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Home My WebLink AboutCapps, Jane 83811C❑CAMA /❑ DREDGE &-FILL 9 8381 1 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 ❑Rules attached, Applicant Name r r Project Location: County Address Street Address/ State Road/ Lot #(s) :� � /,(., { ..E�,k� , ,� City j tIJJ State, 'I� t. ZIP ^')�) ` 1`'(.%t�► `' ---., 4 �t ('/ Subdivision Phone #'(�) "?��'r;, 1 �E-Mail , Authorized Agent City { (� i' �� ;' f,'t,, ZIP ) f ;•_. , . ( .! i ver Basin L�...- Affected ElCW [] EW PTA�S PTS Phone # j ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A /: f ? AEC(s): Adj. Wtr. Body 1.) ! ? nat man unkn ❑ PWS: 0._. Closest Maj. Wtr. Body 1 2: ORW: yes / ,no PNA yes / no Type of Project/ Activity{/ Pier (dock) length Fixed Platform(s) Floating Platform(s) Finger pier(s) Groin length number Bulkhead/ Riprap length avg distance offshore max distance offshore ( s Basin, channel cubic yards Boat ramp Boathouse/ Boatlift Beach Bulldozing Other Shoreline Length SAV: not sure yes o - Moratorium: n/a yes no Photos: yes i 'nod- Waiver Attached: yes no A building permit may be required by: ( Note Local Planning jurisdiction) Notes/ Special Conditions r Agent or Applicant Printed Name Signature ** Please read compliance statement on back of permit Application Fee(s) Check # (Scale: ❑ See note on back regarding River Basin rules. Al Permit Officer's Printed Name Signature NL� Issuing Dace 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 ❑ 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 howto complywith these buffer rules. Division of Coastal Management Offices Morehead City Headquarters 400 Commerce Ave Morehead City, NC 28557 252-808-2808/ I-888-4RCOAST 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 ❑CAMA /❑ DREDGE &.,F11,L N9 83811 A B C D r. 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 ❑ Rules attached. Applicant Name Project Location: County Address Street Address/ State Road/ Lot #(s) City State ZIP Phone # ( ) E-Mail Subdivision Authorized Agent CityZIP ed ❑ CW ❑ EW [I PTA El ES ElPTS Phone # O River Basin Affect A Affected ): ElOEA ❑ HHF ❑ IH ❑ UBA El N/A Adj. Wtr. Body (nat /man /unkn) ❑ PWS: ORW: yes / no PNA yes / no Closest Maj. Wtr. Body Type of Project/ Activity 1 Ir (Scale: ) Pier (dock) length - Fixed Platform(s) Floating Platform(s) Finger pier(s) - I-• - 4:.. -- - Groin length number - - - 4 - - Bulkhead/ Riprap length — avg distance offshore ❑- F �,..' t_' i t ( i max distance offshore s ' Basin, channel cubic yards C Boat ramp Boathouse/ Boatlift i Bulldozing Beach Other — I Shoreline Length w i i LEE l -f— - SAV: not sure yes no Moratorium: n/a yes no yes Photos: no - - - -- �.i - - - -- -- - - - -- -- - Waiver Attached: yes no l A building permit may be required by: ❑ See note on back regarding River Basin rules. ( 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 # Permit Officer'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 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 Iandowner(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 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: Mailing Address: '3 50 Phone Number: Email Address: I certify thatI have authorized Adent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: at my property located at 41 r in} County. I furthermore certify that / 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 K Print or Type'Alame Title RECEIVED Date AUG 31 2021 7- DCM-MHD CITY This certification is valid through 1 < 1. ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to0'"'Us om ' H .. A . A (Name ol*Property Owner) property located at (Address, Lot, BlocK Road, etc. N-We'l — o on sout '50"4 in AflikAil't, &h N.C. (Wateeb6dy) - (City/Town and/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. I have objections to this proposal, DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must rill in description below or attach a site drawing) Amt (,e seawp-A and ma�ka Vic'r reYtLr� WAIVER SECTION I understand that a pier, dock, mooring pilings, 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.) E I WE D I do wish to waive the 15' setback requirement. AUG 3 1 2021 I do not wish to waive the 15' setback requirement Wit ly (Property Owner Information) (Adjacent Property Owner Information TY si'oture attire Jbw t t ± 0:� Print r y, q Name Print or Type Name UA Am to I - Mail' g Address J Mailing Address c' 1/1-J '7 citylsta ip qitylsw ip Telephone NurrIber Telephone Number ......... . . . . ......... Date Date (Revised 611812012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own properly adjacent to 3"e, It Cq ,s 0 1) YK t�.( r os , 5340w do-er property located at !ids Dwy*1 .4 ?).40 (Name ot Pro'perty Owner) on (Address Lol, Block Road etc.) NC N.C. gi in tit) M ��, C- pi&oj (Watel�13ody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above IQcqt, !99- 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, 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.) RECEIVE I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) �0.ylt H Print or Ty e Name Maili Address �J NZJAIV i I It?, (Q c 1:7 54 CitylStat /Z' Telephone Number ........ . . C-1 . . . . ....... Date --(Adjacent Property ,, L A U G I, J ` --Si�nature Print or Type Name ) 3 lk-1 Mailipg Address I , f� C, /i CityIState/Zip telepho'neNumber Date Im (Revised 611812012)