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HomeMy WebLinkAboutAndreeff, AlexR ❑CAMA / ❑ DREDGE & FILL GENERAL PERMIT ❑New 'Modification El Complete Reissue ❑Partial Reissue 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 Applicant Name Address City State ZIP Phone # ( ) ___; E-Mail Authorized Agent ❑ Cw ❑ EW ❑ PTA Affected ❑ OEA ❑ HHF ❑ IH AEC(s): ❑ PWS: ORW: yes / no PNA yes / no ❑ ES ❑ PTS ❑ UBA ❑ N/A Agent or Applicant Printed Name Signa re PI read compliance statement on back of permit Application Fee(s) Check # No71383 A Previous permit # Date previous permit issued Rules attached. Project Location: County Street Address/ State Road/ Lot #(s) B C D Subdivision City ZIP Phone # ( ) River Basin Adj. Wtr. Body (nat /man /unkn) Closest Maj. Wtr. Body - .. Permit Officer's Printed Name .• Signature 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 how to comply with 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/ 1-888ARCOAST 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: 252-264-3 723 (Serves: Camden, Chowan, Currituck, Dare, Gates, Pasquotank and Perquimans Counties) (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 FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: .��x ."q"\M ee � r Mailing Address: %3 3 S-K,�o/�ffc�4U L✓✓ Phone Number: 70j —fib — 3 ! 7.3 Email Address: r�� 4�r� %< 3 7 �'iG />'�cL,` t' •6dm I certify that I have authorized _SCz Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development:�c— at my property located at d r r- HA2, lno- Ati kC �l� � n1 C=, in P 46o /i 1-6 County. I furthermore certify that I 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 Print or Type Name Title 0.- / ,2011, Date This certification is valid through I I ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to _'Lxx✓y�,en/,,`tt �F 's (Name of Property Owner) property located at OFF IMC Indo1! AID (Lot, Block, Road, etc.) on V ,AlbE 1t�kF �� �/� , in / vow /cc ,* , N.C. (Waterbody) (Town and/or Coan Applicant's phone #: 7c3 V03- .?/7 3 Mailing Address: 133S%' A&-cu) a z,.r/ ,SGc01/11r�t AGcUL ilct ='z� He has described to me, as shown below, the development he is proposing at that location, and, I have no objections to his proposal. ----------------------------------------------------------- DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: (To be filled in by property owner proposing development) 4W I o_ (Information for Property Owner Applying for Permit) 133 5 tf ARQvu) HcAj) L-Al Mailing Address �St M�rbucK , Ua aa�� City/State/Zip 7,03 -V03 - 3 /-7 Telephone Number Signat re Date (Riparian Property Owner Information) 1 Signature Print or Type Name qb Telephone Number Date ADJAC'ENT RIPARIAN pROPERT Y OWNER STATEMENT I hereby certify that I own property adjacent to I. y (Name of Pro er 's Property located at cry p h' Owner) (Lot, Block, Road, etc.) on AA1A A EWELS E/1 ody) ' in (Waterb (Town and/or CountL G� ' N.C. Applicant's phone #: 7e3 c��� _ /73 Mailing Address: i� 3$� fleet a/fff av �� CSL.'.OlijJ/a�C .DLt.CiG �: He has described to me, as shown below, the have no objections to his proposal. development he is proposing at that location, and, I --- --------------- AND/OR ------- DESCRIPTION ---------------------------------------- --- - _ DEWING OF P - - ------------------ (To be filled in b r PROPOSED DEVELOPMENT: y p operty owner proposing development) V�rv���CGt<- (Information for Property Owner Applying for Permit) !33 ,y 4R,4cLj- ifFgj I -A/ Mailing Address �.mrr�'.bucK UI City/State/Zip `703 -5/1)3 - .3 1-7 3 Telephone Number ^ �� �r i Signat re Date (Riparian Property Owner Information) Print or Type Name Telephone Number Date R