address, Lou* Block Road, etc.) on 6i C-;- �� ,ti. p , in N.C. (Waterbody) (Cityfl'or+n andlor 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 DRAINING OF PROPOSE® DEVELOP'LTEMT Mvd f dual proposing development trust M In descdpdon heloci or aggach a spa- e-ard.n ) I -T 1° - 1 k } S ECG L i J-}- I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, life, or grain 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.) n i do wish to waive the 16 setback requirement. 1' I do not wish to waive the 15' setback requirement. (ProperW Ovaner Information) (Adjacent Property Owner Information) Signature Signs}t�u�r/ew 'D r " J � h7 � o "�i �if f' I L�- Li- Print or Type Name Print or Type Name Mailing Address MaAt4 ddA L- ,1; N , � , z, ��; ,i V16us*l- i Gt56, o 1- ,A 3 c )2i �Sbtez 5 214 3 �(-) 1 0 c>tv/ , * . Telephone Number/email address e Number/email addreii � � Date (Revised Aug. 2014) Walid for one calendar year after signature ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that 1 own property adjacent to J rr7 �. ►.r -�3 hi is (Name of Property Oumer) property located at 2 Z Y-- l 7 ,- � V L (Address, Ljt, Block, Road, etc.) on � � r+j � �' � � v r. r, , in i , , N.C. (Waftbody) (Cityltown andlor County) The applicant has described to me, as shown below, the development proposed at the above ie�ah'on. I have no objection to this proposal. I have objections to this proposal. DESCRIPTOOM AND/OR DRAWING OF PROPOSED DE@," EI_OPMEMT (Individual proposing development must iiil in description helot , or a9fach a site t r- g 4,1105 <�` sic L►� k '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 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 not wish to waive the 15' setback requirement. (Property Chmer Information) (Adjacent Property Owner Information) Si&Wure Signature 1 ry) ?Lh,o Ch/irl-5 t(►.� Print or Type Name Print or Type Name Mailing Address Ma M Address L. ► l'S 0 N l�1 a Z� `�`' `� Y1 tir✓- K-na t) i ho N.�. citylStateop city/SiateolD z 151Z z,4 -Z52 --I I1L 1-:939 Telephone Number / email address Date *Valid for one calendar year after signature" Telephone Number/email address � - Z`t-- 1-6 Date* (Revised Aug. 2014)