Lockerman, Gloria 77328C

CAMA/ - OREDGE&FILL
ERAT PERMITf,Ncw EModification fJComplete Reissue lPartial Reissue
As authorir6d by the State of Nonh Carolina, Department of Environmental Quality
and the Coastal Rerurces Commission in an area of environmental concem puEuant to l5A NCAC
Applicant Name _
Prwious permit #_\./_
Date orgrious Dermit issued
//,
BCD
Address
I Rules attached.
Project Location: Counry
Street Address/ State Road/ Lot #(s)
Phone#( _ )E-Mail Subdivision
CityAuthorized Agent
Affected tl clv
AEC(s): ' oEA. , t] PWS:
ORW: yes / no
_ ztP
-EW
- HHF
l+ltA
.tH
! PTS
! nvA
des
! UBA
Phone# ( ) River Basin
Adj. Wtr. Body nat an kn
PNA yes / no Closest Maj. Wtr. Body
)<)
Type of Proiecv Activity a)I
Pier (dock) lentth
Fixed Pladorm(s)
FloatinS Platform(s)
Fing€r pier(s)-,.>*
Fffi_ Erl
__r-T;-r_
HaH)4-"{'.
YW
frfr
.i---l----r-----t-
t#
_l--l-i-!
,f ,+lt-JEk+-*G.oin lenSth _
numb€a
Sulkhead/ Riprap length
av8 distanae offshore
max distance offshore
Basin, channel
cubic fads
Boat ramp
Boathouse/ Soadifi
H
+s
*.-;-
I
Belch Bulldozint_
Other
I
;l
Shoreline LenSth
SAV: not sure yes no
Morinorium:
Photos:
yes no
A buildinS permit may be required by:
( Note Local Planning Jurisdiction)
, See note on back regarding River Basin rules.
Notey Special Conditions _
Permiaoff ic;r'fi inted Nan?
** Please read compliance statement on back of permit **SignatureSitnature
Check#lssuing Date Exiriratidn Date
N9 77328
Cit),State ZIP
(Scale:)
E
l
A$nt or Applicant Printed Name
Application Fee(s)
Staternent of Compliance and Consistency
This permit is subiect to compliance with this application, site drawing and attached general and sPecific conditions. Any
violation of these terms may subiect the permittee to a fine or criminal or civil action; and may cause the Petrnit to become
nulland void.
This permit must be on the proiect site and accessible tothe permit officer when the proiect is insPected forcompliance. The
applicant certilies bysignintthis permitthat l) priorto undertaking any activities authorized bythis Permit, the aPPlicantwill
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a wri$en statement or certilied mail return receipt has been obtained from the adiacent 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, certifythatthis proiect is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Proiect:
Tar - PamlicoRiver Basin Buffer Rules
Neuse RiverBasin Buffer Rules
lf indicated on front of permit, your proiect is subiect to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that fuver 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
Wilmin6on RegionalOffice (9 l0-795-7215) for more information on howto comPlywith these buffer rules.
Division of Coastal Management Ofiices
Morchead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ I -888-4RCOAST
Fax:[phone]
(Serves: Carteret, Craven, Onslow -
North of New River lnlet- and Pamlico
Counties)
Elizabeth Cit!, District
401 S. Griffin St.
Ste. 300
Elizabeth Ciq/, NC 27909
252-264-390t
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquoank and Perquimans
Counties)
E other:
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax:252-948-M78
(Serves: Beaufort. Bertie, Hertford, Hyde,
Tyrell and Washington Counties)
Wilmintton District
127 Cardinal Drive Ex.
Wilminston, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River lnlet-
and Pender Counties)
http://portal.ncdenr.orglweb/crn/dcm- home
Revised 7/06/ l7
AGENT AUT HORIZAT ION FOR CA MA PERMIT APPL ONICATI
0-Lp <k rrno^-.
Name of Property Owner Requesting permit:
Mailing Address:
Phone Number:
Email Address: i\)
I certify that I have authorized
Agen t / Contractor
to act on my beharf, for the purpose of apprying for and obtaining ail CAMA permits
lo el^*A I
*
U,1 e,c-, cr. c_q1^-
necessary for the following proposed development:
at property located at
Coun ty
Signature
l_furthermore certity that t am authoized to grant, and do in fact grant permission toolyriylon or coastat Management starr, the Loiar permit orricer and iniii'"itiiiii iia,on the aforementioned rands in connection with evatuating intor*a,tiir-ft=aiii-ti'inispermit application.
Property Ou,ner lnformation :
&,L
I
tn
1i*tro
Pint or Type Name
ntb
-JL1-9-r--u.^.Date
This certification is vatid through 2l rc:1&g
)
Qt"
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NC Division of Coastal Management
Hurricane Replacement/Repair Request Form
nL2
Date of Request:
Property Owner Name:
Address of Property:
Telephone Number:
Type of Work:
NOTE:
/Uf F*{,1,", 'L*.J"
a
The Emergency GAMA General Permit 2500 is for repairs and replacement of water-
dependent structures dem€ed because ofa Hurricane. The replaciment, reconstuction
and maintenance excavation activities shall coDform to curreft standards and rules. AII
work under the Emergenry GAMA GP 2500 must be made in the same footprint of the
previous stucture with no additions, exp.nsiotrs, or enlargements.
If any portion of a structure being replaced is within tbe l5' setback of the riparian line or
access area, signatures ofthe adjacent riparian property owner(s) muS be obtained
acknowledging the notification and waiver ofthe setback on the forms provided by
DCM.
Any maintenance excavation or dredghg requires signanues of the adjacent riparian
properly owne(s) on the notification forms provided by DCM.
/nt^^ L*fuSignah.ue G
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COMPLETE THIS SECTION ON DELIVERY
r Complgte items '1, 2, and 3.
I Prirt your name and addrGs on tl|e rever3e xso tlEt we can rcfum lhs card !o you.
r Attach this cald to th€ back of tho
or on ths fort if space
A. SigrEtue
W,
D. b &q'JE y addrc6s (frter€rt irn frrm 1?
lfYES, erltor d6{v€iy ddrEs below:
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9590 9402 ss89 9274 449015
siqmrutB rt€*iclEd [rdivery
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Codrne.t M.! B6uicted tldtvsy
tr Coll&t on D.Ivry
E Agent
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3. SeryireTypc
tr Adult Siignature
z Artide Numb6 (frdasJbr lrcn syic.l,t,aD
701,8 3058 0800 ELr+D 5 alD
PS Form 381 1 , July 20 , 5 psN 7s3&.02-oo0€0so
I 9&'.9 9d'/3I sdtcred 0c6,ry 3 Slgdu! ConfinatbnB
sgn.ti!! codrndofr
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SENDER: coMPrErE THts sEcTtoN
DIVISION OF COASTAL MANAGEMENT
AD.'ACENT RIPARIAN PROPERTY OWNCR HOTIRCITION/WAMER FORM
Name of Properly Owner:
Address of Properq[
LAJ
(Lot or Sfeet#, Sheet orRoad,County)
\genfs Name Mailing Add,or:h
Agents phone #
I hereby certiry that I own prope(y adjacent to the above referenced property. The individualapplying for this permit has described to me as shown on the atached lhe develothey are proposing.
V I have no objectioqs to this ptoposal. _ I lave objectiols tp, &is proposal.
ff you haw oblections to what is being Noposed, you must notifyfieDMston of Wt llaragament(DCtl) ln wrtdng wtotln iO days of tecalpt of thts nfice.Cottes,pondence should be nalled to 4O0CammercrAve.,Moreh*d Clty,NC,28557. DCM rep,resendives can also be conbMat(252)B0&2808, No ,s flte same as no
Owner I
Signature
Ptint otTW Name
o
Mailing Address
it have he€,n CaftIfreclua.
(Adjacent Property Owner lnformdion)
Siganre
c
Print or Type Name
6r \{
tifallng AN,P-ss
l=2n 1,/City/$atelzip
Telephone NumberTelephone Mmber
Lo.A-.
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Rovlsed 6/18D012
c
Name of Property Otrwt€r:
Agenfs Name *E
Agenfs phonE {k
(Lot or SEeet#, Steet or City & County)
Mailing AddEss:
L6-ttL
Address of Propertlr 1 fnL-Lu"J,8",
8t
I C
I hereby certiff that I own property adjacent to lhe above referenced propeily. The individu€lfor this it has to me as shown on the atached devel ent
-- I have no objectious b fhis proposal.
-
r trave objections to, &is proposal.
tyou havo oblef,onsb whdls belngpr!,o*,d,Wu musi titfryfieDiytsron oiCrnstrd Managellient{DCtt) ln wiltng
CommweAve.,
wrdrrn 10 days of t?{f,,pt of thls nodce.Cortlspondencc shoutd be nalldto$A
2808,Irro
,torelre,d Ctty,NC,28557. DCil rep,,eserr,afiv.-s can alst be conf'c{Ed ate.1iz) BOO-Is considared fie sal're :Ls ,r{,objec,tion lfyouhaw Mn Dotified bY @fttfiedMait.
appfyi,.ls
{hey are
lyfoery o.,at ? pier, dodq r""n"n*ffi,1::ffiJ, b*rhouse, lift, or sroin musr be setback a mlnimum distance of ls from miani
"t
rrp",i"iilG. unt"o ,"ived by nre. (lf youwish to.wafuethe se{bad<, you must iaiEat t . "pir.p,i"t" ii*,x uur*,.t
-
I do wish to waive the I s setback r€quirement
.
-
I do not vrish to waive the 15" se&ack requtr€ment
{Propeily Ownor tnf ormaton)(Adjacent P
hint orTwe Nane
7-
Malling 2tr4
WWBtZp
. 2sA* 72{-0*2A
Telephone Nmber
)-sa =zd
)
or Type Name
I u "JAddrBss
CttyEffienp
Telephone Numbei
253r{
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Revised 6tfi812012
' - - - AD.,A'EN' R'pA*ml?[FIf'?f;'I#:Hffi?ff$IN,wArvER FoRm
ar
Y
proposing.
Sigawe
Dd.
qERTIFIED MAIL' RETURN REqEIPT BE@E$T.EII
DIVISION OF COASTAL MANAGEMENT
ADdACEI,IT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER' FORM
thneotPrcpa{os,* e L:",a, Lcj*px.nn o ^,
Addreeeorpropcrtr lL'1 6.1,&- L*Ai,'-
(Lot or Slroot#, Slrsd or Roa
k SJr,-.YVI
C)'t1 -
r
f.. s4- "r*n*,*&--,
,1"{tl
I
CltyE County)
Pt*ttcr
l&*&tgAddoo*
KstAgents Nameft L1/w
Asurre phonc* 25y'.- l>q- tZqa I )tll,#r, . r\ nr..-ryl
tr n
I h.r*y ccrtff that I own pmperty adlm nt to thc above reforenccd property. Tho ln&ddualapffig forthlc pe nnlt has deocrlbod to ms ac rhoum on ths Ettscfiod d nt
they aro proposlng.E l !
trywhan@Io,,x&-t+.i,,drE bclng ;xt2rnrr,d" Wu ltus/ nodfyt}oDtrrhron of Corclllfrrr Wament(*il)k *zfdtgwrt*nfi&W ''dtalo0
Oorrmercr.A vu., tl*Ctrrd W,NC,86el- DCil ryprooe',lffirss can also !e coniac ed a{
260E lVons oncE trg corslderedfrosrtr. sr rro o rdanll utlrve bern nofrlad CsrtilladMatl,
WAIVERSECTION
I undcnhnd &at q $ar, dodc ggolr€ drns, braaloraier, boathouse, llfr, or groln must b8 sot
back a nftlrnum dhtanco ol 15, fo{n .ln!r_ap.a of rlperlan a..cam urtoGi} ulah/tfi uv *r, tn r.uwirh to.unhro lhc actbac&, you mwt hidel the appropriatra blarft bobur.)
-..-'.._ I do udefi to unhp lho {$ ro.back mqulornorrt
--
I do not u,tsh b vralve thc t R !6eck roqulranent
x (F aport!' qxner lnformrilon)* (eOn*ntFroperty Orflnorlniorma0on)
t
Slgrarrr;
ffi*orfpl
rt Cl",*J*Sd*-+
l&SngAddrccr
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_ I havc no objcctis[B to rhfu proposal _ I lrvc objecdms to tis 1nopos8l.
{252)808-
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