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Home My WebLink AboutFaulkner, Evelyn A. 87351C°"°""' ❑CAMA ❑DREDGE & FILL No 87351 A B C D Previous permit GENERAL PERMIT Date previous permit issued �Vew ❑Modification ❑Complete Reissue ❑Partial Reissue As authorized by the State of North Carolina, Department of Environmental Quality and the Gopstal Resources Commission in an area of environmental concern pursuant to: I SA NCAC t� ❑ Rules attached. t�/�^-(('\General Permit Rules available at the following link: v~vdeq.nc.gov/CAMArules Applicant Name City Phone#(_)_ Email State \ ( ZIP Authorized Agent Project Location (County): Street AddS�//$State Road/Lot #(s) Subdivision City ZIP Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk) AEC(s): ❑OEA ❑IHA ❑uW ❑SPIMA ❑PWS Closest Mal. Wtr. Body ORW: yes/no PNA: yes/no Type of Project/ Activity Access Length Pier (dock) length Fixed Platform(s) kin In Floating Platform(s) 77— 1 .1/ ■AONIo�� ■ ■■■ I■I Finger pier(s) lei ■■■■i0 idC�-'� Total Platform area length/# Riprap length IGroin MME son■■.I ��11fi�'1 mC��■ L i■C. ■Bulkhead/ Vi. 040 C� ■1W ■��HME 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 IAM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) Agent or Applicant PRIN EDN e ./... Signature "4le�se ad compliance statement on back of permit" Application Fee(s) Check N/Money Order Permit Officer's PRINTED Name Signature ' Issui g Date Ezp rlrl atioh date #F!]New ❑CAMA ❑ DREDGE & FILL N° 87351 A B C D Previous permit GENERAL PERMIT Date previous permit issued [:]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: wwwdec.nc.gpv/CAMArules Applicant Name Address City State ZIP Phone # (_ ) r Email Affected ❑ CW DEW ❑ PTA ❑ ES ❑ PTS AEC(s): ❑OEA ❑IHA ❑UW SPIMA ❑PWS ORW: yes/no PNA: yes/no ' Type of Project/ Activity Authorized Project Location (County): Street Address/State Road/Lot #(s) Subdivision City Adj. Wtr. Body (nat/man/unk) Closest Maj. Wtr. Body (Scale:) '- ) �m .m .. mmm.mmm.�.. m■ m°m: �mmmm::mm�mmm m■ Avg distance offshore Max distance/ length Basin, channel yards Boat ramp IBi�3lfi ■ m. ■■■■■■ m.m .m gym, ■ ■ �Li i�i■ mm��;�.mm�....m■■■ ■■■■ ■N■■■■Cubic ��m�� i 1�..-e� . �i■ilmBeach p■■ ■■ ■ ■■■�� Bulldozing Other m� gym; � � mmm�mm��mg m ■ SAV observed:Moratorium; n/a yes no Site Photos: yes no . m ■. ■ 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 I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Agent or Applicant PRINTED Name Signature **Please Tead compliance statement on back of permit• Permit Officer's PRINTED Name Signature r71 i Issuing Date Expiration Date Application Feels) Check k/Money Order ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to (1 2i ✓ l N k 1l Sb q T C' L ( E-H er 's am of Pro erty owner)�N �-A 5 S 7 property located at 44 � S ' Co � (1 � �n 1� �[� (Address, Lot, BI� , Road en) on uP )Ll N� IUY ^ N.C. (Waterbody) (City/Town and/o ounty) The applicant has described to me, as shown below, the development proposed at the above location. 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) -,de �?-x (s J - 11�kwlvve 0.i I -J�2LLYV1 L r q- a _ J C` j n Sa Y14 � fir Z� WAIVER SECTION _— I 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 blank below.) 1 do wish to waive the 15' setback requirement. I do not wish to waive the 16 setback requirement. (Property Owner Inforrpat)on) (Adjacent Property Owner !9fo,7ation) iignatureu t L�J� l Cl N A i 45o.1 T u-. t `� vte C atgnu�ui e 7" �. %� A - / q Q �I R_- - -Pe�wamei �Iri24 Print orTypeName �nt4� U, 'waili g Ad Tess � 8ss7 Mailing Address .4 c ,y C crass' -(� City/StatelZip 7 city/stateljip '2(, �Z�e. ,. z3 RECEIVED - a ca-�ri1g. TelephoneNum er Telephone Number APR 192022 Date Date DCM-MHD CITY (Revised 611WO12) ADJACENT RIPARIAN PROPERTY .OiNNER S€ATEMgNT I hereby certify that I own property adjacent to �j a1ri of FP rty O ner) property located at 44 6 3 ' a � l o 1 C1 �__� (� IU �a8 5 S 7 y (Address, Lo Bloc Road e k j on �7ea l(C' ({ nl(i in. l?Yt fl gN N t t�f _ IV:C- (Vllateebody) ( "r7nown and/o ounty) The. applicant has described to me, as shown below, the development proposed at the above location. —— 1 have no objection to this proposal. _��_ 1 hava�-bj�cttoUs tc thic.�oroon�� --- DESCRIPTION AND/OR DRAWNG OF PROPOSED DEVELOPMENT (individual proposing aleveJopment must fiJ in description below or attach a site drawing) 42 { exi5b S) rP u Z7 i nL5i rr�+ L '- )Qse..�tit�G� f ri 5tx Jr!'I � �i _ WAIVER SECTION... ! understand that a pier, dock, mooring pilings, breakwater, boathouse, fist, 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 blank below- ,.,, I do wish to waive the 15' setback requirement. 1 do not wish to waive the IS setback requirement. (Pro Owner Information) SIffe e A) A 16.1 "i-G2 PrinforT a ame LT Lt t1 2 rn ell 'P4 IF� N1 C ;z S57 s Date Owner Print Telephone Number APR 19 2022 Date DCM=MI-ID CITY (Revised 6n&2012) AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: -1E�-`(E-1'-lt4 4211)) W T4)] kW-f Mailing Address: Phone Number: Email Address: I certify that I have authorized C �. -5y57 Agent I to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: %>-o'aT L --ff 1t4 -6*t5nj tT4<- V>-6y S L-1 f Arty -DbCA� (;6 T55-5GK - at my property located at Ll 'tb '5 C-bTAy f in OA PCECounty. 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 Print or Type Name Date This certification is valid through 1 RECEIVED APR 19 2022 1 DCM-MHD CITY