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Home My WebLink AboutMcCallister, Molly 78895CMCAMA / ❑ DREDGE & FILL O ' ,.. N . 78895 A B ,_ c� GENERAL PERMIT Previous permit# ID (New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC �� / ��'� , -T ' '��• �`< El Rules attached. Applicant Name. / I� i ' �^ f' - f -t Project Location: County �� L Address !;;? , + Street Address/ State Road/ Lot #(s) t City_ `. / State ZIP i Phone # ( ) E-Mail Authorized Agent Affected 'NCW , )JEW —.4PTA �XS ❑PTS AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ WA ❑ PWS: ORW: yes, / no,) PNA (ye'S no Subdivision City ZIP Phone # O River Basin / Adj. Wtr. Body r i' '� t ' - o t` man unkn Closest Maj. Wtr. Body c " M ME 0 EMEMMEM 0 No E MENEM I No �■.■� EMMEMEN IMMEME.. N ME ' MM01■�g■o ®■�M■■■�■f ®■N ■M■ �G_M■E■ ■_■ ■■_g■_MINE%�_ dM■M■■EME d■■■■■■■■■■■■■■=■uii■■■■0=■■■� N■■■�� ■■ ■■■ mmmmi® N■■■■■■■■■��■■■■■■■■■■■■■■■■■ ■MNESSIM! A■■NONE N■■■■■■E� ■■!r iuii7■■■■ I ■■■■■■■■■■■ ■■I■■N■� •EC ONE N :■ME OE E•■MN ■■■NME MEMO■ ■ M. _■■■■NN N Niiiii� ■ii�``■■ ESSEN : OM►��I�� M'■'■'■'■ME No M MEN .�■■..■MO�SEE .. M■M■�■ ®M■■MMiMM.NaM.......a ■■■. .■N■®l MMEMO■■®■ ..■■■ ■■� M....1 NNW� ME INN M ONESMENEM ME Printed Name Signdfure **Please h compliance statement on back of permit'* 1�'o,1, Application Fee(s) Check # Permit Officers Printed Name / Signature / f !/ — JA/V Issuing Date Expiratl'on Date Statement of Compliance and Consistency This permit is subject 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 null and void. This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The applicant certifies by signing this permit that 1) prior to undertaking any activities authorized by this 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, certify that this project is consistent with the North Carolina Coastal Management Program. River Basin Rules Applicable To Your Project: ❑Tar -Pamlico River Basin Buffer Rules El Other: ❑ Neuse River Basin Buffer Rules If indicated on front of permit, your project is subject 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 Office (252-946-6481) or the Wilmington Regional Office (910-796-7215) for more information on how to complywith these buffer rules. Division of Coastal Management Offices Morehead City Headquarters 400 Commerce Ave Morehead City, NC 28557 252-808-2808/1-888ARCOAST Fax: 252-247-3330 (Serves: Carteret, Craven, Onslow - North of New River Inlet- and Pamlico Counties) Elizabeth City District 401 S. Griffin St. Ste. 300 Elizabeth City, NC 27909 252-264-3901 Fax:252-264-3723 (Serves: Camden, Chowan, Currituck, Dare, Gates, Pasquotank and Perquimans Counties) Washington District 943 Washington Square Mall Washington, NC 27889 252-946-6481 Fax: 252-948-0478 (Serves: Beaufort, Bertie, Hertford, Hyde, Tyrrell and Washington Counties) Wilmington District 127 Cardinal Drive Ext. Wilmington, NC 28405-3845 910-796-7215 Fax:910-395-3964 (Serves: Brunswick, New Hanover, Onslow - South of New River Inlet - and Pender Counties) http://portal.ncdenr.org/web/cm/dcm-home Revised 7/06/17 AG914T AUTHORIZATION FOR CAMA PERMIT eaoLICATION Name of Property Owner Requesting Permit: Mailing Address: 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: I)( v QI P 4 1 � �X )� J ,_F1% Dlrf v—f-em)1/Q �41S�,rvrnioru at in I furthermore certify that I am authorized to grant, and do in fact grant permission to Division of Coastal Management staff, the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information related to this Permit application. Property Owner Irdonnation: lILC.-Q-P-E.,l. 1%c111-f Signature rant or Type Neme Qwr)ff Title Date This certification is valid through ojj('l, bn1 - ADJACENT RIPARI ANPgQpZJJTyOWI4Eg116TEMENT I hereby certify that I own property _adjacent to f�`/ v `J � _'s / �[�� t U ( of N C+ p®rty witer) property located at �N � (Address, Lot, Biock, Ro d, eta on C.0 t Y t'f�_, in )l'lE'�Tic`'irl� C !ntyN.C. (Waterbodv) (City/Tewn and/or C u) The ant has described to me, as shown below, the development proposed at the above I have no objection to this proposal. i have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) Se.e /4�U1Ch CA D11-4 W 1,h9 WAIVER SECTION 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. (If you wish to waive the setback, you must initial the appropriate blank below.) K � L I do wish to waive the 15' setback requirement. 1�1)t I do not wish to waive the 15' setback requirement. (Property Owner information) l�— (Adjacent Property Owner information) `Valid for one calendar year after signature` (Revised Aug. 2o14) ADJACENT RIPAOWNt:R STA uFu/* I hereby certify that I own property adjacent to Property located at (N m of party Qyyiler) (Aaa on Pl l.t l v P P L re In atorbody) N.C. The applicant has described to me, as shown below, the development proposed at the above I have no objection to this proposal. 11 I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must IWI /mdesaHpflon below or attach a site dr MnW I understand that a p(er, dock, moorinWAt ER SE at TlOIjI must be set back a minimum distance of f15' frommyarea ofe riparian access boathouse, wor aivadr by me. ft you wish to waive the setback, you must Initial tha appropriate blank belows I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. -�- (Property Owner llnformation).�- (Adjacent Property w er in�rmatlon) Siggnnggturq '�' / r-. 'Valid for one calendar year after signature' (Revised Aug. 2014)