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Home My WebLink AboutBland, Tom4/ [�CAMA / -' DREDGE & FILL GENERAL PERMIT New _Modification 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 15A NCAC Applicant Name Address City - State _ ZIP Phone # (___ ) ______ E-Mail Authorized Agent ❑ CW ❑ EW ❑ PTA Affected AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ PWS: ORW: yes / no 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 t Boathouse/ Boatlift Beach Bull ing .. " Other Shoreline Length f SAV: not sure yes no Moratorium: n/a yes no i Photos: yes no Waiver Attached: yes no A building permit may be required by: ( Note Local Planning jurisdiction) Notes/ Special Conditions ❑ ES ❑ PTS ❑ UBA ❑ N/A Agent or Ap licant Printed Name Signature Please read compliance statement on back of permit ** Application Fee(s) Check # No71619 A Previous permit # Date previous permit issued Project Location: County_ Street Address/ State Road/ Lot #(s) Subdivision City_ Phone # Adj. Wtr. Body ---- Closest Maj. Wtr. Body [D Rules attached. ZIP River Basin B C D _ (nat /man /unkn) (Scale: C See note on back regarding River Basin rules. PermitOfficer'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: 252-264-3723 (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 FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: _iLro hw�A Mailing Address: \L) � 6-N � � A.I 0 4 k\c1,v't 1o(' J , Phone Number: 11 - Lj a, _1 Email Address: I certify that I have authorized bo"�UOety u4nh Agen0 Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: L � sN Lxt 6 0,1, Ct _S 4-Ci r-e z e- b 7 at my roperty located at __ VSA rAA i \ in V�G.�`-t�'1 County. I 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 gnnlinafit) n Print or Type Name 1 ,n,er Title Date � This certification is valid through �RECEIVED Il_LL— JUL 3 0 NIB DCM-MHD CITY ADJACENT RIPARIAN PROPERTY OWNER STATEMENT hereby certify that I own property adjacent to , CAI j�� .r`�C � 's (Name of Property Owner) property located at \k j t r'�1 t 1.11. (Address, Igo#, Bloc , Road, etc. on , in �. �0 C.«- (� 'GtL�C� , N.C. (Waterbody) (City/Town and/or County) The ap licant has described to me, as shown below, the development proposed at the above Iota ' n I have no objection to this proposal. � I have objections to this proposal. I t J DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) 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. o not wish to waive theme' setback requirement. 11J 1 o rY1 kD la (W J Print or Type Name —1ci Madan Addre s City/State/Zi �� Lf��) Telephone NurVberl email address Date *Valid for one calendar year after signature* XSZSi ature * a v 1 , P"-,c Pri r Tyrlit e Mailin Address 7elep�hhonerNuber/emailadd s ate • RECEIVED (Revised Aug. 2014) 3UL 3 0 zol8 DCM-MHD CITY ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to - T �C1Y1 's 1 property located at 1 � � � 1 r'Y\ l v1 f (.�(Name of Property Owner). (Address, Lot, Block, Road, etc.) on , in _. �'�Vt V, ( T , —V VtJ"1 , N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above locati I have no objection to this proposal; I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must rill in description below or attach a site drawing) J 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.) o wish to waive the 15' setback requirement. I do not wish to waive t/hl 15' s tback requirement. (Adjacent Property Owner Information) u cs ii4i L LL Pnn or Type t0 I >✓)1-171 l ►1 r Mali g Address _ City/Stafe/Zi �(el - `ix) -1tgo Telephone N et�rlel �t address Date "Valid for one calendar year after signature` 1 :;6 a -' / � !fin �l6yt.S I Sign e Prih Typ Nam ao r ,f-) r/� P w oN U Mailing Address > c p _1C Rtmr h i _ CVIStatelZip,U Telephone Number/email address U Date' (Revised Aug. 2014)