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Home My WebLink AboutDawkins, Lee®1.0 CAMA / ❑ DREDGE & FILL N9 78924 A B c D GENERAL PERMIT Previous permit# ❑New ❑Modification ❑Complete Reissue ❑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 0711 CyT !/ ' r` Rules attached. Applicant Name ( ' Project Location: County h.��—t, Address n %fir '''' ? (A h I v e Street Address/ State Road/ Lot #(s) ji { City f' kr,dl /e)V,. tateM�7 ZIP D : Phone # ( r) e/i6I iE-Mail Subdivision Authorized Agent Affected ❑ CW �d EW A PTA ❑ ES ❑ PTS AEC(s): ❑OEA ❑HHF ❑IH ❑UBA ❑N/A ❑ PWS: ORW: yes //no PNA yes (no City i �.■■■■■ ■�■■O ■■ ■ a��r■■■N■ MEMOmom MM111M1M11ff1EMM .....■E ■■E ■ aM■ ErgMMEN:�i:�■■■■■■E F ■■■■■■ ■■E■IEEE p■■■EI■ � min ■■■■■. ■■■■ MEMOM. SEE . ::::::;:a:I� �Ca MOVIE P!1■B10111111111 ■HE■■EML�!' ME SEE ME M. ME M H■ M■■Ma IMoloo ...P : OEM SEEM ...��:■■®■■ MENEEN MEEK ■ �E■■i119E■■M �■■■■■■■■ ■■■■■■■ rME ■■�■■■■Is■■■■ EMi�■■■■■Ep■■■■■ M■■ I■ ■■■:aM■■E■■■Eaw A■■■ ■■■■ ■■■■■■■■■■ ■FEMME ®EMO E=Eg REE FI:E MEMO 0::::ENE1.0 i p t Agent or Applicant Printed Name Y i Signature "Please read compliance stat fnentonbackofpermit•* c �67 Application Fee(s) Check # PermitOffcers Primed Natne Signat re / Issding Date rExpiration 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 nul I 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 I) 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 Iandowner(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 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, 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. ncd en r. org/web/cm/dcm-home Revised 7/06/ 17 AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: LF E JJ DIXXUI ) Mailing Address: �206 Ogkleo,rt 7),-- Phone Number: o2So2 —6�V(E— Email Address: �22 �q kJk =175 a eG • r-" ' C Olt - I certify that I have authorized lid 1�I\D F�N1�FP�7� Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: 12 K h �\ Cl\ FCC M y Z l mzy at my property located at 2l-pin 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 Information: �'��1'k S' na /re Print or ype Name CAX\N' -V Title x ac�av Date This certification is valid through / / CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Owner: _I V- E _ X--,y N . --, Address of Property: % ��p \ F�� nP r �� !E [! 1 `,\\C��2\ S CA�TC R A (Lot or Street #, Street or Road, City & County) Agent's Name #: Mailing Address: Agent's phone #: I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit has described to me as shown on the attached drawing the development they are proposing. A description or drawing with dimensions must be provided with this letter. VK l� I have no objections to this proposal. ___ I have objections to this proposal. If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writing within 10 days o available athttp://wwyynccoastaf receipt of this notice. Contact information for DCM offices is \ C' h_7ranagementneggweb/cmfstaN-listinaorby calling1-888-4RCOAST. Noresp(yr onse /s considered the same as no objection if you have been notified by Certified Mail WAIVER SECTION I' —741 I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.) f' t1 1 w I do wish to waive the 15' setback requirement. /_ r I do not wish to waive the 15' setback requirement. r (Property Owner Information) (Riparian Property Owner Information) CfxOOL�\ Signatur Signature Lee M J�ru�l� rs//��i�cy�`y/�r.�% Pnnt or Type NamePrint or Type Name C'�rK�ea-��r;✓e, ��V ,itAa.„alth [(- 1 Madmg Address Meiling Addre 1 lie ��ol�Slioies l?J�o7%z )2,`Ae l<�li 5kc;ts Nc zesiz Cdylstate2rp Crty/SfatelZip Telephone Number/ Email Address Telephone Numberl Email Address le-,o- alfel d f -tS @ Bale /^ ao -aoao Date (Revised Aug. 2014) ■ Compl Items 1, 2, and 3. a ■ Print your name and address on the reverse X so that we can return the card to you. ■ Attach this card to the back of the mailplece, B. or on the front if space oermltR_ D. Is delvery address diffenNit from item 14 ❑ Yw If YES, enter R Palvhe,r delivery address below: ❑ No 3coy VA. NW Carroll , 6" 4 3112 IIIIIIIII IIII IIIIIII IIIIIIIIII 11 IN III IIII III 1590 9402 4999 9063 5209 76 7019 0160 0000 2869 1264 PS Form 3811, July 2015 PSN 7530-02-ODti-auoc :e rype ❑ Pdodtf' Mali Express® seat" ❑ Registered MW1TM ]natum Mall® Restricted Delivery ❑ Heegislered Mall Restricted 1 Mall ResMoted Delivery ❑ Retum Receipt for on Delivery Merolrandise on Delivery Restricted Delivery ❑ signature Confirmation^^ Mail ❑ Signature Confirmation el: MRestrldetl Delivery Restricted Delivery Domestic Return Receipt ur�carn paI �k1r�S 210(o O,ca, _Leo�f Dr. dire Yn_1 SvIores 1Nc 28512 c�Ol 11 -.. �. gOPOSED i o000 Io L Dliplipposc-0,ROP � ° 4- SIB CAU PILINCn JET SY�1 LIFT I