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Home My WebLink AboutFlem, Per 78356C❑ CAMA / ❑ DREDGE & FILL GENERAL PERMIT ❑New ❑Modification ❑Complete Reissue ❑Partial Reissue N° 78356 Previous permit #_ Date previous permit A B /C� D As authorized 6y the State of North Carolina, Department of Environmental Quality �� and the Coastal Resources Cpr�" mission in an rea of environmental concern pursuant to 15A NCAC '� / ❑ Rules attached. Applicant Name t'4 , Project Location: County ( �:..�Q` rr City 1 r 0,1 , State U` ZIP Phone # M) t i' ` (( is rj �.Mail(r Authorized Agent _ _ i?f'�•-, 1... c'V /t -X--f1l A 1 _ Affected ❑CW �pEWp-PTA El ES ❑ — AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWs: ORW: yes / b PNA yes / n Street Address/ State �pad/ Lot #(s) , . Subdivision city L;;� zIP t Phone# O Riv rBasin Adj. Wtr. Body �t t" o,.e ., a an unkn Closest Maj. Wtr. Body I^ - Type of Project/ Activity H■■ aC:0 L' ■■■■■ i1■■■■ 'C': 1 a 01 I■■■■UN■■■■■■�w■■■■ �. A'9:► B■■■N■■■ 8■■■■■■�■ ■■■■■■■�■■■N� �........C..........■■■■■■ MM■■■■■ ■ IMEM■■■■■■■■ ■■ririliil��r��lill■��■�I�'\\■■■■■■■■ ■■■■■mmommo IN� ■RIiM_liMl■ EE■MENIMI■■■ q T :. • EllEMEMMIN ■� IN ►•IYC� vim® r►�■MMMMII■ ��■■■■®■ON �� ®■■■ ■mo■■■� ®��i■ ®■■■_ ��'"::!�\■■d■■■ ■■■■ate■■■I■■ a��l/■■■■ ��■■ F11 ■■■■■ ■l�1s■ ■■� a■■■■■■ - . a■■■■■ INUMN ■■■■■■■■a �■■�■■■■■■■■■■■■■■■■■ ■■■■■■■I a■■■■■■■■■■■■ ME ■��n� i ■MEN . . oilm,��j°::■ mw;ems ■■■■■■■ ■w�l ■■■ ■ai■■..C�� Agent or Applicant Printed Name X si yew- **Ple a read compliance statement on back of permi!* plic ion Fee(s) Check# 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 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 howto 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, 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 Pander Counties) http://portal.ncdenr.org/web/cm/dcm-home Revised 7/06/ 17 AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: T,? r- I� m Mailing Address: ' i Z wC, 4 C iKiGl"e,�4-i-i �()t7;o Phone Number: S I '3 22 2 I I V - Email Address: "] f,--to moo e4w-el4 moo• , I certify that I have authorized E '� U )ci t -p zG 'j 'C . Agent 1 Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: "J No 4 raj at my property located at S C In n nn I Dri Im- 'E w,.v, n I el -LI in C3-�t4-e*�.-I 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: Signature 9 F l�'V,, Print or Type Name 0ww-<r Title /2 I I") I 'ZO Date This certification is valid through I I ADJACENT RIPARIAN PROPERTY OWNER STATEMENT 1 hereby certify that I own property adjacent to r' f Crz-z-rv-) s (Name of Property Owner) property located at I O 1 a r„ z 'D, r cw�er.a lci ZS I lV G.Z`5Sr(y (Address, Lot, Block, Road, etc.) on O N.C_ _ (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. t/ 1 have no objection to this proposal. r, .. . . 11771sx61.. 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, 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.) C 1 do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) K-e�t -0e Signatwe ft� -�c� P�Q'nt or Type Name rz��i�^ r L, ', U d LL AgalGng Address C IN _It1 A. -'.Ohio 4-SZ4Z oty/Stateop ;1 3 5't2 I I V'Z Telephone Number r (Adjacent Property Owner Information) Signatures ��-z'l thev, h'g..z Print or Type Name Mailing Address Em�r9IcJT51z_�N C' /State/Zip ` qz '35y -3o°1 I Telephone Number la.`z�_2ca =1 (Revised 6/1 W2012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT 3v°1 I hereby certify that 1 own property adjacent to �� r 1 ✓' s (Name of Property Owner) property located at �aa�� 17r�� cwL-ernld1 r,1�IVG,.Z55� tom` (Address, Lot, Block, Road, etc.) on �.>>; 5 in C--- - -e;� n I d I r- N.C. (Waterbody) (CitylTown 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. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill in description below or attach a site drawing) 3 3" '743A WAIVER SECTION I understand that a pier, dock, mooring pilings, 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.) B :5 1 do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner information) (Adjacent Property Owner Information) —124,,1r4 Qe Sg, wtw•e Pgnf or Type Name Agailing Address `' C IVI _1�1✓A TSz City/State/Zip I •3 5''1'Z I I �"� Telephone Number Dare Print or Type Name � •3o1Ch�.. I Vn, G Mailing Address LDS �l Telephone Number 1 T3 --z,-2 0 Date (Revised 61182012) - N V- 4� A441 'J 0 13. tiv vso: cA . s 11,104w_ r!" lo :LW0f": a .Jfp_ 0 .ft. v) cn%, :'%b '41 _IIAM w gay 1 A _Le tvfl r ft 1wx • I -,-LAqhT Aw Ase, $,Spumy I of"!! �4)rl; 01 3;4?m i" ;4' Ve_ 01 0 I'll Jj"jvjrj Jt'rj':jf." Aly a ,