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Home My WebLink AboutCleeveland, Don 73180CVIA/ El DREDGE & FILL F(or-r/LCZ No. 73180 A B o L=14ERAL PERMIT Previous permit# ew ❑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 mmission in an ar o(environm ntaI conce n pursuant to 15A NCAC f (/^ `/J ❑Ru1esatta�ched. Applicant Na/m�e /tom `��C V, 1cR o Project Location: County Address d�' / `� nrr Ucr, J� yi' Street Address/ State Road/ t #(s) City �y� p State ZIP tom/ J (0 /AJ Phone#�)� /"!�J /� E-Mail Subdivision ' f t/ t� Authorized Agent City /�Y' G ZIP Affected TA ❑ ES ❑ PTS Phone # Rker .boat Basiny�� AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body vVt✓ /man /unkn) ElPWS: / . n ORW: I yes] no PNA yes Type of Project/ Activity Pier (dock) length Fixed Platform(s) Floating Platform(s) Finger pier(s) Groin length number Bulkhead/ Riprap length avg distance offshore max distance offshore Basin, channel cubic yards Boat ramp 6S Boathouse/ Boatlift _ (j, - c/ Beach Bulldozing Other Shoreline Length _ w SAM not sure yes no Moratorium: n/a yes no Photos yes no Waiver Attached: yes no-- / — ----— I------ 1 (Scale: t'leli6I A building permit may be required by: ��/�� (/ ❑ See note on back regarding River Basin rules. ( Note Local Planning jurisdiction) Notes/ Special Conditions k &'J C- _i Signature ** Please read compliance statement on Application Feels) 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 41formation and belief certifythatthisprojecris consistentwiththe N01 '.Ca.olinaCoastaWanagementPrograiii. 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/ I-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, Berrie, 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 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT �oN C'�evclRwi 1 hereby certify that I own property adjacent to T e 2e w Vi l oo s (Name of Property Owner) property located at t S N Sh 001e , oo� pW-e -- (Address, Lot, Block, Road, etc.) on �6?Cuc Sn�r,in=merz'tIJ rSI� ,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) 1 9- 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) Q ,,- Signature &) o Print or Type Name l 2,\G r\,J ' h' nn0 Mailing Addr ss Ew eawlr r-S I, , �J L ZK` 1 y City/State/Zip �Iq 2N4-SSS��cle�( /trTGlob�l. Telephone Number/email address N� r Date Telephone Number/email address Date* i5-74 cFS ram) ynm,1"oP71 (Revised Aug. 2014) `Valid for one calendar year after signature* ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to Cle. J.,J A A I � a J s (Name of Property Owner) ` property located at a I e N S �o -�4,� k.� rz (Address, Lot, Block, Road, etc.) on E 6� uu W in C ,v`e IJ �5 t� N.C. (Waterbody) (city/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location. o 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) m- 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) (-- Signature 1y,J C \"r�ltk�,� Print or Type Name .a\ �� IU Si\c,2—Weoei �2 Mailing Address r M,J,'d 15tgj NL City/State/Zip glR d �y, 5y5b'1 p � I vim@ &rrt-lo✓arl, NET Telephone Number/email address N 'rj � Vt , . v.�-v Date (Adjacent Property Owner Information) Print or Tt pe Name ('g2.zo > G . SEtareu��nc0 'Cjc. Mailing Address r�r.�ltfl5)� l�L C't /State/Zip Z.oZ-(.q'30 Telephone umber/email address (- *Valid for one calendar year after signature* (Revised Aug. 2014) AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: t:lw /C�e�'� Mailing Address: Z ti� �� 1 k 5f 0r-I' cl*- Phone Number: 9 /D 5 3-1% 40L/7-5 I certify that I have authorized to act on my behalf, for the purpose of. applying for and obtaining all CAMA permits necessary for the following proposed development: —Z) oc�e \>,' 1� at my property located at,? in Crtr^he✓ee 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: CQ Signature S C_� Print or Type Name Title Date This certification is valid through