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HomeMy WebLinkAboutBarrett, Bill❑CAMA / ❑ DREDGE & FILL No 71391 GENERAL PERMIT � Previous permit # A B C- D ❑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 15A NCAC Applicant Name Project Location: County Address Street Address/ State Road/ Lot #(s) City State ZIP Phone # ( ) E-Mail — Subdivision Authorized Agent City ZIP Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Phone # ( ) River Basin AEC(s): ❑ O.EA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body (hat /man /unkn) ❑ PWS: ORW: yes / no PNA yes / no Closest Maj. Wtr. Body 3 Type of Project/ Activity Pier (dock) length Fixed Platform(s) Floating Platform(s) u 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 t Shoreline Length SAV: not sure yes no Moratorium: n/a yes no Photos: yes no Waiver Attached: yes no A building permit may be required by: ( Note Local Planning jurisdiction) - Notes/ Special Conditions L Agent or Applicant Printed Name [-]Rules attached. (Scale: t ) [See note on back regarding River Basin rules. 4 j� Signature ** Please read compliance statement on back of permit Application Fee(s) Check# Permit Officer's Printed Name Signatur g / d f/I't 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: 252-264-3723 (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 FORM FOR PERMIT APPLICATIONS Name of Property Owner Applying for Permit:1�i � n Mailing address: VA 1,2_ Telephone Number: ^ -, 9 I certify that I have authorized (agent/contractor), to act on my behalf, for the purpose of applying and obtaining all CAMA permits S J necessary for the proposed development of �-�i t�� ��-v� ( A�, ' J:r rQ CV^tea t at my property iocated at aYI,,I t ,t v G ki Dki�GI- This certification is valid through (date). (Property Owner ii Signature Print or Type Name --Zt-Lj -Title, co. owner or trustee r property Date Telephone Number Finail Address ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to T�l l l g t�-�"1U _b0.YV2.�' s (Name of Property Owner) property located at o��J�- StiwyC�.�h.e -I)V-. (Address, Lot Block, Road, etc.) on �t 1�l�eV , in 1�i1rC��9e-+mil . 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) ex Is"ti Iq --- 0t7C 3 In � =Iolf; 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_) r 1 do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. -- 4R-m"rty Owner .�0- Print or Type Naje1 o TYl 1 to KU Mailing Address r1� vA usst�_ City/statelzip ,,-�_4n - ,�O7 FS�l`l �- Telephone Number Date (Adjacent Property Owner Information) Signature Pnnt or Type Name .-15o l6K: - Mailing Ad ress atw %-), Inc, 2-�5 City/State2ip Telephone Number Date (Revised 6/1WO12) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT hereby certify that I own property adjacent to i�t (I ; Alt T�QYYe-�- 's property located at :Suy((kk—� -br(Name of Property Owner) -�-,' (Address, Lot,Block, Road, etc.) on Iy CY - ll�� in VC✓)Qe- t N.C. (Waterbody) (City/Town and/or County) T e aplicant has described to me, as shown below, the development proposed at the above I dor_ I have no objection to this proposal. ✓i 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) Maui !c1 ex r �OGk -cq73?-' Ld 1} 11.4 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 wi§ih to -waive the setback, you must initial the appropriate blank below.) )-�3 1 do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. Owner 1 Print or Type Nan2e TY t 1'- Zd Mailing Address Svr�f v A 2z-5510 City/State2ip 15 Telephone Number Date ( dj np t Prope U-1- � I formation) lure �r C."01 Print or Type Name Mailing AiddCess _J�aern, City/StatelZip Telephone Number Daie (Revised 611812012)