Powell, Cynthia 76654C

/ DBEDGE & FILL
GENERAL P ERMIT
y nModilication EComplete Reissue DPanial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an areapf environmental concern pu 6uant to l5A NCAC
N9 76654 AB
Previous permit #
Date previous permit issued_
CD
2il2'
I Rules attached.
Appl icant Name Project Location: Counry __
Street Address/ State Road/ Lot #(s)
Subdivision
City
Phone # ( )
Address
City State ztP
Phone#(--._)
Authorized Agent
Affected lcw
AEC(s): ! oEA' fl PWS:
ORW: yes / no
ztP
lEw
I HHF
., PTA
itH
! PTS
N N/A
River Basin
Adi. Wtr.(nat /man /unkn)
Closest Maj. Wtr. BodyPNA yes / no
)C
(Scale: )
Type of Proiecv Aqtivity ,
Pier (dock) len$h
Fixed Platforrn(s)
FloatinS Platform(s)
FinSer pier(s)
Groin length
Bulkhead/ Riprap length
avt distance oflshore f
max distence o&hore/
Basin, channel
cubic fards_
Bot nmp ......---
Boarhouse/ Boatlift
Bcach Bulldozint_
Odpr
Shoreline Length
SAV not sure y6 no
$
il
-
rl
l-!ltI_#
See note on back reSardinS River Basin rules.
J
Mor.torium:
Photos:
A building permit may be required by:
( Note Local Planning Jurisdiction)
ffi
I r_L lffil
Agent or Applicant Printed Narne
Signatr,re * Please read compliance statementon backofpermit**
*'.n-*"rfilffi"ry_
Application Fee(s)Check #
\___-
E-Mail
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Notcd SpGGial Gnditionr ,( .l l'i ' ." ' ' -v -'{
Signature
l**8 D"," frpi.atOn OE
Statement of Compliance and Consistency
This permit is subiect to compliance with this application, site drawint 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 permit to become
nulland void.
This permit must be on the proiect site and accessibletothe permit oflicer when the proiect is inspected for compliance. The
applicant certifies bysigningthis permit that l) prior to under6king 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 written statement or certified mail return receipt has been obtained from the adiacent riparian
landowner(s) .
The State of North Carolina and the Division of Coasal Management, in issuing this permit under the best available
information and beliel certirythatthis project is consistentwith the North CarolinaCoastal Management Program.
- ] Neuse River Basin Buffer Rules
lf indicated on front of permit, your proiect is subiect to the En\/ironmental 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 Oivision of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington RegionalOflice (910-796-7215) for more information on howtocomplywith these buffer rules.
Division of Coastal Management Oflices
River Basin Rules Applicable To Your Proiect:
Tar - Pamlico River Basin Buffer Rules
Morehead Citrr Headquarters
400 Commerce Ave
Morehead Clty, NC 28557
2s2-808-2808i r -888-4RCOAST
Fax: [phone]
(Sewes: Carteret, Craven, Onslow -
Nonh of New River lnlet- and Pamlico
Counties)
Elizabeth City District
401 S. Grifiin St.
Ste. 300
Elizabeth City, NC 27909
252-26,4-390t
Fax:[phone]
(Serves: Carnden, Chowan, Currituck,
Dare, Gates, Pasquoank and Perquimans
Counties)
[] oth".,
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-U8t
Fax:[phone]
(Serves: Beaufoft, Bertie, Hertford, Hyde,
Tyrrell ahd Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-721s
Fax: 9 l0-395-3964
(Serves: Brunswick, New Hanover,
Onslow - South of New River lnlet-
and Pender Counties)
http://portal.ncdenr.orglweb/cm/dcm-home
Revised 7/06/ I 7
AGENT A FOR CAMA PERMIT A
Name of Property Owner Requesting Permit:
124 ?..-L. ?or Bt,J.
L".L..P-,^-[ Al( zt<<
Phone Number:9to-z 40- 4z nE1
Email Address:
I certify that I have authorized l^1",. / P.L (o\-,
TION
4
rl ()
Ag€nt / Conracbr
to act on my behall for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
&",- L'"^J I'Lz\+br,^+ l-,orq L
at my property located at lzq Crl"-. P,,J t),. At t- zg1gLl .
tn l,A.r-+County
I fufthermore ceftify that I am authoized to gnnt, and do in fact gnnt permission to
Division of Coastal Management staff, the Local Permit Oficer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Prcpeily Oumer lnformation:
Signature
Pint or TyW Name
0u
Ti e
sJ-A)zn-u)-
Date
This certification is valid through I I
Mailing Address:
l
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certity that I own property adjacent to S
property rocat€dat rc\ ed"* P"t^{ BIJ
(Name of ProoertY Ownerl'C-Ai P"r"'lite z-&g4
(Address,Lof, Bloch &oad, etc.)A.* \'atn*on n , N.C.
(Waterbody)(Clty/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
(ln{widual propodng Mqmurt must fill in d€s,uip on below or al,,,ch a site dnwlng)
ln4o.r*"L\
q 9)t
I do wish to waive the 15' setback requirement.
Pro perty Owner lnformation!(Adiacent Pro
Si
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lz-Ll
Tvoe Ndme't'A-r P;A El,o\
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te'
0J* ?"*}$l,t{o',lU d.P,'^* Bl'al
WAIVEREECNOil
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. (lf you wish to waive the selback, you must inltal the appropriate blank below.)
?,P-
or Print or
J.Lg
Mailing
Twe
/qddr9ss
City6ta@.ip
Telephone Number / email a&lE,ssElztlzozt)Tdephone Numbor / email addrcss5-zz- vlzo
h+
2tIn I
It}-
I
Date
1/alid fur one calendar year after signature"
(Rev,s€d Aug. 2011)
in
_ I do not wish to waive the 15' setback requirement.
i
Citu/State/ZiD'qth- i4o- L.tzog
I
I
Date'
ADJACENT RIPARIAN PROPERW OWNER STATEMENT
I hereby certify that I own property adjacent to
rcq Por,^.{BIJ ([amp or
( ob{
s
e c)property located at
on I.,\..."r*L\ r:^1,.L* Bloclq
Lotf
Load,
\)nl.t
stc.)+N.C.
(AddrBss,
t-ter../ , in@ (cttytrownandrorcounty)
licant has described to me, as shown below, the development proposed at the aboveThe app
|ocEyrt.
I have no objec{ion to this proposal.
I have objec{ions to this proposal.
DESCRIPTION AND'OR DRAWNG OF PROPOSED DEVELOPMENT
Qndrvlduat popostng devdopmant mustfrll in decrip on bdow or atuch a site dnwlng)
l^{"r.r""L\
q 91t
I
loz'
t
tg'
0J," ?o"IsuHo''lU d..P''^-t g"al
wAtvERsEcTloll
I understand that a pier, doc( mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15'trom my arBa of dparisn access unless waived by
me. (lf you wish to waive the setback, you must lnltlal the appropriate blank below.)
I do wish to waive the 15' s€tback requirement.
_ | do not wish to waive the '15' setback requirement.
b+ f!.r.,
2tII I
(Prop€rty Owner lnformafion)
ILLI
Tvoe Name
i.-J-.- P"r^{ tgtJ
(Adlacent Property Owner lnfomation)
\l
Pdnt ot Twe Name/z
PY
F AR (4il/T FAuo? ./-or
Citu/State/ZiD'Ato-
=,1o-
Ll"JJg
Telephone Number / email a&re$slzt lzozt)
<.n)2*Xffp,t Atul@ trc,RA
feFrpt:rlne tlundeil ei;ilEdfltess
A 9t-&4
<d4
Dale
ryalid fur one Glendar year after signature'
Date'
(Revi*d Aug. 2014)
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