HomeMy WebLinkAboutStephenson, Will 78300CCFE
/ L� �REDGE & FILL N9 78300 A BDID
RAL PERMIT Previous permit#
Modif cation ❑Complete Reissue El Partial Reissue Date previous a mit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal R urces Co is ' n an area environmental concem pursuant to 15A NCAC t
1 attach d.
Applicant Name Project Location: County
Addres trees Ad S� Road/ Lot NO
City State IP 1I
Phone # _Mail _ Subdivision J A r\ (2&
Authorized Agent City ZIP
ffected ❑ w ❑ Phone PTA Fis
A ❑ PtS Pho# — er Bazir
AEC( ❑0EA ❑HHF ❑1H ❑URA ❑WA Adj.Wtr.Body
ORW: yes / o PNA yes / Closest Maj. Wtc Body
Type of Project/ Activity
MEN M
i
no
■■■■ ■■JJ■ ■M■ ■■ ■■■
■■■■■■■■■ IN M
■■■■■■■■■■■■�■ ■
■■■■■■■■■■
_EMEMOMEMEMEMEM
■H■■■ ■■■I
■N■■■■■■■■■■■■■■ ' ■
�SEMI
Nommi
no
Beach
Other
Shoreline Length V
SAV: not sure yes
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
S' "6r read comp**6e}5t) read compliance statement on bwk of ermit **
Application Fee(s) C/ Check #
Signature
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, 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 comply with 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://porLai.ncdenr.org/web/cm/dcm-home
Revised 7/06/17
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: W' 1 �
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
Agent
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: v , t� a
at my property located at 19 5, <�% orC Y. oea or��'V' �r �Lv/t
in CI' 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:
Sigature
ksr.
Print or Type Name
Title
?e1 1,115/ 77
Date
This certification is valid through I I
V
RECEIVED
DEC 212020
DCM-MHD CITY
S4
I hereby certify that I own property adjacent to (Narp� of Pro dttY.
to t �� ,_", �,I (<��n�. G X/C a$s f 6
property located at v `' ' '
(� �� �, (Address, Lq1, Blo k, Roadie c. N.C.
on �.Y�1 �y �---' in ` v-
aterbody) (CitylTown andlo Coun
(VVTh applicant has described to me, as shown below, the development proposed at the above
I have no objection to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in desoripti9 oe ow or attach a site drawing)
I
PvoP1,1 cA
vt r
WAIVER SECTION . --- -"
1 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 tAa*below.)
I do wish to waive the 15' setback requirement.
_ I do not wish to waive the 15' setback requirement -
Adjacent Property Owner Information)
(,Revised 6118RO 12)