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Home My WebLink AboutRucker, Amy®r6(�Y 'YI�DREDGE & FILL W 78980 A B Gc D r. RAL PERMIT Previous permit# ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As authorized bythe State of North Carolina, Department of Environmental Quality ) -/ G /' and the Coastal Resource;'Commission, in an area of environmental concern pursuant to 15A NCAC / LJ Rules attached. Applicant Name A- � � � " Project Location: County e Address �% �� Street ddrre'ss/ S- Road/ #( L t fs) City �C 'r`\ State; ZIP 1 ��r �Or Phone # ( ,1 `%9 E- ail _ Subdivisions Authorized Agent I'"/City ZIP, l 7� ❑ Cw Ew ,2I%TA j2ES ElPTS Phone # ( ) River Basin i "7 Affected OEA AEC(s): ❑ ❑HHF ❑IH ❑UBA ❑WA Adj. Wtr. Body /f,ti,V - fiat man unkn p Ws: ORW:( yes no PNA yes�o` Closest Maj. Wt.. Body Type of Project/ Activity ■ MEMO ® ■■■■■■■M111■w MEN � l�l1■■\l //'1®■ ■�MI■S ®■ ■ ■■■ ■■■:■■ ■:�■■:■ ■■::i11M•r ..■..■.. ■■E■EME■■■�1■■■■■■�..� MEN ... ....MEME MEMO.■■ .■■■. .■.®■■....MIMME ■■■E■■■■■M =E ..■�� E.....■EME E■m■■■■■m■■■M■■■■■■■■M■Eu �af■I1i11.9 ■MEM �ommomm: Comm MD��1 :No IMEME ■■■■■■■■■■.■■■.■. M■E ■■■■■■ ■■■■■■■. MEN .I,..■■■�■■. NONE .® MEN m1A■■MMEMEEM■■E■■■OHM M.■■■■■■■■■■. jjjjjj�.�e■....•--� ■:1 MME :l :M'.■.■ ■■■ ■ ■■■o■■ �_-� ■� G■■ i Gi1G1w��::�iwC■P!r■►JIiI FAR i 1WEE ■ • �.a rM■■M■■11IENWAKEM1111a MME MENEMME MEMEM ME ■■■■■11■M■■M■■■M■■.!■■■ME ■■E■■111■E■■Mo■■■■ Room�IME■■M■M■■■ M■M■■■■■� aM.■::■■.1 ME Omni ME E: or Applicant Printed Name SigurVs`*flease read compliance statement on back of permit""" Signatux pplicati Fee(s) Check# IssuingD a Expira &ll Vle 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 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, certifythatthis project is consistentwith 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 howto complywith these buffer rules. Division of Coastal Management Offices Morehead City Headquarters 400 Commerce Ave Morehead City, NC 28557 252-808-2808/ 1-888-4RCOAST 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:Hportal.ncdenr.org/web/cm/dcm-home Revised 7/06/17 AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: / I /t ( 94C L Mailing Address: 9 �o I ✓JYU ✓C tiro �✓ Phone Number: _ �Il �j 3 5 -) Email Address: I certify that I have authorized Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: V t h y) --e-4 Ltio✓l:/ at my property located at ) a I D- jr) ✓h b -ems✓ :Z ., in C-Ov ✓ County. I 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: t%Z Signature Print or Type Name 0 w rn ]'i Title Date This certification is valid through I I ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to A v\ + Aew 9"e-r 's Name of roperty Owner) property located at � ZI 7 [ 1,M� � c-.,.t (7 (Address, Lot, Block, Road, a c.) on I"� Lx, A �&� , in �v� (off 5�C 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. 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) i -ZAL " l ILIZ - "'(' 1 ZIP TO�L' 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. (Property Owner Information) (Adjacent Props* Owner Information) Date U Print or mantng Hoo s , ry) City/State/Zip .0 ri Telephone Number/ail a ss 1 Date* 3 'Yet (Revised Aug. 2014) *Valid for one calendar year after signature` ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to Mae, h 's property located at ((Name f Property Owner) � ZI Z � },,,�� 7cia 1 (� (Address, Lot, Block, Road, ggtc.) on _I � 4U6 , in t vw �.1�. Istc , N.C. ` (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above locatio . 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) \L \r\,r,) , I\ _ I � ZIZ. )5vhb� 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 I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. Owner Information) 7El lyn�a�iwN aili g Address ��Ce 1 7 City/Sta Zip 7l '35 7-yw !✓ ✓14 C IL, Telephone Numb r/email address ,y p . C% — e2 (Adjacent Property Owner Information) Signalu •e* W !r4 el L-- 1_ - 12�=BEI Print or Type Name t z io -r—)m F'e r T,.?,- Mailing Address 01h j' r' I Sze . 6�G 2 s54 City7StatelZip 4 ( -oK-2Gsj Telephone Number/email address -z /// /zo zo Date* (Revised Aug. 2014) *Valid for one calendar year after signature*