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Home My WebLink AboutDouble R. Farm Services 83810CENERAL PERMIT Previous permit # ew LModification }Complete Reissue Partial Reissue Bate previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Cemmissign in an ar## of etiv�nmental coryc4krn pursuant to 5A NCAC w Applicant City . _ ,S4. ----.--,State , Phone Authorized Agent-- ...................... _ Affected CW * *7 TA ES r ' PTS A Affecte OFA HHF IN ueA ,H/A Pvvs:�.�.®.._. O RW: iP`I no #NA yes I Beach Bulldozing Other Short?iir etsgth „ ,, SAY: not sure yes no Moratorium: ri a yes no Photos: yes no W4iver Attached. "e' A building per d 4: ( Mote local Planning jurisdiction),-, Not,4l Special Conditions _ t,�'Mh r Application Fees) T �-/11 W L. - ted Name read compliance statement on back o � emit Check ies nee, le Lion; County ,` __ _ _._....._. . iee Addressl Star ad/ Lot #(s}< - Subdivision__, Ple City f_.'- ZIP Phone # 1 .. �''V � )Nver Basin Adj. Wtr. Body Closest !vial. Wtr, Body suing is, i See note W back. regarding River Basin rules. 4 le Fxpw ation Lute AMA / ❑DREDGE & FILL NI? 83810 A B C� D ENERAL PERMIT Previous permit# ew ❑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 Commissi n in an ar of environmental vi onmental co ce`rn pursuant to 5A NCAC ules att hed. Applicant Name -- VvPI oiec cation: County Addres=,ail I eet Address State ad/ Lot #(s) CityStateZlP Phone # � Subdivision �j Authorized Agent City ZIP ElCW *EW PTA ❑ ES ❑ PTS Phone # � 'v ` / iver Basin AEC Affected ElOEA ❑ Ad Wtr. HHF ❑ IH ❑ UBA ❑ N/A j Bod y I O C` nar an nkn ❑ PWS: ORW: es / no PNA yes / Closest Maj. Wtr. Body Type of Project/ Activity (Scale: Pier (dock) length Fixed Platform(s) Floating Platform(s) 0 pier(s) — Groi ' ength number Bulkhead/ Riprap length avg distance offshore `— max distance offshore Basin, channel cubic yards Boat ramp Boathouse/ Boatlift Beach Bulldozing Other Shorelin _ ength i SAV: not sure yes no ........._. Moratorium: n/a yes no Photos: yes no Waiver Attached: yes no A building per L rejd �Y: ( Note Local Planning jurisdiction) NotA/ Special Conditions Applicant Printed Name ❑ See note 9,T back regarding River Basin rules. re ;P4tsAread compliance statement on back of permit Application Fee(s) Check # spa pal - /-U /o<o� 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 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 thatthis 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/ 1-888ARCOAST 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 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) (1 Name of Property Owner: IDIADI', yr� , UL�I M �%ih1, &L ; Ll j - Address of Property: _ i D,2) li- p' n Mailing Address of Owner: I� L�i1 x t.0� CI I 1 �. �"'q Owner's email: 11i�VU'S(/,d,{'11�15( �� t� � (Owner's Phone#: ��10 0 Agent's Name: Agent Phone#: Agent's Email: ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom portion to be completed by the Adjacent Property Owner) I hereby certify that I 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 I DO NOT have objections to this proposal. I DO have objections to this proposal. If 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 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted at (252) 808-2808. 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, lift, 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 riprap revetments). (If you wish to waive the setback, you must sign the appropriate blank below.) I DO wish to waive some/all of the 15' setback Signature of Adjacenkvloaridn Property Owner Lys -OR- I do not wish to waive the 15' setback requirement (initial the blank) Signature of Adjacent Riparian Property Owner: Typed/Printed name of ARPO: c� �2C ? ✓I C_ r`C S c Mailing Address of ARPO: a Ili ARPO's email: 1c:/s 7 0 ARPO's Phone#: %2 0 Jf77Al4, /"coift Date: *waiver is valid for up to one year from ARPO's Signature* Revised May 2021 ■ Complete items 1, 2, and 3. Print your name and address on the reverse sothat-we can return the card to you. ■ Attach this card to the back of the mailpiece, A.TSiqature■ X gent Addre B. Receiyeedby rintd Narpe) l ✓`J�°� o; D to of li or on the front if space permits. p , d /r7/�h 1. Article Addressed to: Y/Uri� D. Is delivery address different from Item 1? ❑ Y s If YES, enter delivery add�reNosIC Pv BoX-QC' :� 5q21 .o £�c3 2soT i PDI Il I I IIII I'll lii I Il III I'll' II lI I II IIII l 3. Service Type ❑ Priority red Mail ress@ ❑ Adult Signature ❑Registered Mailr'^ ❑ Adult Signature Restricted Delivery ❑ Registered Mail Restricted ,Certified Mail@ Delivery 9590 9402 5069 9092 5254 97 ❑ Certified Mail Restricted Delivery IAReturn Receipt for ❑ Collect on Delivery Merchandise 2_ Article -Number tTransfer-from❑ Collect on Delivery Restricted Delivery ❑ Signature ConfirmationT" -.- --- dail ❑ Signature Confirmation 7 012 3460 0003 6879 8 116 O,il Restricted Delivery Restricted Delivery PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt Complete items 1, 2, and 3. Print your name and address on the reverse so that we can return the card to you. Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: A. Signature X ❑ Agent _ _ ❑ Addressee B. Received by (Printed Name) C. Date of Delivery D. Is delivery address different from item 1? U Yes If YES, enter delivery address below: ❑ No Service Type ❑ priority Mall Express@ II I'II'I I'II II I II II l IIIIII II lI I I I l II I III ❑ Adult Signature ❑Registered MaiIT"' ❑,t Adult Signature Restricted Delivery ❑ Registered Mail Restricted 9590 9402 5069 9092 5255 03 �3. ❑Certified Mail@ Certified Mail Restricted Delivery Delivery Return Receipt for ❑ Collect on Delivery Merchandise _9 _AdirAR N L1 Collect on Delivery Restricted Delivery 0 Signature Confirmation*'" ❑ Signature Confirmation Sail 7 012 3460 0003 6 8 7 9 8109 fail Restricted Delivery Restricted Delivery PS Form 3811, July 2015 PSN 7530-02-000-9053• ' •• . Domestic Return Receipt USIP ► TRACKING # �. � �,�--��.� First -Class Mail HE TPostage & Fees Paid USPS — Permit No. G-10 9590 9402 5069 9n9p ;aqu 97 United States Postal Service • Sender: Please print your name, 'bOWOL �- fZ/Vivt L'u, 1155 I�GU,�S Qum �)c 141� - R.S. this box* !!,!„l,;Is!!!!li,l�I!l,,j!ll;!!i,!!j!a!i!al1II111li!'I!11'!II First -Class Mail Postage & Fees Paid USPS Permit No. G-10 ggqn quna gni_g gnga Fagg nq United States Postal Service WM,— W5. • Sender: Please print your name, address, and ZIP+4® in this box" `jowbL P, fc-tA . ,-9/ery oo-, a , 115 5 M"' P"U+n kazA fuo N� �L Wq C O E N +� C � fa U cc c� co 4- .- cn Uco O 00 45 2 c o N > U � L M E 0 o z -0 Li 0 z c Q co > � U a) E — N O d O Q. o� a ¢ o ¢ U- 0 0 U)