Ross, Harry 77398C

N9 77398 AB
Previous permit #
Date previous permit iccr rarl
7il llcuof environmental concern pursuant to l5A NCAC
uJl Prolect Location: County
CD
and the Coastal Resources
Applicant Name
in an
/t /'
I Rules attached.
State ZIP_
Street Address/ State Road/ Lot #(s)
( r a'tr-'
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uPhone #
Authorized Agent
trcw trES trPTS
N UBA D N/A
Phone # (_)
Adl. Wtr.
Closest Maj. Wtr. Body
tr PTA
trIH
PNA yes no
trEW
tr HHF
Basin
Affected
AEC(s):trOEA
ORW:no
# Please
1_O r{Type of ProiecU Activity
(Scale:)
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
-
Finger
Groin length
number
Bulkheadi Riprap lengh
avg distance offshore
mo< distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/
Beach
Other
Shoreline Length
SAV: not sure
Moratorium: nla
Photos:
Waiver Attached:
yes
yes
yes
yes
no
no
no
no
A building permit may be required by:
( Note Local Planning Jurisdiction)
E S"" note on back regarding River Basin rules.
Notes/ Special Conditions
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Agent or Applicant Printed Name
lssuing
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Fee(s)
on back
Check #
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trCAMA/trDREDGE&FILL
NER/AL PERMIT
EN"ry EModification IComplete Reissue EPartial Reissue
(nat /man /unkn)
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PermitOfficer's Printed Name
Signature
Expiration Date
Statement of Compliance and Consistency
This permit is subiect 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 accessibletothe permit officerwhen the project is inspected forcompliance. The
applicant certifies bysigning this permitthat l) priorto undertaking any activities authorized bythis permit, the applicant will
confer with aPProPriate local authorities to confirm that this proiect 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, certirythatthis proiect is consistent with the North CarolinaCoastal Manatement Program.
River Basin RulesApplicable To Your Proiect:
lf indicated on front of permit, your proiect 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 Olfice (252-946-6481) or the
Wilmington Regional Office (9 I 0-796-7215\1or more information on how to comply with these buffer rules.
Division of Coastal Management Of,ices
Tar- Pamlico River Basin Buffer Rules
Neuse River Basin Buffer Rules
E oth".,
Washington District
943 Washin4on Square Mall
Washington, NC 27889
252-946-6481
Fax:[phone]
(Serves: Beaufon, Bertie, Hertford, Hyde,
Tyrrell and Washington Countiei)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-72t5
Fax: 9 l0-395-3964
(Serves: Brunswick, New Hanover,
Onslow - South of New River lnlet-
and Pender Counties)
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ r -888-4RCOAST
Fax: [phone]
(Serves: Caneret, Craven, Onslow -
North of New River lnlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
hnp://portal.ncdenr.orglweb/cm/dcm-home
Revised 7/06/ I 7
CERTIFIED ilIAIL' RETURN RECEIPT REOUESTED
, DIVISION OF COASTAL iTANAGE]IENT
ATUACENT RTPARIA}I PROPERW OWNER NONHCAIIOT{'WAIVER FORM
I( Nameof Propstyo,Yner
Addrss of Propertyr
(Lot or Stseet *, S:heet or Road,& County)
Ag€nfs Name *
Agenfs phone *h
Mailing Address:l.1(
)
c-
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o o {/
I hereby oeft? $at I o!,yn proporty adjacent to he above refierenced poprty. The individual
applying for his permft ha8 desotibed to rYE as sho,vn on the atached drau,ir€-$e dewloptnent
they are poposing. A descriolion or drewino. wi$ dimensions. must be oovk,ed wih this letbr.
.totl ra*"oo objectiors to dris pmposal
-
I bave oliections b this proposal.
Ityo.,har?o&{,Er7nbrrrr.tisHrgprqose4 Wt mu*@ ,EDi,&itr, dW r,3r'.go/t qf @C{) h,
vtfl,,rg rrfi,*tr n d,y* of ,€ccira of {ii3 ndce Coflt+onderce srlo.rrd bon},0pdbfif c.r,,,nl Drft,! Ert
Wlnf/,g|ot , NC, ?811Erfi15. DCI GprerttffG an ,b ba cfiAcrcd at pt0) f!r6m5. rrro ,Ewnse i8
corlrrderEd fie same s no otiediqt ll wt l,eve Nt notlfrd by Cgfli,,gd l,,,lL
WATVER SECTION
I understand lhat a pier, dock, mooring pilings, breelo€ter, boafiouEe, lifi, or groin must b€ s€i
back a minimum distance of 15' fiom my ara of riparian Eccas unless wai@ by m6. (lf you
wish to waive the setback, you @I!&! the appropriate bhnk bdoet.)
*H/L .I do wish to waive th€ 15' setback requirement
-
| do not wish to wait/E tt€ 15' s€back requirement
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(Property Ownor
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PrintorrflNdnd
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Date
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Revised 6/1U2012
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NC Division of Coastal Management
Cashier's Official ReceiPt
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Date 6--
Oate:
Date:ao20
$
Received From:
v7 Zq &Check No.:
Qo County:
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Please retain receipt tor your records as prool ol payment tor permit issued'
Permit No.:
Applicant's Name:
Project Address:
Signature of Agent or APP|icant:
Signature ol Field Representative:
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