HomeMy WebLinkAbout83906A_Samuel, Frank & Debra_20210909t/CAMA / DREDGE & FILL
.� A B C D
G�,ENERAL PERMIT Previous permit #
New Modification Complete Reissue Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality 'f�F'/ / ,,0�
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC—s
= ules attached.
Applicant Name Fpt,, ('DCpCC. '—pC .fit Project Location: County f�,'{Z
Address 90y MO/`te-r Street Address/ State Road/ Lot #(s) _Q Mrk-�{�y l
City Cofo_tiG State/\JG ZIPD;'9-Jl- D vC,
Phone # (75�) -$iO E-Mail Aet' Subdivision _(loti% [-y - S�Ore-S
Authorized Agent Q 13_ 13vIa2-C'� City.-11G -- - - -- ZIP
Cw �W 14TA ES PTS Phone # Affected - (_ -) _ --- - River Basin Ja (na o. i
AEC(s): oEA HHF lH UBA N/A Adj. Wtr. Body[�[t''�t-G -
t'?trn;ki1_/unkn)
ORW: PWS: �^
y / no PNA yes /�
Closest Maj. Wtr. Body �tf'-�'--�Ck-
es
Type of Project/ Activity NCGJ eT Sgi ' I i.c4-
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
1
Boathouse/ adi t jQ �X IG
Beach Bulldozing _
Other S-kn— : r S
aw
Shoreline Length — - $0 _ -
SAV: not sure yes 3n
(Scale: /( T ()
ate tk
i
i F C Oer + Ptr.+�dr
`4eP s r---
Ad
fOf r� � •---- �� ri (tuhre'
Moratorium: n/ yes no
Photos: G> no 5:,4,1e
Waiver Attached: yes no a [Ct ► 1
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
A�geennt or Applican ted Name
Signature * Please read compliance statement on back of permit*"
Application Fee(s) Check #
See note on back regarding River Basin rules.
iZober fCocbe ft- _ ---- - ----- -
itofficer's P inted Name
Signature --
Issuing Date Expiration Date
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: FYWK
Mailing Address: i O v 01 13 0
C Oro110. N C. 27 92'l
Phone Number:
Email Address:
1 certify that I have authorizedDk_6_gUlk,t Ka&_,NC —DQ-o-'---=—'dCOTO —
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
lt-�
at my property located at �� i0 _IQ (k+vC Cor011a NC 2192-
in ��_County.
l furthermore certify that l 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:
Signature
�Q,i1u. a rYu �,r i
Print or Type Name
Title
Date
This certification is valid through _�____i
iA w 1/ w a-
1
C N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: F` O^Y- ,
Address of Property. rQ10kO M ors}-cX" QYjVC C orollq NC- Z79 7-1
Malting Address of OwnerPO O $ OX Q O C-or oil 0. NC. 27 9 Z--7
Owner's email ry ,���i Vt7AZwil-•c0i, ne. Phones'-757 S �� 3 1
Agent's Name w1 l _ Agent Phoneme 1'57-
Agent's Email. Q_.. 9_(34 f\WC)r 9 A CWIA
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
{Bottom portion to be completed by The Adjacent Property Owner)
I hereby certify that I own property ad)acenl to the above referenced property The individual applying for this
Permit has described to me. as shown on the attached drawing the development they are proposing A
des Crlplion or drawing- With d'rrv"-" ns -- be provided with this letter.
pzrV�IIDO NOT have objections to this proposal I DO have objections to this proposal
M you have objections to what is being proposed, you must notify the N.C. D)vision of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin Sr., Ste- 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at (252) 264-3901. No response is considered the same as no objection i1 you have been
notified by Cervired Mail.
WAIVER SECTION
I understand that any proposed pier. dock. mooring pilings, boat ramp. breakwater boathouse. Oft. or
groin must be set back a minimum distance of 15' from my, area of riparian access unless waived by me
(this does not apply to bulkheads or rrprap revetments). (If you wish to waive the setback. you must sign
the appropriate blank below.)�)/UU,
DO wish to waive sorne/all of the 15' setback r" V
-OR-
Signature ofAd)acent Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property O
lw
ner �✓Z
Typed/Printed name of ARPO: J 0 Y jY: -ru�-Vv , L
Malting Address of ARPO: 60X 40Z C ocol 1 a` NC. 27 oa7
ARPO's email: LVAA 1 ARPO's PhoneX:
Date: $ 3 I" Z •waiver is valid for up to one year from ARPO's Signature -
Revised July 2021
---- — N.C. DIVISION OF COASTAL_ MANAGEMENT
- --ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner of their agent)
Name of Property Owner Tlwx, &&ova e 1
/�
— dcess of Q_--pertyQ
T - - �l CAD M O jJ(W i��i�. %(\A0.
Mailing Address
rofOwner Po Boy. 13o COroklq• NIL nal -i
Owner's email: t Q u41 ev'(�LZ,p�_0&wner's Phone0 -7cji 9j 10 1 S al
Agent's Name: -0OWt Agent Phones 2 52 yS�j 1,322
Agent's Email OQ l�pil�� O�C1�+1�,j I • (0M
ADJACENT RIPARIAN PROPERTY OWNER's CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that 1 own property adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown on the attached drawing. the development they are proposing A
d-escnption or drawing w1h d+mens)ons must be provided with this letter.
_ 1 DO NOT have objections to this proposal. I DO have objections to this proposal.
ff you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at (252) 264-3901. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, left, or
groin must be set back a rrunimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive somelall of the 15' setback Shwi Fnf,
Signature of Adjacent Riparian Property Ovvner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: shayf Flit,
Typed/Printed name of ARPO: hw -C
Mailing Address of ARPO: P u v`\0300
�'te.5 w gy Q 201117
ARPO's email: t�PCIMAil ARPO's Phone#:
Date:% 3). 21
'waiver is valid for up to one year from ARPO's Signature'
Revised July 2021
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