Green, Mike 77354C

DocuSign Envelope lD: OF8B738B-Et494BD7-82D2-F0FF6F6373C0
/ OREDGE I FILL
NER/AL PERMIT
Modification CompleteReassue .PartialRelssue
by the Slate of North Carolana, D.panment of Envlronmental Quality
of enrronmeital .oncem pursuant lo l5A NCAC
N9 77354
Previous permit #
Date previ
and rhe coastar Resou** alTT
Applicant Name I '
- Rul.5 rttr<h.d.(.rj^-z
(,,
/t La/^Proiect Location: County
Street State Road/s)
(
1 L/f
ztP f
1r-*.,,Subdivision
City
ES
UBA
PTS Phone # ( )
Adi. Wtr. Bod),r
Closest Mai. Wtr. Body L- A
@r*1u.kn)
Authorized Agent
Affected
AEC(s):
-:Ft ,rr^
OCA HHF IH
i Pws:
r ('c,.1 zlP
River in
rlORW: yes PNA yes
Type of Proiecv ActiYity
Pier (dock) lcnSth
Fixld Phdonn(.)
Flo.tint Platlo.m(.) _
(s,crle't ,lr--y'
L./ry' y. -t\
Fin8cr p'Gr(!)
Groh bEth
(),11 tr (A,rf
mar disrancc offshore / L
8.sin, chennel
Boathousc/ Boatlift
B€r.h Bull&ring
)
*r"l..u* Ind
SAV: not /ra
Morltoriumr n/a
Photos:
0vac ll0 \t,t/1 . /' (,,
A buildin8 permit may be required by
( Note Local Planning lu risdiction)
Crrrlo.'See note on regardinS River Basin rules.
lConditions ff h /Tn.t t,(
o (C-/t.
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(
BRIAN DEANHARDT
tfnted Namo
1,"$ /g+L"h
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L)
comphance s!atement on back of permit r*
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/ l DREDGE & FILL
NERAL PERMIT
ew lModification lComplete Reissue Partial Reissue
rized by the State of North Carolina, Depaftment of Environmental Qualit)'
and the Coastal Resources on in an ofenvironmental concern pursuant to l5A NCAC
N9 77354 D
Previous permit #-
es attached
Applicant Name
Address
ci
Phone #
Authorized Agent
4
o')(-/(
E-Mail
't-1/\Proiect Location: County
Street Address/ State Road/ Lot-#
Q,r/,q
G)
t, ()(,f3 CiztP
t<^
SubdiYision
r(>.\F."
River astnft cwAffected
AEC(s): ! oEA'' l1 Pws:
W iyra rEs
I]HHF lIH N UBA
L] PTS
tr N/A
PNA yes
Adi. Wtr.
Closest Maj. Wtr. Body
n
ft LtA n-,
Phone # ( )(unkn
ORW: yes
{{r
Agent or Applicant Priflted Name
SiSn c
read compliance statement on back of permit **
0fttab
)c
Type of Proiect/ Activity
(Scale:)
Pier (dock) lenSth --l ffi
Fixed Pladorm(s)
-
l-4c/ r" -t ffiFloating Platform(s)HFinger pier(s
Groin length -F*-, . i I-- 1 i--
---lt,i l::-f--r.+ ;
P
i-t ....-i--_+....+...+_.-.-+....l.4-
i{&,fiBUlengthL''r -tlt
(.)
max distance offshore II
_1
I
----.1----r----+i-+-F+-f-ltr-ffiBasin, channel
cubic yards
Boat ramp
Boathousd Boatlift
i I
B€ach Bulldozing _
Other FI+
H
rL,,tr
I
A building permit may be .equired by:
( Note Local Planning lurisdiction)
Ot'L.l
7,,
note on regardinS River Basin rules.
Conditions K rf h l( rj
(c a
a
(
s)Check#lssuingDate
7-
irat
c
Date
^B@
Date preYious permit
no
9r riD U2
,nor"t***] F
SAV: not sure nt A
Moratorium: ntz ,* WPhotos: y., 0WaiverAttached: y., e
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
nulland void.
This Permit must be on the project site and accessible to the permit officerwhen the proiect is inspected for compliance. The
applicant certifies bysigningthis permitthat l) priorto undenaking any activities authorized bythis 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, cenify that this proiect is consistent with the North Carolina Coastal Management Program.
River Basin RulesApplicable To Your Project:
fl Tar - PamlicoRiver Basin Buffer Rules
] Neuse River Basin Buffer Rules
] other:
lf indicated on front of permit, your proiect is subject to the Environmental Management Commission's Buffer Rules for the
fuver 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 (9 l0-795-72 I 5) for more information on how to comply with these buffer rules.
Division of Coastal Management Of,ices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
2s2-808-2808/ | -888-4RCOAST
Fax: [phone]
(Serves: Carteret, 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, Pasquoank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax:252-948-M78
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
I 27 Cardinal Drive Ext.
Wilmington, NC 28405-3845
9to-796-7215
Fax: 9 I 0-395-3964
(Serves: Brunswick, New Hanover,
Onslow - South of New River lnlet-
and Pender Counties)
http://portal.ncdenr.orSlweb/cm/dcm-home
Revised 7/06/ l7
Name of Property Owner Requesting permit:.kt Vrrr.p
Mailing Address:
)
Phone Number:
Emall Addres:
I certify that I have authorized
-70 -{t-7 3q\
ffl . N€f
Agent /ctor
to act on my behalf, for the purpose of apptying for and obtainlng all CAMA p€rmits
necessary for the following propo.sed dovelopment:
at my pro perty located at s)0
uI k?.,>County.
m ,th a 6 tLe ,1
Print or Type Name
t\e)-
Ti e
r furrhermore cedrfu that r am 2.Ltthsri2s, to grant, and do in fact grant permrssion toDivision of coastar Manaoement staff, the L"&t;;;;;;rlJr ano tneir aganrs ,o onrer
1ZX"r :W;:::ned t6nds tn *nie,iii iiti Ziiiliiii" nr*^ation ietated to this
Proporty Owner lnforma on:
\
eztfigt_ao
This c€rttflcation is vafA Urougn d t 3 f t bZl
tn
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to l(t l,AceJ
property ,ocated at b I,te 3
(N ame of Property Owner)
ACkS6e^J
(Add , Lot,Iock, Roa c.on A/11 lJ
s
!ln A
)\
c N.C.(Wate odv)(ci ty/Town and/or County)
Tho applicarlt
tocap.,.-'lias dsscribed to me, as shown below, the development proposed at the above
I havo no obiection to this proposal.
I have obj€ctions to this proposal.
DESCRIPTION AND/O R DRAWNG OF PROPOSED DEVELOPMENT(lndividuat proposing dovelopment mist fi in descrtpfion below ot attach a site drcwing)
S ee ,< ktbl
WAIVER SECTIONI understand that a pier, dock, moori ng pilings,boat ramp, breakwater , boathouse, lifl, or groinmust be set back a nimum distan ce of 15'from my area of riparian access unloss waived b vme. (lf you wi waive the setback, you must initial the appropriate blank below.)
I do wish to waive the ls,setback requirement.
=-..-_ I do not wish to waive the ls,setback requirement
(P OwnEr lnformation)cent P Owner lnformation)
k, Vn-,,Signalll
Ptint or Name e
(
0 /rZ I al.Print or Typo N,ame
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Mailing
PA /P tt
Telephone Numbei / email addresso- Lfl- 774
r7/
Telephone Number / email addrass
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City/Stale/Zip
Date
'Valid for one calendar year after signature*
Datea ?L?
(Revised Aug.2O14)
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lha
doscribed to me, as shown below, the development proposed at the above
ve no objection to this proposal.
I have objections to thls proposal.
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DESCRIPTION AND/OR
(l n d ividuat propos i n g developm ent
DRAWING OF PROPOSED DEVELOPMENT
must lill ln desc ptlon below or ettach a site drawing)
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WAIVER SECTION
I understand that a pier, dock, moori ng pilings, boat ramp, breakwater, boathouse , tift, or groinmust be set back a minimum distan ce of 15' from my area of riparian access unless wai ved byme. (lf you h to waive the setb ack, you must initial the appropriate blank below.)
I do wish to waiv6 th€ 18, setback roquirement.
I do not wish to waive the 15' setback requirement.
(Prope r lnfofmatioR) -tP Owner formationa
s
or
3fi
Telephone / omail address
ke
Print or
L"
C
Telephon e Number / email address
Date
.Valid for one calandar year aftor signature*
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(Revised Aug. 2014)
ADJACENT RIPARIAN PRO.PERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
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