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Home My WebLink AboutTysinger, Thomas 84671C°"°"'❑CAMA ❑DREDGE & FILL N° 84672 A B C D GENERAL PERMIT Previous permit s Date previous permit issued ] New ❑Modification []Complete Reissue ❑ Partial Reissue 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. ❑ General Permit Rules available at the following link: www.deq.nc.goy/CAMArules Applicant Name " 1 ' - Authorized Agent Address �' i f l ',•� Project Location (County): City State ZIP Street Address/State Road/Lot #(s) i/s/✓.� ,�'! t Phone # (_ ) Email Affected ❑CW MEW ❑PTA AEC(s): ❑OEA❑IHA ❑uW ORW: yes/no,' PNA: yes/no Type of Project/ Activity ❑ ES ❑ PTS ❑SPIMA ❑PWS City Adj. Wtr. Body Closest Maj. Wtr. Body moon ■■� ONE ME ■■ 1111111M ■■■■ M■ ME MEMEMMEMEME Floating Platform(s).■ ■�j . ■■■ . QI■ ■■■■ ■ . ■ ■Rl�i,■■��11�■.I■�11(■i■■:■1■►''::: Ei1 ■�■� .�..�� ■ . ..■ Total .. area Groin h/ .. Max distance/ 11 th Basin, channel eng ■ . N■■I■■■■■■■■ .■�■■.■ �'' ■'r� � .rim■ 0■■ �� i 0.■ .. ..... ..... ■■ l M .�. ..�.p�■■■ ■....■.■■■■.. ..■■■ ON ME MEN ��®■ ..�� .C�CS.=C■� A building permit/zoning permit may be required by: Permit Conditions TAR/PAM/NEUSE/BUFFER (circle one) See note on back regarding River Basin rules ❑ See additional notes/conditions on back 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 I Signature**Please read compliance statement on backof permit**,,yy ,p Application Feels) Check p/Money Order Signature Issuing Date Expiration Date 0EMU,&L,]CAMA ❑ DREDGE & FILL N° 84672 A B C D Previous permit 3 GENERAL 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 Coastal Resources Commission in an area of environmental concern pursuant to: I SA NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nagov/CAMArules Applicant City State ZIP Phone # (_) Authorized Agent i Project Location (County): Street Address/State Road/Lot #(s) Subdivision City Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk) AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body ORW: yes/no PNA: yes/no Type of Project/ Activity ti (Scale: Miss �0 v■■■■■■■■on :■■ ■■■ ■■ ■■ 0 Floating Platform(s) ...■■..■■.. .■■■.■■■■■■■�■/■■■■■.a■ ®=Is EM■S■ ■®R■�. ■ Finger pier(s) E ■ UN:a:::aA::�.■.■■■�: ::ia' �..:■:■�■ Total Platform area Groin length/# Bulkhead/ Riprap length distance offshore Breakwater/Sill _ Max distance/ length Basin, channel•:• Boatramp Boathouse/ Boatlift Bulldozing—. ■M 0■■■■■1■■■■■ rua:r■■■� a�:iii��■Avg �■.■■ : r■.:■.■■..�■ a:ua::■■::■■■iM:u:■■:■n■a:a::aa �■ MEN ■■C■■■■::::a■■ •:• M:�aa::■:::: ........... ■■■ ■ ■■■■■■■■■■■■■ ■■ ■■■:■■■■.■■■■�i■■■a■ ■■■■■■■■■■■.■■■Beach ■■■■ Other■ ��■ME—M : 0M■■■■■ ■■■■■ ■::a SAV observed! yes n Moratorium: n/a yes no Site Photos: yes no Riparian Waiver Athu ': ■a:: :a:�:Caa:::�::: •a■::i:::a�a■:�: r A building permit/zoning permit may be required by: Permit Conditions ❑ TAR/PAM/NEUSE/BUFFER (circle one) ElSee 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" Application Feels) Check N/Money Order Signature Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: gh!'4A /y, Mailing Address: Phone Number: Email Address: 1 fr ! _�Sc«�irdl•/t� I certify that I have authorized "/Idt. xi%A, b Agent / 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 in 4—IA144eet County. /abu�lLo/do�1r; dc�%w�lku��K � I furthermore certify that I 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 Print or Type Name Title —7— Date This certification is valid through N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY (Top portion to be completed by owner or their agent) Name of Property Owner: Address of Property: Mailing Address of Owne Owner's email: 11 1An4g(AL14,bj1 Unk �Oowner's Phone#: QyZ 74 1 05 Agent's Name: Agent Phone#: r% "57 J ? Agent's Email: ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom Portion to be completed by the Adjacent Property Ownerl 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 description or drawing with dimensions must be provided with this letter. I DO NOT have objections to this proposal. 100 have objections to this proposal. Jf you have objections to what is being proposed, you must notify the N.C. IVIslo -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 notMed by Certified Mall. 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 somelall of the 15' setback Signature of Adjacent Riparian Property Owner -OR- I do not wish to waive the 15' setback requirement (initial the blank) M Signature of Adjacent Riparian Property Owned( rA Utrv'" I Typed/Printed name of ARPOmmd , C�� Q N `'' Mailing Address /o�f,ARPO: ✓1d 1 Ba'IA )�./tlIjfu 1,d\C y I ARPO's email: f t/ri Ut r f! ` I� � ARPO's Phone#: 3 i J CO�d Date:,3'�ov� `waiver is valid for up to one year from ARPO's Signature* Revised May 2021 c'.1�"�wsin•a.�.r�u,N=u..s yiu'µtx,•�s`,�*ya,�w:oey`taswi.r+b+,.Wtii.wyrrfiri,a$su.,,tlB.F.i+.eom�r�tmm.��a.,+.aua u��+s:•+:;,,sv,.z..,..�u.>,.��. N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY (Top portion to be completed by owner or their agent) Name of Property Owner: Address of Property: Mailing Address of Owner: ttw O4/r'il�� Owners emai . v Owners Phone#: L� Agent's Name: u%C�Oir7 Agent Phone#:JZ 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.G. uivision or r,oasrai Managerrient (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 slan the appropriate blank below.) 1 DO wish to waive some/all of the 15' setback Signature of Adjacent Riparian Property Owner OR C I do not wish to waive the 15' setback requirement (initial the blank)_ Signature of Adjacent Riparian Property Owne TypedlPrinted name of ARPO: w 1 5 Mailing Address of ARPO: ARPO'i dmail: 0—Pon, Date: KS )�1,AVe(. NL z�o37 Phone#: 0 'waiver Is valid for up to one year from ARPO's Signature' Revised May 2021 wxc, NC. TOM TYSINGER ' �� Av' m" 1126 SEA GATE ORNE NEWPORT, NC SoaVMFOURow PEWC[J.�J, W 26562 PROPOSED SITE PLAN .. 252-60.018 v