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HomeMy WebLinkAboutUpton, HowardkCAMA / E DREDGE & FILL NO. 73351 A B C D r. GENERAL PERMIT Previous permit # _- New 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 -__ Project Location: County - Address Street Address/ State Road/ Lot #(s) - City - State - ZIP - - - -- Phone # (-- ) _ --- - E-Mail Subdivision Authorized Agent - City - ZIP_-- ❑ CW ❑ EW ❑ PTA ES PTS Phone # ( ) _ River Basin Affected ❑ OEA ❑ HHF ❑ IH UBA N/A AEC(s): Adj. Wtr. Body � :�F".�� ;,�,.� � �� I }, (nat /man /unkn) ❑ PWS: Closest Maj. Wtr. Body - CrRW: ves / no PIMA yes / no Type of Project/ Activity Pier (dock) length Fixed Platform(s) Floating Platform(s) Finger pier(s) -� Groin length ,r number Bulkhead/ Riprap length avg distance offshore max distance offshore Basin, channel cubic yards Boat ramp Boathouse/ Boatlift Beach Bulldozing Other % - s--Shoreline Length _*w SAV: not sure yes no -- Moratorium: n/a yes no Photos: yes no I Waiver Attached: yes no A building permit may be required by:g.} ( Note Local Planning jurisdiction) Notes/ Special Conditions Agent or Applicant Printed Name Signature Please read compliance statement on back of permit ,f Application Fee(s) Check # I (Scale:i ) See note on back regarding River Basin rules. PermitOfficer's Printed Name f Signature Nxl 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: 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/ I-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 AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS Name of Property Owner Applying for Permit: �'i O Vi a C� do �kv`r1•✓ 'S `°5 U l�+Vrr, Mailing address: U aV- 9- L _I : C 0 V 2-7E Telephone Number: c % i certify that I have authorized / 4 � �t � �Xe, (agent/contractor). to act on my behalf. for the purpose of applying and obtaining all CAMA permits necessary for the proposed development of �, r '4 k- Li � i � '�'"� c0A aL my property located at /& 4 / Za - 5 cam►'` C -, P This certification is valid through I(date). (Property Owner Information) Signature �. Print or Type Name Ate` Vd, S- �4vll Title. co. owner or trustee for property � l ate Telephone Number Email Address