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Home My WebLink AboutDavis, Jason 80489C (2)❑CAMA / ❑ DREDGE & FILL Na 80489 A B C D GENERAL 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 /,/ and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC F Rules attached. Applicant Name . ` / ', Project Location: County i 1r--*,J ; Address } (,�T ? �` (y{i;( 1( �4,�� Street Address/ State Road/ Lot #(s) City Li(r,- State )(ZIP n Phone #( -Mail Subdivision Authorized Agent City 'I zip Affected / ElCW [I EW e ❑ PTA' [I ES ` [IPTS Phone # (� ) �/ '?.) :'River Basin ''"4•... - - - ❑ OEA ElHHF ❑ IH ❑ UBA El N/A // AEC(s): Adj. Wtr. Body %/I r.�i�t ., j � ` _(nat /man /unkn) ❑ PWS: Closest Maj. Wtr. Body- ORW: yes / no PNA yes / now Type of Project/ Activity Pier (dock) ler—h Fixed Platforn Floating Platfc Finger pier(s) Groin length number Bulkhead/ Rip avg dista max dist Basin, channel cubic yai Boat ramp _ Boathouse/ B; Beach Bulldoz Other Shoreline Len; SAV: n, Moratorium: Photos: Waiver Attacl A building pe ( Note Local Planning jurisdiction) Notes/ Special Conditions Agent or Applicant Printed Name Signature ** Please read compliance statement on back of permit Application Fee(s) Check # !fr (Scale: PermitOfficer's Printed Name Signature Issuing 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 I) 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 ❑ 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/ I-888-4RCOAST 252-946-6481 Fax: 252-247-3330 Fax: 252-948-0478 (Serves: Carteret, Craven, Onslow - (Serves: Beaufort, Bertie, Hertford, Hyde, North of New River Inlet- and Pamlico Tyrrell and Washington Counties) 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) 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 ❑CAMA / ❑ DREDGE & FILL NI? 80489 A B C D GENERAL PERMIT Previous permit# ❑New ❑Modification El Complete Reissue El Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC Rules attached. Applicant Name Address City State Phone # ( ) E-Mail Authorized Agent Affected ❑ CW ❑ EW ❑ PTA AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ PWS: CIRW: yes / no PNA yes / no ZIP ❑ ES ❑ PTS ❑ U BA ❑ N/A Project Location: County Street Address/ State Road/ Lot #(s) Subdivision CityZIP Phone # ( ) River Basin Adj. Wtr. Body (nat /man /unkn) Closest Maj. Wtr. Body Type of Project/ Activity (Scale: ) Pier (dock) length _ Fixed Platform(s) — ' Floating Platform(s) Finger pier(s) Groin length number Bulkhead/ Riprap length— I I ' ._ i .... i — - avg distance offshore max distance offshore t _ 1 Basin, channel i cubic yards _- ` I Boat ramp Boathouse/ Boatlift i , _ Beach Bulldozing - I I ..... _/ - ; . - -- ...... / L. - , i Other Shoreline Length SAV: not sure yes no- __....---........... ; =— — -- Moratorium: n/a yes no - . - .._ ......... - -- -- - - - -......- — — - - -- i - -- ----- - - - Photos: yes no .......... _'-..__.... Waiver Attached: yes no I — -- -- J-d- - - - A building permit may be required by: ;f ❑ See note on back regarding River Basin rules. ( Note Local Planning jurisdiction) jf Notes/ Special Conditions Agent or Applicant Printed Name Signature ** Please read compliance statement on back of permit ** Application Fee(s) Check # PermitOfficer's Printed Name Signature Issuing 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 [)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, certifythat this project is consistent with 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 400 Commerce Ave Morehead City, NC 28557 252-808-2808/ 1-888ARCOAST 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 CAM PERMIT APPL.ICA PION Name of Property Owner Requesting Permit:____' Mailing Address: C, �I00 Phone Number; Email Address: -- I certify that I have authorized-4a i Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: � �'- �� E'. �"` '��' � �e•��, at my property located at�d- in (� Jf"��" County. l 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: Signature _ � � .�-•4� Cam- � iC.,N � �� Print or Type Name Title Date This This certification is valid through JUL. 14 Mi 0(,% N,MNI� CITY • CENT RIPARIA PROPERTY OWNER STATEMENT ADJA ,S I hereby certify that I own property adjacent to -�� w` er caner) (Name of Prop tY property located at (Address, L t, Block, Ro etc.) N.C. in on �� (City/Town and/or County) (yYaterbody) The applicant has described to me, as shown below, the development proposed at the above loca�i I have no objection to this proposal. v_� obj-ecxions to ttL s_praposaL--- -- NT _ DESCRIPTION AND/OR DRAWING OF PROP On below or attachEa site drawing) (individual proposing development must till in description b ed 1 WAIVER SECTION _.. - ---_ .. _ .. aess unless t bset -" - -" I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin waived by mee(if you back a minimum distance of 15' from my area of riparian wish to waive the setback, you must initial the appropriate blankbelow) I do wish to waive the 15` setback requirement. I do not wish to waive the 15' setback requirement. —" (AdjaCe e caner Info r ation)�� (Prope y Owner nformation) t l 'r rgn atwe, Ji tore ?rint or Type lame Print or Type Name Z -2 ��o,--e S "� C �" ` °-�� Q`'r �J� _ Ma 'ling Address �� h c i3�a�� Nc Mailing Addrels S � b 7 <<,�- -v ar, "�- i City/stalelzip = City/State i 911 l v` q 1 1 - Telephone \lurnber elephone Numbers 0 ") z, Date — �ate I�ECEIIX� P2o12, JUL 14 2021 DCM-MHD CITY k 4 ADJACENT RIPARI 4 PROPERTY OWNER STATEMENT S I hereby certify that I own property adjacent to Of located at � '� �' � J property Address, Lot B qck, ad, etch N.C. on �in (Cityltown and/or County) (Waterbody) low, the development proposed at the above to The applicant has described to me, as shown be cation � I have no objection to this proposal. hav_e�bj�cton_s_to---- DESCRIPTION AND/OR DRAWING OF PROPOSEDEVLf OPM a T drawing) (individual proposing development must fill in description beIow o Q4aA1vl=Rslrcrt.oN -- - understand that a • r, dock, mooring pilings, breakwust be set atnraaess°unlesuse s waived ft, of 'bymme. (If you I and area of npana back a minim distance of 15' from my blarkbeiativ.} wish to waiN the setback, you must initial the appropriate 07— I do wish to waive the 15' setback requirement. ant I do not wish to waive the 15' setback requ►rem . - (property Fner Information) Sigr!at e Print or Type Name F -toe C 0 ,vi fling Address a� .,ity/St te�Lip Tslepnone Number Data N rty Owner Information) ,�gitaru ° r%� C"" ✓ 11 i �?�li`r�- - ?rir!t cr �• pe Name Z f C. III, �blaili Ad Foss r L 76, Ci citylsgglzih ,, ' // Telephone Plum er / Date RECEIVED ,Revised j/i g/2012) JUL 14 2021 DCN -MHD CITY