Pajerski, Alicia 80047C

BCAMA/IDREDGE&FILL
GENERAL PERMIT
DNlew EModification EComplete Reissue lPartial Reissue
As authorized by the State of Norch Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to l5A NCAC
Applicant
Address
N980047 A B c D
Previous permit #_
Date previous permit issued_
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
State ZIP
Phone # (-)-e-mait
Authorized Agent Ciq/ztP
Affected tr cw trEw n PTA
AEC(s): to* fHHF tlH
L] PWS:
oRW: yes / no
-rp4
^.
/ no
flES
tr UBA
tr PTS
trN/A
Phone # (-)- River Basin
Adl. Wtr
Closest Maj. Wtr. Body
/man /unkn)
)C
(Scale:)
Pier (dock) len4h
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)_1__
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore_
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift _
Beach Bulldozing
Other
Shoreline Lengh
SAV: not sure
Moratorium: nla
Photos:
Waiver Attached:
A building permit may be required by' .
( Note Local Planning Jurisdiction)
E S". note on back reg'arding Rivcr Basin rules,
ycs {}
yes Ino/)-(yes gd
FE no
Notes/ Special Conditions ,\tn u lli
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Signature ** Please read compliance statement on back of permit **
PermitOfficer's Printed Name
Signature
6
Application Fee(s)Check #lssuing Date Expiration Date
I Rules attached.
Type of ProiecU Activity
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Agent or Applicant Printed Name
C^.r)<)-')
Statement 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 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 proiect site and accessible tothe permit officer when the prolect is inspected forcompliance. The
applicant certifies by signing this permit that l) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to conlirm that this proiect 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 Nonh Carolina and the Division of Coastal Manatement, 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 RulesApplicable To Your Proiect:
' Tar - PamlicoRiver Basin Buffer Rules ] Oah".,-
L ] Neuse River Basin Buffer Rules
lf indicated on front of permit, your project 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 Office (252-946-6481) or the
Wilmington Regional Office (9 I 0-796-72 | 5) for more information on howto comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ | -888-4RCOAST
Fax: [phone]
(Serves: Caneret, Craven, Onslow -
Nonh of New River lnlet- and Pamlico
Counties)
Elizabeth CitY District
401 S. Griffin St.
Ste.300
Elizabeth City, NC 27909
252-264-3901
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax:757-948-M78
(Serves: Beaufon, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmin6on, NC 28405-3845
9t0-796-72t5
Fax: 9 I 0-395-3954
(Server: Brunswick, New Hanover,
Onslow - South of New River lnlet-
and Pender Counties)
http://ponal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ I 7
Applicant
Address
Name
TCAMA / t] DREDGE & FILL
ENER/AL PERMIT
INew EModification EComplete Reissue EPartial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant
N9 80047 ABCD
Previous permit #
Date previous permit issued
to l5A NCAC
E Rules attached.
Prolect Location: County_
Street Address/ State Road/ Lot #(s)
c ztP
Phone # (_)River Basin
Adj. Wtr.(nat /man /unkn)
Closest Mal. Wtr. Body
State' ZIP
Phone # (_)
Authorized Agent
E-Mail
Affected
AEC(s):
trcw
tr OEA
tr PWS:
u Elv
N HHF
tr PTA
LIH
trES
tr UBA
!PTS
trltVA
ORW: yes / no PNA yes / no
Type of ProiecU Activity
(Scale:)
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)_
Groin length
number
Bulkhead/ Riprap length
avg distance offshore_
max distance offshore_
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Leneth
SAV: not sure yes ho
Moratorium:
Photos:
WaiverAtached:
nla yes no
yes no
yes no
A building permit may be required by: ' ' , tr See note on back rcgarding Riwr Basin nrhs.
( Note
Notes/
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Agent or Applicant Printed Name
Signature ** Please readcompliance statement on back of permit **
PermitOfllcer's Printed Name
Signature
Application Fee(s)Check#lssuing Date Expiration Date
+-l-
River Basin Rules rApplicable To Your Project:
Tar- PamlicoRiver Basin Buffer Rules
Neuse River Basin Buffer Rules
lf indicated on front of permit, your proiect is subiect to the Environmental ManaSement 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 (252-945-5481) or the
Wilmington RegionalOffice (910-796-7215) for more information on howto complywith these buffer rules.
Division of Coastal Management Of,ices
Morehead City Headquarterc
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ | -888-4RCOAST
Fax: [phone]
(Serves: Caneret, Craven, Onslow -
North of New River lnlet- and Pamlico
Counties)
Elizabeth Citv Dist?ict
401 S. Griffin St.
Ste.300
Elizabeth City, NC 27909
252-264-390t
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
E oth..,
Washintton District
943 Washingon Square Mall
Washington, NC 27889
2s2-946-6481
Fax:[phone]
(Serves: Beaufon, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
I 27 Cardinal Drive Ext.
Wilmington, NC 28405-3845
9t0-796-7215
Fax: 9 l0-395-3964
(Serves: Brunswick, New Hanover,
Onslow - South of New River lnlet-
and Pender Counties)
hnp://portal.ncdenr.orglweb/cm/dcm- home
Revised 7/06/ I 7
Statement 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 subject the permittee to a fine or criminal or civil action; and may cause the perrnit to become
null and void.
This permit must beon the proiect site and accessible to the permit oflicerwhen the proiect is inspected forcompliance. The
applicant certifies by signing this permit that l) prior to undenaking any activities authorized by this permit, the applicant will
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 written 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 beliel certit that rhis project is consistentwith the North Carolina Coastal Manatement Program.
Name of Property Orner Requesting permit:
Mailing Address:
r
5 (b0
Phone Number:
Email Address:
I ceffry that I have authorized
4 1l)-q-,4rt ila1
J+xl natmy property
h5
(
En eCo
Agent /Contractor
Io(0'
15 5 c ln 1 Je
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to act on my behalf, for the purpose of applying for and obtaining all .AMA permits
necessary for the following proposed development
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I futthermore cettitu that t .1yt a.utltolzX to g,nt, il!
-ct9
in fact grant pemission toDivision of coastar'Mana@ment staff, ne tdat izilit officer and their agents to enter";::i:;"trn;::yedtindsnco,,iiixiiiii,,ru"ti,g-i,,r"iiti",iffiiilatni"
Proporty Osrnor lnsomrtion :
County
1...^,"^bi
Print or Typo
Wtgr
L
Date
Titlezl
This certification is valid through , /
lb' x Aot d o"k {rx el )0"1r,
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I hereby certify that I own property adjacent to
property located at
on
(Na of perty Owher)
(Ad dre6s,Block,etc.
,in
, N.C.(Waterbody)(ci ty/Town and/County)
The applicant has doscrlbed to m e, as shown below, th€ development proposed at the above
I have no objection to this proposal.
I have objecuons to this proposal.
S
f^fi\t r)L
. DESCRIPTION AND/O(lndivlduat proposlng davetopme
R DRAWING OF PROP OSED DEVELOP MENTftt must fi tn d,escription below or attach a stae drrr/lng)
*< 41++.1.J ),'*,-r
WAIVER SECTION
onng pitings, boat ramp,
nce of 15'from my area
cK, you must iniflal the a
I understand that a pier, dock,momust be set back a mlnimum distame.tf
Signa
la 4rlik'
Pin
/05 tor
,,.t4(
./L 74
L13l ap Pti"r t"ie
Teloph one Nu r / emall
breakwater, boatho use, lift, or groinof riparian access unless waived byppropriate btank b elow.)
roperty o lnformati on)
,^'nd
I ttc
wish to waive the sotba
I do wish to waive the 15, setback requirement
ldo not wish to waive the .15,setback requirement
lp (Prope Ow ner lnformatlon) $(Adjacent p
\
t .rQ''.,-S.r.r^,<
Pri ot./o T NemeAcagt .tea Cvt-L
o e .Cs
Va l'.r"'Numbot /omall address
D :Jit_ (tLlF
{Dale
*Valid for one calendar year after signature*
Date*
(Revlsad Aug. 2014)
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certlfy that I own property ad.lacent to
(Na of perty Owher)
property located at
(Addrees,
S
ln
Lot _Block, fload, stc.)sncdd4 l-€rf(/, N.C.
4*j
(Waterbody)(Clty/Townand/g-Coun$
The applicant has descrlbed to me, as shown below, th6 development proposed at th€ above
l@0on.'ryt\
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPT]ON AND/OR DRAWING OF PROPOSED DEVELOPi'ENT
(lndMdual proposlng davelopmeil mast fill Ltdcscrlodon bek w ot allach a st& &arlng)
3r<. A1+,K1-J )f4ob\,\\r
lunderstand that a pier, ro"n, .oor,nffir,breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unlgss waivad by
me. (tf you wish to waivo the s6tbac*, you must lnltlal the appropriate btank below.)
bL,
'tIl
I do wish to waive th€ 15' setback requiremsnt.
_ I do not wish to waive the 15' setback requirament.
;F (Pro Owner lnformatlon) {f (AdIa nt
lq 4tsh'
,lL 14 0
o L73l 7o .rtkie
Telephone / email rhr
or
nlao
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4ra -"T'byo**
'ry'alid for one calendar year after signature'
Eor;e. d_/ - Jt
(Rovlsed Aug. 2014)
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