Wasley, Crystal 77305C

. CAMA / DREDGE & FILL
GENERAL PERMIT'New Modification Complete Rerssue Panral Reissue
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resolrrces Commission in an area of environmental concern pursuant to l5A NCAC
Applicant Name
Address
B D
Previous permit #
Date previous permit issued_
' Rules attached
Project Loetion: County
Street Address/ State Road/ Lot #(s)
Phone # (_)E-Mail Subdivision
Authorized Agent
-, cw EwAltected
AEC(s): ! oEA f- HHF
' ' PI,YS:
City_ztP
I PTA
IH
ES
] UBA
PTS
N/A
Phone # ( )River Basin
Adj. Wtr. B
Closest Mai. Wtr. Body
-
_(na! /man /unkn)
ORW: yes / no PNA yes / no
)<>
Type of Proiect/ Activity
(Scale:)
Pier (dock) length
Fixed Platform(s)
Floatin8 Platform(s) -
Finger pier(s)
Groin length _
humber
Bulkhead/ Rjprap len8th
avg distance offshore
max distance offshore
Basin. channel
-l#t+++t++-rEt
lfrtq-l I
cubic Frds
Boat ramp
Boathous€/ Boatlift
t
I
1l
i-a #-----+-
11 IBeach Bulldozint
Other --+w"r
T
Shorelan€ Length
SAV: not sure
Moratorium: nle
Photos:I-t _1
A building permit may be required by:
( Note Local PlanninS Jurisdiction)
E See note on back rega.ding River Basin rules.
Notes/ Special conditions
AEent or Applicant Pnnted Name
Signature **Fleas;6ad compli",,... "t t"."nton U".n of permit **
PermitOffi cer's Printed Name
Si8nature
Applicataon Fee(s)Check #lssuingDle Expiration Date
N9 77305
City State ZIP
H
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Statement of Compliance and Consistency
This permit is subject to compliance with this +plication, 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 perrnit to become
nulland void.
This permit must be on the project site and accessible to the permit oflicer when the proiect is inspected for compliance. The
applicant certifies by signingthis permit that l) prior to undertakingany activities authorized by this permit, the +Plicantwill
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 \rvritten statement or cenified mail return receipt has been obtained from the adiacent riParian
landowner(s) .
The State of Nonh Carolina and the Division of Coastal Management, in issuint this Permit under the best available
information and belief, certirythatthis proiect is consistent with the North Carolina Coastal Management Program.
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 River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Oflice (252-946-6481) or the
Wilmington RegionalOffice (910-796-7215) for more information on howto complywith these buffer rules.
Division of Coastal Management Ofiices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ | -8884RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
Nonh of New River Inlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
2s2-264-3901
Fax:252-2&4-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
E other:
Washington District
943 Washington Square Ma.ll
Washington, NC 27889
252-946-6481
Fax:252-948-O478
(Serves: Beaufon, Bertie, Hertfo.d, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
9to-796-7215
Fax: 9l 0-395-3964
(Sewes: Brunswick, New Hanover,
Onslow - South of New River lnlet-
and Pender Counties)
Revised 7/06/ I 7
River Basin Rules Applicable To Your Proiect:
-
Tar- Pamlico River Basin Buffer Rules
- ] Neuse River Basin Buffer Rules
hnp://ponal.ncdenr.odweb/cm/dcm-home
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Ptoperty Owner Requesting Permit t
Phone Number:
Email Address:
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:\ e$-
l^f1trtherm9r9 certify that I am authoized to grant, and do in fact grant permission to
Division of coastal Management staff, the LoCal permit offrcer and iheir agents to enter
on the aforementioned lands in connection with evalualing information ielated to thispermit application.
Propefi Owner lnformation:
at my property located at
rn \q \*County.
Signature
\:
Pint or Type Narne
Title
5,p,-Saa
This certification is valid through
Mailing Address:
F.)
CERTIFI ED MAIL. RET URN REC EIPT REO UESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERry OWNER NOTIFICATIONMAIVER FORM't
Name of Property Owner:sfAL- l,l)AStf 't
Address of Property u Et t
(Lot or Street #, Street or Road, City & County)
-sE\-t)s\\"
I hereby certify that I own property a djacent to the above referenced property. The individu al
ntapplying for this permit has described to me as shown on the attache d drawi the devel methey are proposing.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boalhouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waivei by me. (lf you
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
{I do not wish to waive the 15' setback requirement,
(Property Owner lnformation)(Adjacent Property Owner lnformation)
Signature Signature
Ke(f
rint or Typo Name Print or Type Name
tcE li-tr.r.t: 11>)a
Mailing Addr$s
Gluoc-";k. Nr- .)t S.rk
Crty/State/ZtpCity/StateZ.ip
)( q)&
Telephone Number
5-}1 - zb
/c' A .,,r /42-
Mailing Addr$s
('€?r tJc r
?z'r - 7<" r,i
Telephone Number
lJ 2-.)
Date Date
Revised 6/182.012
Agent's Name #:
Agent's phone #:
Nltaiting nod ress: FR \$,f,N.. \A...-
\\..:\$\s\rsrr
:( I have no objections to this proposal.
--
I have objections to this proposal.
lf you have obiections to what is being proposed, you must notifythe Division of Coastat Management(!CM) in writing within 10 days of receipi of thii notice. Correspondence shoutd be mailei to 4oocomm.erce Ave., Morehead city, Nc, 2|ss7. DcM representatives can also be contacted at (2s2) oog-
?808' No response is considered the same as no obje ction if vouhave been notified bv Ceiiti"i uait.
A',i-t/l)J*.,t^
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CERTI FI ED MAIL. RETU RECE REQUES TED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Owner:L /t .,( I
Address of Property l_,i c-( -)ys4(Lot or Street #, Street or Road, City I County)
Agent s Name #
Agent's phone #'T\E -
I hereby certify that I own prope rty adjacent to the above referenced property. The individuatapplying for this it has described to me as shown on lhe a ttached dra develo mentthey are proposing.
\ t have no objections to this proposal. _ I have objections to this proposal.
lf you have objections to what is being proposed, you must notify the Division ot Coastal Management(DCM)in writlng within 10 days of receipt ot this notice. Correspondence should be mailed to 400Commerce Ave., Morehead CW,NC,28557. DCM representatjyes can arso b€ co ntacted al [phone]. No responsa is considered the same as no obiection if youhave been notified by Cettified Mait.
I understan.j th3r a pier. dock, ,r"r,rrnYfl'r::o.t*I'"T, oo.*or"., rin, or sroin musr be setback a minimum distance of 15' from my area of riparian access unless waivei by me. (rf 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
\erope.ty owner lnformation)
.l t*Li,^
(Adjacent Property Owner lnformation)
Robby L. Taylor
Print ot Type Name
1701 vJest 5th street
Mailing Address
washington, Nc 27889
City/State,Zp
2 52-62 3- 5300
Telephone Number
6/Ls/2020
Sig"a ture
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Print or Type Name
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Mailing Address
f*i,'i ,/v'(' .f,
City/State/Zip
2<r5 1/a)
Telephone Number
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Drte
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Ddle
Revised 6/1gnfi 2
Mailing Address:\as<$L*,s*"-
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