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Home My WebLink AboutChleborowicz, Gregory-CAMA / DREDGE &FILL ti NO. 73375 D GENERAL PERMIT Previous permit # - New Modification -Complete Reissue _Partial Reissue Date previous permit issued 1 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 7 H# 1 Rules attached. Applicant Name �"'�.. > ��-- Project Location: County Address, Street Address/ State Road/ Lot #(s){� City OVA lit ZIP. Phone # Subdivision ( ) %. E-Mail -- Authorized Agent - 1 I • City_ _ — _ - _ ZIP ❑ CW _ EW] PTA S ❑ PTS Phone # (_ ) River Basin Affected El HHF ❑ IH ❑ UBA ❑ N/A I {� AEC(s): _ Adj. Wtr. Body I. nat m un ❑ PWS: -"� Closest Maj. Wtr. Body---`,� ORW ves / no PNA yes / no w. MEN E ON MEN 0 No MEN M ON No 1 ■ moms ME MEN ME 0 IMEM No rE �l' ° ■ _:.��II III_ � rEl MEN 1 ENE No IMMEM Mi MEN ONE 1 IN all WIN ■ Agent or Applicant Printed Name SignaJ�� Please read compliance statement on back of permit Application Fee(s) Check # Permit Officer's Printed Name-,.., Signature Issuing Date Expira 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 Orher: 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/ 1-888-4RCOAST 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 9CAMA / kDREDGE & FILL iGENERAL PERMIT i ❑Modification ❑Complete Reissue As authorized by the State of North Carolina, Department of and the Coastal Resources Commission in an area of environn Applicant Name city_�(�.� Phone # ) Authorized Agent Mail L`ZIP , Affected ❑ CW `AW `fir , A T-S ElOEA [IHHF ElIH ❑ BA ElN/A AEC(s): ❑ PWS: ORW: yes /,oCP PNA yes �� f2- )4 A ip # permit issued N "w ules attach d. Gt- B (!5:) D ZIP River Basi i' `- en nat a unkn Closest Maj. Wtr. Body ! a =` •'"'" ■■MEMO■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■EI/'/■■ O■■E■■■■■■■E■E■EEE■EMEENN■ENNEMMEMEMEN■ E■■■■OEM■■■■■■■■■■■EMEM■EMMMEMMNMME� iIEE■ IENO . . = ■■■■■■■■■EN■■■■E■■■E■■MENEN■■■MEMB M■NEM■EE■MEMEMEEMM■NEME■■M EM■EE■EE■ME■■ NMMEEN■ MENE■MMMMM MEN ■NN■w-i■■O INE■ EMENEE■EN■MM■MMONEMEMEME■ME■EN■■■■■■■ ■■MEMME■■ENE■MEMM■M■■■ME■EMMOME■■E■■■E ME OEM= MENOMONEEN■■ME■MMMM■■M■EM■ONONE .. ■■■■■■EE■E■EEM■■■■MEE■NE■EN■MOEM■NONE ■■■■■■■■■■■M■■n!l NONE M■MO■■■EN■■■■E■NE■E MON0MMEMNONM��.II9[I11EMMMEMMEMNMOMEMMMEM■E MENE■■■OMEM■ MEMM■M ■■ ■■■N!:!O■ v►1rM■�`iiJ�M■■■■■■■NEE■MM .■■.■■EN■ME 0 ■ENEMNM■NEEOMMEME■M■MEM■■ NONE ■MM■■EM■MMEMMMMMMMM■MOO■OMMMENMM■MMM■ ME■MNO■MMMM■MM■MCE■MM■MM■MEM N■EME■EMME■ ■i■■■■■■�ia►wi■ ■M�■mmmo■■■■■■_� ■■■■■■■■Mom �I.lm�1CIMEM�M■ENEEMEE■N■■iiC'��ZSI WINE�EM GiiME� 11E■i i■M�+1►>IIII2VM`Ji/MEO■■■N■■OMEN MEO■■ f Ii11 MEN ■■MEE■■■■Seffirg-s- MIZAA (9' Agent Si ature ** Please read compliances ent on back of permit; Application Fee(s) Check # '—od 6,1 are, PermitOfficer's Printed Name Signatur Issui g D e Expi tion Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION 1 � 1p19 PIN', Gxi� GM r e of Property Owner Requesting Permit: • Mailing Address: r7 Phone Number: Email Address: certify that I have authorized _ L/L) R ��.. f'� (e- E f15 ► Wr Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: _-S � 14 'iCEA A // at my property located at in (!-"'AifL-c-re County. 1 furthermore.. certify that 1 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: L4 cltn lam. -- i, 7_-- Print or Type f_ L - Title Date �— This certification is valid through / I