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Home My WebLink AboutEverhart, John 77195C®PrCAMA /DREDGE & FILL N9 77195 A B 0 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 an area of environmental concern pursuant to I SA NCAC 0-7 1// � f ��" ulesattached. Applicant Name �J �v ft _ Project Location: County��r�,_ �E�...;1•- Address _ Street Address/ State Road/ Lot #(s)Q. City StateW�', ZIPJ91-Q- Phone # 4�) -$GI $ E-Mail _ Subdivision___________ ___.__ Authorized Agent "' City Affected ZIP ❑CW AEW YIA ❑Es ❑PTS Phone# (_) Ri erBasin L�t� IKk AEC(s): ❑ OEA ' ❑ HHF ❑ IH ❑ UBA O WA Adj. Wtr. Body S (net a unkn ❑ PWS: ORW: yes�Yhoj� PNA yes /�� Closest Maj. Wtr. Body Type of Project/ Activity ' J Ml l�/►�iFJnI� /) 1�. �KeaV.1 I I Pier (dock) length__ .+- Fixed Platform(s) r Floating Platform(s) 'R Finger pler(s) ate_ Groin length •e _.5.,,, _,. number - Bulkhead/ Riprap length / - - �. avg distance offshore , - max distance olphore in. ann4�0 Al cubic yards_ i Boa[ ramp Boathouse/ Boadih r Beach Bulldozing •~ — , �- Other__....___ Shoreline Length rV _ SAV: notsure yes 'no Moratorium: n/a yes no Photos: yes no Waiver Attached: yes \ no - A building permit may be required by: ( Note Local Planning jurisdiction)�� ff v^ Notes/ Special Condit{ons +Jt'�tQl I MAt'li t 1 V6� Agent o li yrnMed Name i XSig re **Please read compliance statement on back of permit Application Fee(s) Check # (Scale: /",26 / ❑ See note on back regarding River Basin rules. 11CAMA/DREDGE &FILL " — N9 '7'7195 A B � 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 an area of environmental concern pursuant to 15A NCAC ules ttached. Applicant Name v V �_ Project Location: County�e Address Street Address/ State Road/ Lot #(s), City StateW&— ZIP Phone #), t%�$O�$ E-Mail Subdivision Authorized Agent City Z ZIP Affected ❑ CW AEW . rTA Li ES ❑ PTS Phone # ( ) Ri er Basin ❑OEA ❑HHF ❑IH ❑UBA El N/A AEC(s): Adj. Wtr. Body nat a unkn ❑ PWS: ORW: yes no PNA yes / ip Closest Maj. Wtr. Body d LAO und Type of Project/ Activity nf.. _ Fixed Platform(s) .� Floating Platform(s) r r Finger pier(s)= Groin length .r number i Bulkhead/ Riprap length / avg distance offshore / cubic yards Boat ramp Boathouse/ Boadift Beach Bulldozing - Other Shoreline Length SAV: not sure yes no Moratorium: n/a es no Y I Photos: yes no Waiver Attached: yes no A building permit may be required by: ( Note Local Planning jurisdiction) l Notes/ Special Conditjons 6C; t I I Agent oreBEIi Mt Printed Name 'T� S)g ture ** Please read compliance statement on back of permit** r5.� �355 App�n Fee(s)Fee(s) Check # (Scale:)yy� ❑ See note on back regarding River Basin rules. 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 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 how to complywith these buffer rules. Division of Coastal Management Offices Morehead City Headquarters 400 Commerce Ave Morehead City, NC 28557 252-808-2808/ 1-888-4RCOAST 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://portal.ncdenr.org/web/cm/dcm-home Revised 7/06/17 AGENT AUTHORIZATION FOR CAMA PERMIT, APPLICATION Name of Property Owner Requesting Permit: 'TOA/I Y--Q 1,ne Z/r'lZ Ql� Mailing Address: P- Phone Number: Email Address: 336 �s o-9(2/F' I certify that I have authorized Agent I Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: � a-ro u-VV— / at my pro locatedat locateat I J 7 in (? 4��County. I furthermore certify that l 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 iWated to this permit application. Property Owner Information: Signature 56�� E✓ed ccrl' Print or Type Name Title 7 l ql aaao Date This certification is valid through / ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to property located on 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) Dredge ground dock 1rJ�e4�1��k1IV0 � tJniae� I-��' 'E�)-i41N5 b6z Iz 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.) I do wish to waive the 15' setback requirement. ✓ I do not wish to waive the 15' setback requirement. (Pro Owner I ormation) 4ignature o � toh Lver{�ar- Pnit iTyp�Narrlej nor Njatlii Address , g �r� C}}ity/State/Zip , 56 Telephone Number7Z / 5 20 Date (Adjacent Property Owner Information) ignature 177-11alr W,1,651,1 W r e 7- Print or Type Name / D t7 G vD/�/SS_ CST Mallls f K 5 p City/S ester - Telephone Number Date (Revised 611812012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT hereby certify that I own property adjacent to J e h n t- ( )am P I a Cye r- nnrT 's property ��n �d ��/ e of��o erty O rL 1z located at 1 Y l � II (Address, Lot, B ock, Roafd� e�tc.) II on I i n 2 Y7C 1' caterinJaV , in �i n e Y� Ll ' 11,5kr)res N.C. (Waterbodyy) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. _ 1 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) �rec��e. groUne� docK t ti,5I- a5 'Dc3c,AL. I () X(�(4 2 `�2qf,C-,yd5- 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.) do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. co h i? Print or Typnne NaTII % I PiCard l plil q Addres$ City/State/Zip Telephone Number Date (Adjacent Property Owner Information) Signature �uZQnh_ l ' I3a1�1�;n Print or Type Name p f Mailing Address C' aCga s� l Z CityiState2ip 3 �, 3 3- 9 q q,3 Telephone Number 71 islao Date (Revised 611812012) ....... .� �. c-. is