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Home My WebLink About88408C - Zehner, JeffAcour'&EICAMA ❑ DREDGE & FILL N9 88408 A B C D Preous permit GENERAL PERMIT D teprevious permit ised 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: wwwdea n<gov/CAMArules Applicant Name 111 1 F' 'i Authorized Agent Arm-- - - Project Location (County): Street Address/State Road/Lot City Phone # (_ ) State ZIP Email Subdivision City ZIP Affected 0 CW ❑� W ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body �� 1 i 11 (� i Lv (nat/Tan/unk) AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body ORW: yes/no PNA yes/no Type of Project/ Activity ,t X / (% -��; �_,S-..i.i'a .� �.>� r� 7 �L-✓('«=� (Scale:! v l 5) 0 MEN OEM1111m, loomsME MEMO so I Now NMI e 0ieOM u 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 r 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" 1 Signature Application Feels) Check p/Money Order Issuing Date Expiration Date #F-]New ❑CAMA ❑ DREDGE & FILLN9 88408 A B C D GENERAL.PERMIT otePegoslpermitissued []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: wwwden nc gov/CAMArules Applicant Name _ Address City Phone # ( ) Email Affected QCW AEC(s): ❑OEA ORW: yes/no ❑' ❑PTA ❑IHA ❑UW PNA: yes/no Type of Project/ Activity ZIP Authorized Agent Project Location (County): Street Address/State Road/Lot #(s) Subdivision City ES ❑ PTS Adj. Wtr. Body (nat(man/unk) ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body (Scale: ; ) ■ a ■ ■�■■■ ■■■■ ■ ■1■� ■■■■ ■■�a■■■■■ ■n■■.■■■ .1. . ■iliiiin11�1111ONES lSEE 11::111 1'�'.�11 ��MEN :: 1111:111111111 a ■ ME on ■■1■111■ 1a■.■.� ■■ONES■11■11■1■■■1 ME MEN MEMO "11 :"1 01: 1 1110 E �110 .11�11111.■■11.■■E�1NE1111111 ■11■ :1111 11p11C�� 1� 1in 11C11111 :1 '111"' • 1. IN 1is ■MEms111�..�i.■, 1 ■1■11...111: 1i . ..i■1■■.■.■.■■.■■�■ �■ SAV observed: yes no.■■■■..■■■■■ Moratorium: n/a yes noNOON Site Photos: yes no ■■. ■N - 0 8■■1 ■■1 ■ ME am ■■H.. ■■ . ■.■. 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 Initial) Agent or Applicant PRINTED Name Permit Officer's PRINTED Name Signature **Please read compliance statement on back of permit** Signature Application Fees) Check #/Money Order Issuing Date Expiration Date Name of Property Owner Requesting Permit: Mailing Address: Phone Number: Email Address: I certify that I have authorized e ff er A. -- Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: P' t ter II at my property located at --� in— bml o cV 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 permit application. evaluating information related to this Property Owner Informatlon: Signature Print or Type Name Title S /2 12L Date This certification is valid through N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION..NVAIyERFQRM CERTIFIED MAIL • RETURN RECEIPT Rr rnr lent,.. . . _ (Top portion to be completed by owner or their agent) Name Of Property Owner. c L9_ti r!n Address of Property: —IiM f-i j) AtiIipr %n/o4 OA a /'sn ,1 Mailing Address of Owner: YI M (1 Owner's email: a=-=4�%ent Owner's Phone#: Agent's Name: Phone#: 41o,9ati�+try Agent's Email: i.. _J n _ - •. ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom ooRlon to be completed by tha Adjacent Prooertv Own i I hereby certify that I own property adjacent to the above referenced roe The individual a this permit has described to me, as shown on the attached drawing, the development they are proposing. 9 de tlo dre wth imensi s mustb2 grovidedis I fter . J b� I DO NOT have objections to this proposal 100 have objections to this proposal. Management (OCM) In writing within f0 daysOf aQO rece pt of (hk notlea�Comes D1 v�l on o/ Coastal mailed to 400 Commerce Ave., Morehead C/ty, N receipt DCMreresents Correspondence should be Of (252) 808-2608. No response /s considered the same ss no ob ec0on If s can also be oontected Certified Mall. /you have been notMed by a1 I understand that an WAIVER SECTION 191i groin must be set back a mnnmum dis ce of mooring my area of riparianbreakwater. xcess unlesspwaived by me r ��Q�1 (this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign p J the appropriate blank below.) I i DO wish to waive some/all of the )setback -0R- Signature of Adjacent Riparian Property Owner U I do not wish to waive the 15' setback requirementkInitisl the blank) np'L Signature of Adjacent Riparian Property (20r Typed/Printed nerne of ARPO: 11 N)tY)- 7 H 71 otJ {Lr`t bn Mailing Address ofARPO: 2Vl? ARPO's smell: ... ARPO's Phone#: Date: �i �I �, y v 'waiver Is valid for up to one yearfrom ARpO's Signature - Revised July 2021 N.C. DIVISION OF COASTAL MANAGEMENT r ADJACENT RIPARIAN PROPERTY OWNER NOTIFIcAnoN1WAIVER FORM CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY (Top portion to be completed by owner or their agent) ADJACENT RIPARIAN PROPERTY OWNERS CEOTiFICATION mew_ I hereby earthy that I own property adjacent to the above referenced property. The individual applying forthis permit has described to me, as shown on the attached drawing, the development they are proposing. A deacriotion or drawinn with i DO NOT have objections to this proposal t DO have objections to this proposal. geme»t MI in writing wlth/n 10 days of receipt of this notice. Cpnespontlerice should be waited to 400 Commerce Ave., Morehead City, NC28557. DCMrepresentatives can also be contacted at (252) 808-2m. No response 18 cotrsfdersd the same as no objection if have been �otmad b Cery UBed Mall. TA�` 1'vnderstand that an WAIVER SECTION y 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 yt (this does not apply to bulkheads or dprap revetments). (if you wish to waive the setback, you must sign pin the appropriate blank below.) I DO wish to walve(�so31011of the 15' setback •OR - Signature of Ad% cent Pip, Property owner I do not wish to waive the 15' setback requirement (initial the Wank) Signature of Adjacent Riparian Property Owner: TYPedlPrinted name of ARPO: / Mailing Address of1/ARPO: lbQ�� ruS �Coc" /1A/Pr t/c 276/�' ARPO's email: er'k a -.I A,7 crrl _ ARPO's Phone#: __ LL ( ,E7 / Date: S 2 7iZ *waiver is valid for up to one year from ARPO's Signature* Revised July 2021 -s c t r ,,_ J 7 k