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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)