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Home My WebLink AboutLineberry, Jeff 80401C�LCAMA / ❑ DREDGE & FILL N�) 80z-10 I A B OC D GENERAL PERMIT Previous permit # 1,New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit` issued As authorized by the State of North Carolina, Department of Environmental Quality fl] i and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 9.r' ROO aAzi�' Applicant Nam Project Location: County Address) " f Street Address/ States Rgad/Aot #(s) City Phone W�Aj Authorized Agent Affected AEC(s): ❑ CW ❑ OEA ❑ PwE ORW: yes / V / PNA yes / Type of Project/ Activity -As Pier (dock) length Fixed Platform(s) — Floating Platform(s) Q� Finger pier(s) Groin length `�— number Bulkhead/ Riprap length avg distance offshore max distance offshore Basin, channel cubic yards---' Boat ramp Beach Bulldozing Other Shoreline Length SAV: not sure yes no Moratorium: n/a yes no Photos: yes no _ Waiver Attached: es no A building permit may be required by: ( Note Local Planning jurisdiction) NotSsj Special Conditions ❑ ES ❑ PTS ❑ UBA ❑ N/A Agent r Applicant Printed Name Signature "Please read compliance state ent on back of permit" 0 z Application Fee(s) Check # Subd city Phone # Adj. Wtr. Body JJLa/L Closest Maj. Wtr. Body ❑ See note on back regarding River Basin rules. Pri Signature I/ (t�112 / 6U — Issuing ate Expiration ate 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, certifythatthis project is consistentwith the North Carolina Coastal Management Program. River Basin Rules Applicable To Your Project: ❑ Tar - Pamlico River Basin Buffer Rules ❑ 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 Washington District 400 Commerce Ave 943 Washington Square Mall Morehead City, NC 28557 Washington, NC 27889 252-808-2808/ 1-888ARCOAST 252-946-6481 Fax: 252-247-3330 Fax: 252-948-0478 (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) (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 AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: -e.. ; h.l rk Mailing Address: /77 Phone Number: / Email Address: 1 certify that I have authorized t a rrni �S ' Agent ! Contractor to act on my behalf, for the purpose of applying for and obtaining all CAM/A permits necessary for the following proposed development: �/. 'ram at my property located at�r in e County. 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 Information: —�* m Signa e Print or Type Name " Title 1Z12�-L Date This certification is valid through!b2y aay � r�G gibo d $ 1/00 Gk RECEIVED APR 19 2021 DCM-MHD CITY Gl�� ADJACENT Rlf ARIAN PROPERTY OWNER 51 A 1 tmcry i I certify that I own p perty adjacent to e e er) I hereby ro e f P op c� 07 property located at Address, L lock Roa etc.) //�� in c..� ve-rZ N.C. aterbody) , on (CitylTown an 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. _ DESCRIPTION ANWOR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) �5 a�'`c�b�1� 1�D A `^" ru ^�v°s3ceZ oed or groin st be set -- I understand that a pier, dock, mooring pilings, breakwater, boathous , 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 blark below.) �✓ _ I do wish to waive the 15' setback requirement. I do not wish to waive the 15, setback requirement. (AdjacentProperb/ Owner Information) (Property Owner Information) , / _ atrp(re OPJ print or Type Name Pnnt or Typ a e '212, N.(. o /ter c M ling A dress L �2s� Mailin Address `�-�— -� (_ i City1 tal �P City/ tate/Zip _2, /Sl 7 Telephon Nu bar :. rele hone Number �Z t ----- -�4 � J?.'� A Date Date (RevisedEIVE APR 19 2021 DCM-MHD CITY ADJACENT RIPARIAN PROPERTY OWNER STATEMENT �� GaCJ� S I hereby certify that 1 own properly adjacent to (Name of MPef er) property located at 3d (Address, ot, Block, R d, etc.) I on _ fin! (r in aterbody} (City(iown and/or County) The applicant has described to me, as shown below, the development proposed at the above location. �^ l have no objection to this proposal. _ t have ntatesSio�WposW _ DESCRIPTION AND/OR DRAWING Of PROPOSED DEVELOPMENT CAS 0 (Individual proposing development must fill In description be lo � \�� h a, site drawrng �4 MC Dry l►v^-- 1� 6t, e oA�� 0h PJ o�� 2:6- ell ('Cc_ww' ---lam WAIVER SECTION `- 1 understand that a pier, dock, mooring pilings, waived by me (If you breakwater, bo house, lift, or groin must be set back a minimum distance of 15' ffom my area of riparian aaess unless wish to waive the setback, you must initial the appropriate black below.) I do wish to wAWe,the 15' setback requirement. 1 do not wish to waive the 15' setback requirement. (Property Owner Information) (Adjacent Property Owner Information) rgY1 E Print or T e Mailin Addres—r Ci tate/Zip�, rya i Telephone Number Date Sigrwture ,n/i=-LIA'� iZ TNo��aS Print or Type Name Mailrn A�rgss Al C. 2719 d6 LNr CVSt8te/1ip yrq '2i0-'(742--_--- retephone Nurnb.er 2 - 2 K L- LL------ Date (Revised 6/1 /2012) 1-1L X3F I V F j APR 19 2021