Dismukes, Gary 80052C

trCAMA / T DREDGE & FILL
ENER/AL PERMIT N9 80052
Previous permit
ABCD
#ENew IModification IComplete Reissue EPartial Reissue Date previous permit issued
fu authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to l5A NCAC
E Rules attached.
Applicant Name Project Location: County
Address_ Street Address/ State Road/ Lot #(s)
State /U ('ztP
Phone # tJ$E-Mail Subdivision
Authorized Agent zlP
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trOEA
tr PWS:
N E}Y
tr HHF
N PTA
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trES
D UBA
tr PTS
NN/A
Phone # (_)River BasinAffected
AEC(s):Adl. Wtr (nat /man /unkn)
Closest Maj. Wtr. BodyORW: yes / no PNA yes / no
Type of ProjecU Activity
(Scale:)
Pier (dock) len4h
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 Length
SAV: not sure yes no
Moratorium:
Photos:
Waiver Attached:
A building permit may be required by:
( Note Local Planning Jurisdiction)
nla yes no
yes no
: yes no
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E S"" note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature # Please read compliance statement on back of permit **
Permit Officer's Printed Name
Signature
Application Fee(s)Check #lssuing Date Expiration Date
*n
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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 subiect 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 to the permit officerwhen the project is inspected for compliance. The
applicant certi{ies by signing this permit that I ) prior to undertaking 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 certified 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 belief, certifythat this proiect is consistent with the North Carolina Coastal Management Program.
River Basin RulesApplicable ToYour Projectl
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
Wilmin4on Regional Office (9 I 0-796-7215) for more information on howto comply with these buffer rules.
Division of Coastal Management Ofiices
Tar- Pamlico River Basin Buffer Rules
Neuse River Basin Buffer Rules
E oth".'
Washington District
943 Washin6on Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: 9 I 0-395-3964
(Serves: Brunswick, New Hanover,
Onslow - South of New River lnlet-
and Pender Counties)
Morehead City Headquarters
400 Commerce Ave
Morehead Ciq/, NC 28557
252-808-2808/ r -888-4RCOAST
Fax: [phone]
(Serves: Caneret, Craven, Onslow -
North of New River lnlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste.300
Elizabeth City, NC 27909
252-264-3901
Fa><: 252-264-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ I 7
NAME OF PROPERTY OWNER APPLYING FOR PERMIT GaTT
MAILING ADDRESS 507 HarborDr
New 28562
TELEPHONE NUMBER 919.74 ::04L
I certifo that I have authorized agent/contractor) ,
to act on my behalf, for the purpose of applyrng and obtaining all CAMA permits
necessary for the proposed development of DocklBoatlift
at my property located at
This certification is valid through (1) Year (date).
(Property Owner Information)
trru T\lrh,kr-t
Print or Type Name
Title, co. owner or trustee for property
s. 9 t*'tA
Date
Telephone Number
Email Address
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r llurrruy r..Er rxy ural r (,wrl Pt(Jpelty aujacelll to (
of PrcperQr Owner)
property located at ft t l+*rza "*a 'Il-
(Address,Lot Block, Road, etc.)
on 1h,,,' P;.,*ln ntEat /3,<u Z q:A at)N.C.
The applica,a-ry
(Waterbody) (GitylTown andror County)
nt 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 DRAWNG OF PROPOSED DE1/ELOPMENT
(ldMdual prcpoE,ing futelopmentmustfrn in dosElripdoa !€towotaffich a sttednwing)
tii? t)Lttt'i'a
I do not wish to waive the 15' setback requirement.
WAIVERSECTION
I understand that a pier, dock, mooring pilings, boat ramp, brealsvater, boathouse, Iift, or groin
must be set back a minimum distance of '15'fiom my area of riparian access 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.
(Propeay Own€r lnformalion)(Adiac-ont Ow or lnfomation)
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)
Print or Name
t hoohr4
Pdnt or TWe llame
1o'1 O"-
Mailing Addrcss
Br'atr.fL
City/State/Zip
QiQ - "lte cr 4 <L
Teleibne Numb$ / email address
2t - t3-
Telephffie Numbet/ emdil addrcss
Mailing Address
City/StateZip
Date
'Valid for one calendar year after signature*
Date*
(Rqised Aug. 2014)
ADJAGENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certifo that I own property adjacent to
s
a?-
Name of Property Owner)
s
property located at {t,1 [+*aa 4a ,7n
(Address, Lot, Block, Road, etc.)
on ,Pl-t .tn A.tEt+t /3€ua C ual , N,C.
The applicanttocf.
(Waterbody)(CltylTown and/or County)
has described to me, es shown below, the development proposed at the above
I have no objec,tion to this proposal.
I have objections to this proposal.
DESCRIPNON AND/OR DRAWING OF PROPOSED DEVELOPTiENT
(tndMdual propcing ctrIreloryneot must frtt ln ctesctiDfon Detow ar at'6lch a site dnwrng)
t7t oaALl"'-(
lnformation)
WAIVERSECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15 ftom my area of riparian access unless waived by
me. (lf you gdsh b waive the setback, you must lnltial the appropriate blank below.)
./ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement'
Prtnt or Name
Mailing Addrcss
City/StatelziP
Print or
D".
L
4t 1j,. o A <2-
Telephone Number / email address rebpho?
'Valid for one calendar year after signature*
Date*
. /5--
(Revised Aug. 2014)
(Property Owner lnformation)
Lt- t?- 3t
Date
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