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Home My WebLink AboutGentry, Shawn 80534C®a ❑,CANJ/ ❑ A DREDGE & FILL O �. N. 80534 A g c D GENERAL PERMIT Previous permit# ❑N9w ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality � i/ and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC / / � nr r l/ ❑ Rules attached. 9 Applicant Name / Project Location: County City State ZIP r, Phone # O E-Mail Authorized Agent Affected ❑ CW ❑ EW O FfA - ❑ ES ❑ PTS AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: ORW: yes / no PNA yes / Ro Street Address/ State Road/ Lot #(s) Subdivision City ZIP_ Phone # O River Basin Adj. Wtr. Body Closest Maj. Wtr. Body _(nat /man /unkn) ENEMIEMEN S ■ ■i^iiirifL®■■ ZERO 0 ■■■ ■ ■I OWNS INN ■■....�. m� MEN 111HEM111 mom ■ ■■■■■ �EE■�■■■�i� ■■■ ■■■ MEN iM■■■■■ ■■■■■■■■■■m■■■■■■■i■�■■■■■■■■■■ ■■■■■■■[1■■m■■■■■■■ SEEM ■■■■■■ ■ iiiiMEIN Em�iii0iii■■MMM1MM ■■■■■■A■ WMMIM■■■■ ■■■■■■■ ■■■ ■■■■ ■A■■■■■■■11■t�■■®■■■ C..■■■■■�...C.■■ ■ ■■■■■■■■r�■■®■■i■■■■N■■■■i■■■■■■■N ■■::: M::�::0ME �� :C'.0 Cism ■■■■■ ■I■■■ ONE■Yr IN SEE :-. .. IN■■■■ Elm ■■■ ■!1111 6■■■ ..LL...■.■■ • ■®■■■■■ ■I■■■■1;■■■Y■■■■■ Llgfl■■■■■■■■■ ■�®■■ mom ■a■.■.■■. �■I■■■■N■■■r■ii■■li■■■■■■■■■ .■■■a■.■■..........C..■■ q■■■■■■■!�■a■ig■■■■■■■■�I■■■■■■ ■■■■ ■■■�iiiiCZ MOMEM■■.'LriiiC_■�y■y��N��C�ry■�t■■■I■■y■�I�1■ftl■ - - I��■ �it�lo■■■�C��C■ ■�■■■ ■■�■■lion=, v■�■■■ ■■■■I�■ ■■�■■ ■■��N ■■I ■®®■/III ■■■■:�■ ■ Agent or Applicant Printed Name Signature ** Please read compliance statement on backof permit** Application Fee(s) &eck # r / i Permit Office�%Printed Signatur ;' -a Issuin Date Expiration 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 comply with these buffer rules. Division of Coastal Management Offices Morehead City Headquarters 400 Commerce Ave Morehead City, NC 28557 252-808-2808/ 1-888-411COAST 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 AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: '�A(w j ej- WA Q- Mailing Address: y32 144 e)AZ V "w <:tAUC rZa'loc cL Phone Number: :ea?- VO 4 - /4 b 1 Email Address: S 2 er, Pram 0 S kH6-e y -k co I certify that I have authorized y Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining //all CAMA permits necessary for the following proposed development: �JYa ' (- at my property located at /0'7 /nax'.Jell /* a853 in A rfktn -� 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 (Tuner Information: �An� Siginaturd / Shama Lyen 1Y� Print or Type Name Own er Title , o- Date This certification is valid through !a 1 a I a 1 DJACENT RIPARIAN PROPERTY OWNER STATEMENT_ I hereby certify that I own property adjacent to g4r4wn /) -r-t s (Name of Pro arty Owner) property located at 0 7 ax we// (Address, Lot, ock, Roa , etc.) on 6, its Cr. t k in c' N.C. (Waterbody) (City/Town and/or County) The appllc nt has described to me, as shown below, the development proposed at the above to tl 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) 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.) ✓ I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) / Slgn a- s),ct,,,tn :�e��-rN Print or Type Name /07 Infix ( �r Mao ,2 ddre NC 24531 3— City/State/Zip S a tr Not, l4 r, b Telephone Number/ email address to-13- ;L t Date 'Valid for one calendar year after signature' / email t -5 (Revised Aug. 2014) i jMuJ Co*- ADJACENT TWARIAN PPOPERTY OAR STATEI®iT 1 t4mby owtify loom property ataceffd to � %& u,* '!i .- -r •s plame Off PEOPWty own") prapairf k4ulgad W (o-r W%4* m as'a Mr A S fJ G a.rs 31 ,p N EOodr. Road. etr-) raj Wvo r s . b 3.. - }- , mr— Waterb odA (CJWTvan andk.r Cm rRy) The aWn;ard has a'ieurbed to .-m., as shown beow. the dev*Ioperrenl proposed at 'Ihe above 1 teeL^ no skriva to its pr.Vosal 1 ha'.'e 43 ihm p.' .+at DESs;fai}"7FiiN AteO OR DRAWING OF PROPOSED DEVELOPMENT Muffndrual propasxW dftWopqmo m3ust ® in desk ore below or a€iach a sate d:rasemv) ¢� yy -As WAfVER SECTION 1 jTdarVA &,43 a per.. dDcV, .mooring piiv+gs, boat ramp. breakwater, boathouse, ill• or groin ms4 be s,rri back a mwrrr um dmtance of 16 fare my area of riparian acoess unless warred by rr,--. !ti yrns'vshha to zrame tee sethw-c, pu must initial Ithe appropmAp blank mow.) 1 do,.aish io naive tie 15 setbar lc requirement ram. .46A? Te/e�hane i4rwnder/an>ai a4r1'eas rMr (Revised Auy. 2M4) 'VaAd tar one after sgnature' eh,OA ft, 5. IAII)IIS sale�f/ IOi Maxwc!/ DA. 5cArx RRerrall Ob —� Relnde OLd D�qck T Cuitl Nos S/ O \ � F Rleeoks' 64,eek A I Alc M a a fD N m 0 a T A 0 w m L\ HZE n N 3 CD N O 0 w C m m -o C�J O CO O