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Home My WebLink AboutLesneski, CheryllfdAMA/€1DREDGE&FILL 1V9 78952 �� A B dC D ®GANERAL PERMIT Previous permit# ew ❑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 ❑ Rujes attached. Applicant Name hc�t "il I rF ��f'J ' Project Location: County r r' f - Address Phone # cV,k t r+-k State -A/C ZIP �,—)-)0 1:115F.111 Authorized Agent G e�-1, / t7 I " ❑ Cw �� El ES ElPTS Affected A Affecte ❑OEA ❑ HHF ❑ IH ❑ UBA I-] N/A ❑ PWS: ORW: yes / fro/ PNA yes / Street Address/ State Road/ Lot Subdivisio 'l City U �1`" ZIP /J Phone # O River Basin Adj. Wtr. Body man unkn Closest Maj. Wtn Body �y r '.'.'.:■`:■:■■m� ■■o■■� :E=:::IS ■■ ■■::MEN ■■■■ ::::::::�LM:'�::::::� NONE MEN so IS p...■■■■■■� MEN //■H■■■■■■■■■■ NEE ■■■��■ �w ib1■1Z1MVilw ■"■ No ■■!1I!Jl ■e�i■■s m■■■■ — t�I� rRUM"&W omm ■waif ■■■■■■d ■■ ■■■■ ■■■■■■��■■■ ■A ■�/■�' ■■■■■■w 7■■■■■■� ■■■■■■ M.■■ _ ME ll MIMmils IS ENE .M.' an ME wool IS • ■H■■■■■■■R \■■■■■■■■■%■q■■■ ■■■r/■� q■N■®■■■■ ■p■■■■■■1■1�%�■y■■:■■■�►1■■■■ MMMMNONE ■■■■■ommon��■■■■■■■■■■■■■■=MESON?/.�i■■� ' 'C�= C=■'::■No�®��C ::::::�■■■�. ■..■:1A:.� Agent or Applicant Printed Name t Signa r•'Please read compliancestatement onback ofpermit" placation Fee(s) Check # Name 3 /'S I'j , -7 / 36/1 V 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 officerwhen 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 complywith these buffer rules. Division of Coastal Management Offices Morehead City Headquarters 400 Commerce Ave Morehead City, NC 28557 252-808-2808/ 1-888ARCOAST Fax: 252-247-3330 (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) Washington District 943 Washington Square Mall Washington, NC 27889 252-946-6481 Fax: 252-948-0478 (Serves: Beaufort, Bartle, 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/I7 AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: C.v)ecV 11 & eri k- ut6 Ivt Mailing Address: Ditot aq Phone Number: alQ —'� �gI�J�Ckt y1b1 Email Address: �CSrc k, t 67ejy-,C1I OLt C. I certify that I have authorized Wl u I.kXas,l r'�►'�I C C005fa/ -r?-C(C rfldn 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 11 $hora lrnD at my property located at lS I R1lJC n lA n� tov C�CsI� NC, in County. 1 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 Info ation: Cary it y, 4signaturp S#Ie5 Cr �riK �¢S�7t3 Lri Print or Type Name Prnpeci� t'w„ t f S Title F� b ► 13 / a�ao Date This certification is valid through Qa / 1 "),C>2=� 1 v z-<; ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to s (Name of Property Owner) property located at /J�) Not erny) LC- nx (Address, Lot, Block, Road, etc.) on I he T C� J in �n 10f _)CC le/ N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above lam. 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) 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,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. (Property Owner Informs on) (AdJ cent Property Ow or Information) SigQureCkc.ryll Legnes Signature& edu Date* (Revised Aug. 2014) 'Valid for one calendar year after signature' Q ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to a X I ( % E t IL LSfe6lS •t s (Name of Property Owner) property located at 1,51 t uo, c t LA r %R (Address, Lot Block, Road on A Cir %5 in IOU C�6 '�C�'" N.C, (Waterbody) (City/Town and/or County) 4Tapplicant has described to me, as shown below, the development proposed at the above o I have no objection to this proposal. I have objectlons to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individualproposing development must fill In descriplion below or. attach. -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 (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. (PrQ aerty O�rner nformatl n), j an r pe wrier Information) 4 K. ecu plur•e*/ . la ive l J2 Pb ✓fe or Type Name umpcin !� o� (Revised Aug. 2014) *Valid for one calendar year after signature" c m 11 N JJ N �•R 4 a �jj .M�'�, B 'w�rTe-`i' �� v �a u 4 m LU c E 0 N N O C N L O O a --I -r. 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