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Home My WebLink AboutGibson, Andy, CAMA / ❑ DREDGE & FILL NO. 73169 A B C D GENERAL PERMIT Previous permit # .New AModification Complete Reissue Partial Reissue Date previous permit issued As authorized by the Stat: of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC Rules attached. e f �, Project Location: County_ Applicant Name �.. - Address Street Address/ State Road/ Lot #(s) City.•j,t State ZIP—�/, -- Phone # _ Subdivision ( ) - E-Mail Authorized Agent ty ZIP _•} --- CW J EW ❑ PTA ❑ ES ❑ PTS Phone # (_ ) River Basin Affected El OEA HHF ElIH ElUBA ❑ N/A AEC(s): Adj. Wtr. Body — _ _ —_ nat_ /man /unkn) ❑ PWS: nRw• vP� / nn PNA ves / no Closest Maj. Wtr. Body — -- — ■ ■■■■ ■■■��fiJ■ M.■■ �■ �■ ■■ ■■■■■■■■■■■■i�■■■■■o ■■■■■�■■■■■■■11ii3�7 ■■■■■■■■�11!■■■■■1?�!1■■OW■= ■■�!`!!�■■■■;+�■■ NEW NEW ON 21 ■�i■■WgN ■■■■11 -■■■ .. ■■■■■■�lii■t��► [:05 NlTi "INNO . ■■Y■■■■■ ■ liVA ■■■■ 10091.1 ■ ■►■c�l��iE��a�E��■11c■■�..■��,I�r�i■� Ila WHOMso r�■■��■■■■r�■ .. ■■■�■■■►�r��rr■ws ��i■��wc��r�■��■��®�i�■`��►•■■� M E on MEN■■■■■Now WIN ■■■�h■ Li�li��t■ /■1�lia-■RJ ■■EIIh [iYt�■ �!■!a 'l■� ■ 1�r��tl■■i1: ON �l 71r7i■■ � 1■■■■�� i��`,�ri�ilt�■�I� 1�ltii+��lt AN S pin ■■■■■■■EM ■■COY �'■ ■■�i■■■■:*■■■�i■ ■' s Agent or Applicant Printed Name Permit Officer's Printed Name Signature Please read compliance statement on back of permit Signatur� t ApplicationFee(s) Check# 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) 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 Hurricane Florence Repair Request Form .�,,pc/ �bc�.y--� Name of Property Owner: Date: Address of Property: Mailing Address (if different than above): Telephone Number: l S Repairs due to hurricane Florence will be made in the existing footprint of the previous permitted structure. RECEIVED Signature: OCT 3 2 DCM-MHD CITY ***Please note that if the structure is within the 15' setback of the riparian line and/or any dredging you must have the adjacent riparian property owner notification/waiver form signed. J ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to X-Ui re;-J 6' t Scl^1 's (Name of Property Owner) property located at (Andress, Lot, Block, Roadf, g;c.) on 1 ayrs r � in B �— --- . N, C. ( aterbody) (CitylTown anchor 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 rill in description below or attach a site drawing) WAIVER SECTION t understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a minimum distance of 15' frorn my area of riparian ac ;ess unless waived by me- (If you wish to waive the setback, you must initial the appropriate blank below.) r v �'- I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Pr ape Owner Information) Srg tore �gt. re ,j G'S40..3 Print or Type Name, G' h `7 49 7 A lC Mailing Addr�.ss R eo( CitylStet� e2ipT T� 7/0 _V/S - 1900 Telephone Number io - o2sg-/d' L?crte (Adj�cent Property Owner Information) Sign lure t-f4%4x a - Print or Type Name "7DI W l.,' fie.. tit � — Mailing Address �.,tz $fit U�� - c=, ,L 2783 CitY/ tat 17l 257-7S - Telephone NUMber �ECE�VEU .t13l-- Date ��(( 3 p 2018 (Revised �/ r �-[C1�rr;012) oCM-MwD CITY ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to Avd^C-..) 's !� (Name of Property Owner) property located at / `�46 Fro-4- (Address, Lot, Bigqq k, Rec�ad, etc.) on �1nrl Cruk in .3-,W arfF- 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. A/ I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT ondividual 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. I do not wish to waive the 15' setback requirement. (Prop , Owner Information) Sign Lure >�i/c.�reta.) Print or Type Name M 'ling Address Pra -S 7Ns S /VL )X37 7 City/ tate/Zip /o — RV3 - /90o Telephone Number/email address Uute 'Valid for one calendar year after signature' (Adjacent P operty Owner Information) Sin * 1 � s Pnrh I& Type Name Mani "ress Ci tat e ip T phon umber/email address EECfc1V�D (Revised At7014) TY DCM.MHD C1 ■ ■ CD po a m aka ' w b q d z tT m O� ►Ai Ph va to tom* A q r Camn a Vi Z mgaHmy rn tOXI 9 H.ly �tO►�73 O 7� bN) U? o n N , It 0 Cn y z w w -9O W � 0 OC7 'y V CC m O (Ln G WO tTl 3 g mg V O 1y J_I O m w � ° 3�� a C C' " °� x �" o d G N r a d ITI Z et oao c� a�g mli O a k CIl N V N O v ? 00 W _S gQo` �J QmJ a yz LY m m A c � O 3y m _9 m 0 N 'a R a J Oq. 0 7 �g 0 0 ?o y. y m m _ P' 2. �c { o y mo i O1 J J m (D gi CD t1l m � Q � 63 c W m `G w P 09 fmh E L " A (, Andrew L Gibson, give Harry Cooke permission to pick up my CAMA dock permit. Andrew L Gibson Date