Hankley, Allyson 80022C

tsCAMA / f] DREDGE I FILL
ENER/AL PERMIT
6tt"- trModifiaion nComplete Reissue EPanial Reissue
As authorized by the State of Nor6 Carolina, DeparfiEnt of ErlvironmenEl Quatity
and the Coasal ResourE€s Commlssirn in an arca ofenvironrnental conoern Frn ram
Applicam
Address
Name H^
irle,-, B €dn sa"-il{-z &
N9 80022 AB I D
PrEvious petrmit #
Dde previous Frmit issued_
to tsA NCAC e a o
Proiect Loaion:
Street Addresy Sate Road/ tot #(s)
-!-.+1jA
SubdMsion
AP
Phone # (_)River Basin ezie
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enone* tri-ail E-Mall
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Audorized Agent
Afiected lcw
AEC(s): tr oEA
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Adi. Wtr.
ORIY: . yes PNA yes Clos€st M4. Wt Body
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Type of ProjecU Activity 'to
(Scalc:/i /o')
Prer (dock) le4dt
Fixed Phtfom(s)
Flodirg Pwdm(s)
Fing.. ple(s
Goin bEdt
l6.rtdt
dii:nca ofrtlor€
mo( diirarrcc oftho.r
8asin, chaxrd
cutic fards /
B@ ramp
Bodrousr/ Bodft
Beadt Eulldozing
Odrer
StErClne LerEdr
SAv: not sune
lYo.'dorium: da
Phot6:
Wai\c. Afia.hed:
yes
)'Gs
yes
F
E See note on tact< ESardinS Riwr Basin rules.A building permit nny be requirEd bt
( Note Local Planning Jurisdiction -IQ ltl,lot ./condi6or \r o
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Applkzrrt Printed PG.mhOffis
permit
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Sitnerre /
4h/./t s/7/at,2
Appt<don Fe.(s)
g sErtcfiEnton of
Ch€(k#l*lifffi 66D6
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StaernentdC.omptiance anO Gnsistenq
This permit is subiect to compliance wi6 this applicdbn, site drawing and atached general and specific conditions. Any
violation of these terms may subiect the permittee to a fine or criminal or cMl action; and may cause the permit to korne
nullandvoid.
This permit must be on the proiect she and accessible to the permit officerwhen the Fopct is inspected for compliance. The
applicant certifies by signing this permit that I ) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to conlirm that this proie€t is consistent with the local land use plan and dl local
ordinances, and 2) a writ@n stfement or certified mail return receipt has been obtained from the adiacerrt riparian
landowner(s) .
The Stare of North Carolina and the DMsion of Coastal Managemem, in issuing this permit under the best available
information and belief, ceftit that this proiect is consistent with the North Carolina Coasal Manatement Program.
Rirer Barin Rrdcc Applicable To Your Proiecc
Tar - Pamlico River Basin Buffer Rules
Neuse Riner Basin Buffer Rules
lf indicated on front of permit, your proiect is subiect to the Erwironmenal Managemem Commission's Buffer Rules for the
Rlver Basin checked abo\re due to hs location within that River Basin. These bufrer rules are enforced by the NC DMsion of
Water Resources. Contact the DMsion of Water Resources at the Washin4on Regional Oflice (252-9t16{481) or the
Wilmington Regional Office (9 I 0-796-72 I 5) for more information on how to comply with these bufrer rules.
Dhbion of Gastal Managemcnt Ofic-"
Morchead City Hcadquarten
4(X) Commerce Ave
Morehead City, NC 28557
252408-2808/ r -&RCOAST
Fax: [phone]
(Seru: Carteret, Crren, Onslow -
l.101th of New River lnl€t- and Pamlko
Counties)
ElLabeth Cit, District
401 S. Grifiin St.
Ste. 300
Elizabeth City, NC 27909
252-2&4-390t
Faxl:252-2&4-3723
(Se.!€s: Camden, Chowan, Currituck
Dar€, Ge1 Pcguotank and Perquimarc
Cound€s)
E other:
Washlngton District
943 Washin6on Square Mall
Washington, NC 27889
252-91$4481
Faxl.252-948-04.78
(Serrc: Beauforr Berde, Herdo.d, Ft/de,
tr/rrsll and WashinSton Coun6€s)
Wilmington District
I 27 Cardinal Drive Ext.
Wlmingon, NC 28,105-3845
9to-796-7215
Fax [phone]
(Servee: Brunswlclq Nsrv Hanover,
Onslortr - Sonth of New River lnlet-
and Pender Counti€s)
lmp'//poral,ncdenr.orgAret/cnVdcm-home
FE|/,!ErtzioutT
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NCDENR
North Carolina Department of Environment and Natural Resources
Beverry Eaves perdue, covernor
Divisionof co:"t:iflil;39:lt"
Dee Freeman, secretary
Date l'- t\-a(
Name of Property Owner Applying for Permit:
N 4^Jt<LE
Mailing Address:
toq 5l-+.oA.tr \/tF DR
Ben-,.J
I certify that I have authorized (agent)to act on mv
behalf, for the purpose of applying for and obtaining all CAMA permits necessary to
,,.rs{aLC L I oinstall or construct (activity)
at (my property located at)loq s o-€Vr€W-bR.NEr^:B&-p ruc-
This certification is valid thru (date)
LL
Property er Signature
/,
Date
pr'on", zsz-133-i3&1'I;iX!5ils!.J[Tfl 3ly;i.ffi::Hx,1fi:lasement net
An Equal opponunity \ Affrmalive Action Employer - 50% Recyded \ 1o% post consumer paper
dotlmo 3i.netur. v.n6.,rion:'JAr2Vt1 Richard Gaylod Homss Mal - Forms
ADJACET'T RFARIAX PROPERTY OU'NER STATEIENT
, hn€btoi{y llld t dr Elp.rty a.tE* b ?vG Ex ,n Erlfi5 tl 's
Ownor)Pro9sly l.{Et€d al
on S
It aEu tC DR f 5
(AddrEr, Lot, Block, Ro.d,etc.)
Q-B{.lLr R-
ln N-C(w'brDody)andror County)
Tha appforf ,ra3 .r@lbod b flE, 6s stEwn b€lou, thE d€vdormerlt prcpGsd at ttle above,octdo.!.
I havG rp oqlcdofl ao thlE pmpcal.
I hsr6 olr.cdoE b frtr p{opcsal.
O€SCRIPrlOll A'ID'OR OF PROPOSED DEVELOP EI'T
descrrpUon balow or al,ach a sita dG(lndlulclaa, prwosbrg DRAYVT{G
must fr ln wtog)
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FBr+0lg6 vl e o)
vi"y t tr.l kheaA
ER\CEk cREErA t+Ae8ara
breakwater,boatlpr:se, lift, or grdn
ot ripari{rn ac@ss unless waived byppropriate bhnk below.)
I\JJ?<t:t
E(t*a.
WATVER SECNOila pEr, ooct(.mooring pilings, boat ramp,a mm,mum dtstance of 15, fiom my area
u.aive the setback, you musl initial the a
I unders{and that
must be set bad(
me. (rf you wis,h to
I do wish to waive the 15, setback requirement
to waive the 15' setback requirement
)
l/0 SignaWel
6\ry D k.LE
Pdnt or Narne
Mailing Addoss
Clty/$at&tp
Talophone Numbr / emal address
Dote Daler
(Revrsed Aug. 2012
<)Ia\lfi
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not
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I hereby certify that
property located at
I own L ON ,KLE
(Name of Property Owner)
,s
l0 DA, L oT 9.5 SnLuttArEA 4AA BOuA
(Address,Lot Block, Road, etc.)
on Srices CLEEq- ll*M)p-,tn
(city own 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
(lndividual proposing development must fill in d*cription below or attach a site drawing)
5t1o R-f, v't El,bP-
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WAIVER SECTIOI{
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lifl, or groin
must be set back a minimum distance of 15'from my area of riparian accqss unless waived 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.
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Adjacent Ow(lnformation)ner
Signature
Attv-gr'l fl4rt/kLitt
iriil1irvpe uarnetlame
Mailing Addrcss
Telephone Number / email address Telephone Number / email addressa- -l-10:t
Print or TygeInf 5t Name
v-) L
-t a
Dale
*Valid for one calendar year after signature'
(Revised Aug. 2014)
ADJACENT RIPARIAN PROPERW OWNER STATEMENT
adjacent to
N.C.
(Waterbody)
vi ty I BitLt<ft€AD +
(Property Owner lnformation)
City/State/Zip
Dqte*