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Home My WebLink AboutRamsey, William 88315C#F]New ❑CAMA ElDREDGE & FILL ,l d t1 i I I A B C D GENERAL PERMIT Previous permit Date previous permit issued ❑ Modification ❑ Complete Reissue ❑ Partial Reissue As authorized by the State of North Carolina, Department of Environmental Quality and the CCopstal Resources Commission in an area of environmental concern pursuant to: yl / I SA NCAC ❑ Rules attached. I General Permit Rules available at the following link: wwwdegnc.gov/CAMArules i Applicant Name Authorized Agent Address Project Location (County): City State ZIP _.._ Street AddresgState Road/Lot#(s) Phone #O Email Subdivision City ZIP Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (naUr�ian/unk) AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body ORW: yes/no PNA: yes/no Type of Project/ Activity fl......l:..n I.-n—h Access Length Pier (dock) th Fixed Platform(s) ... � i _..—.'— _._ f ' Floating Platform(s) — ------ — — Finger pler(s)—__.__-__ J-- _ _ . !—_ — _ Total Platform area--- -----"' Groin length/(t- Bulkhead/ Riprap length Avg distance offshore Breakwater/SillMax distance/ lengthBasin, channel Cubicyards-i— Boatramp Boathouse/Boatlift Beach Bulldozing - Other ._._...--- -- ---i— M ,' / !_ _ I I rF" � I - I SAV observed: yes no _ Moratorium: n/a yes no Site Photos: yes no—i Riparian Walver Attached: yes no i /- A building permit/zoning permit maybe required by: Permit Conditions ❑TAR/PAM/NEUSE/BUFFER(circle one) ❑ See note on back regarding River Basin rules r ❑ See additional notes/conditions on back I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) Agent or Applicant PRINTED Name Permit Officer's PRINTED Name Signature"Please read. compliance statement on back of permit" Signature •��_,- Application Feels) Check#/Money Order Issuing Date Expiration Date WOte"r"� ❑CAMA ❑ DREDGE & FILL N° 88315 A B C D 1) GENERAL PERMIT Previous permit Date previous permit issued ❑ New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue As authorized by the State of North Carolina, Department of Environmental Quality and the Costal Resources Commission in an area of environmental concern pursuant to: 15A NCAC - ❑ Rules attached. EJ.,General Permit Rules available at the following link: wwwdeq.nc.gov/CAv1AnuIes; Applicant Name Address City State ZIP Phone#(�) Authorized Agent Project Location (County): Street Address/State Road/Lot #(s) Subdivision City _ Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/mzn/unk) AEC(s): ❑IDEA ❑IHA ❑uW ❑SPIMA ❑PWS Closest Mai. Wtr. Body ORW: yes/no PNA: yes/no Type of Project/ Activity (Scale: ) Access Pier .. Fixed Platforms) OMEN �iii�i■■ii■o ii■■g■■i■ ■■ HE ■■■■■■� 0 IN Floating Platform(s) �.. ..Lois ■.Elmo �■■M■N9�� ■OMEN■■NONE ii ii��ii�i■i M. ...:.. ■■■■■ ■■■■■■■■■ME■■■■■■ ■■■■■ ■■■■■■ ■C■'■M•■C��■"'::: ■� ■■ :::::::M �■ .■■.■■■ � ..........a�.. MOM iAV observed: yes no n/a yes no' Cite Photos: yes no Riparian 41alver CII r ves no I ..... ■. ■■■�■ ■■�■■�■�■ N ■■■■■■�■■■■Moratorium: I. ii A building permit/zoning permit may be required Permit Conditions ❑ TAR/PAM/NEUSE/BUFFER (circle one) See note on back regarding River Basin rules See additional notes/conditions on back I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) Agent. or Applicant PRINTED Name Permit Officer's PRINTED Name Signature -*Please read compliance statement on back of permit" Signature Application Feels) Check N/Money Order Issuing Date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: ✓, &'q /t' Mailing Address: 11-51- ,�lm, tJ - /j Sf 44/4,i-L Phone Number: 9/ 9 Email Address: I certify that I have authorized Agent I Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA1permits necessary for the following proposed development: Ce �� firc f 0. /uCLi V''jV/ /3UC/ J0/� f/e%f��c3�C��/f 1✓( (Jx�� at my property located at �� r� ° �� S� �� ✓>� c �c•Fc { in County. 1 furthermore certify that 1 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 tt-, Fi Print or Type Name Title a��laa- Date This certification is valid through 3 / ao 1 1217 ADJACENT RIPARIAN PROPERTY O NMER STATEMENT I hereby certify that I own property adjacent to /`r er Owner) p (Name of property property located at PQ W E /J (Address, Lot, ock, Rod, etc.), N.C. . i l r Fa c on (� ✓ ( at'rbo ---- n (CitylTown and/or County) (yyaterbody) The applicant has described to me, as shown below, the development proposed at the above location./ I/ I have no objection to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (individual proposing development must fill in description below or attach a site drawing) a�FX (S7i t� W t!l CAI S� WAIVER SECTIONboath. -- groinft, or must be set ----- - - I understand that a pier, dock, mooring pilings, oreriparian pw teraaessounlesuse s wa'i ed by me. (If you back a minimum distance of 15' from my ip appropriate blank below.) wish to waive the setback, you must initial the app p I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. nwns+r information) (Property Owner Information) Sib ature Print or Type Name Mailing Address City/StatelLip Telephone Number (Adjacent Property Date Date (Revised 5/18/�'012) I hereby certify that I own property adjacent to ( Mame of Proper Owner) property located at ,r U/ f (Address, Lot Block Road, etc.) N.C. . on �a r�0. (yt(aterbody) (City/Town andlor 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 ton-_s_to thisprop-o-sal.----------�— DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) psi "ilvx WSet AIVER SECTION -- -- - I understand that a pier, dock, mooring he p'I'area ofenparaanraccessounless waived ft,Iby muet (If you back a minimum distance of 15' from my wish to waive the setback, you must initial the appropriate blank below) I do wish to waive the 15' setback requirement. I do not wish to waive the 15, setback requirement - (property Owner Information) 11119-nen w �Y Signature Print or Type Name Mailing Address City/State/Zip Telephone Number (Adjacent Property Owner Information) Date Date (,Revised 5/18/P012)