Phillips, Kelly 88605C

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ECEUa trDREDGE&FILLiGENgPlqL PERMIT
N9 8860s ABCD
Previous permit
Date previous permit issued
New E Modification I Complete Reissue E Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commlssion in an area of environmental concern pursuant to:
! n U. attached. [-l General Permit Rules arrailable at the following link: www.dE.nc.gov/CAMArulesI5A NCAC
t,
rApplicant Name
Address
Authorized Agent , "
Proiect Location (County):
Street AddresVState Road/Lot #(s)State ztPCiq/
SubdMsion i
City 7to
Affected Ea*
AEC(s): Eo*
ORW: yes/no
[]r* Erro
lrxa Er*
PNA: yes/nii
ES ! rrs Adl. Wtr. BodY
!serrrre Closest Maj. Wt.. Body i .' 'E(*
Type of Projeal Activity
(Scale:)
Shoreline Length
Access Len4h _
Pier (dock) length _
Fixed Platform(s) _
Floating Platform(s)
Finger pie(s)
Total Platform area _
Groin length/# _
Bulkhead/ Riprap length _
Avg distance offshore
Breakwater/Sill
Max distance/ length
r*r*r*j*-r*r-r
t
IT
Jt
Basin, channel
Cubic yards
Boat ramp
-
Boathouse/ Boatlift
-
Beach Bulldozing
Other
SAV observed:
Moratorium: n/a
Site Photos:
Riparian Waiver Attached:
Abuildingpermit/zoningpermitmayberequiredby:
yes no
yes no
yes no
yes no
Permit Conditions
TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
I S"" additional notes/conditions on back
*r-r
i
+s
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPTIANCE STATEMENT.(Please lnitial)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature iiPlease read compliance statement on back of permitii . .- .
r
Signature
Application Fee(s)Check #/Money Order lssuing Date Expiration Date
rv/-.!(
+
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I
Statement of Complianc€ and Consistenry
This permit is subject to compliance with this application and permit 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: 1) 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 from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(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 Neuse River Basin Buffer Rules
lf 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. lf you have any quesfions, please contact the Division of Water Resources at the
Washington Regional Ofhce (252-946-6481) or the Wilmin8ton Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
proiect area and disposed of in an appropriate upland location.
Division of Coastal Manaeement Offices
Morehead Clty Headquarters
400 Commerce Ave Morehead City, NC 28557
2s2-808-2808/ 1-8884RCOAST Fax: [phone]
(Serves: Carteret, Craven - south of the Neuse River, Onslow
counties)
Elizabeth City District
401 5. Griffin St. Ste. 300
Elizabeth City, NC 27909
252-264-390t
(Serves: Bertie, Camden, Chowan, Currituck,0are, Gates, Hertford,
Pasquotank and Perquimans Counties)
Washlngton Dlstrlct
943 Washington Square MallWashington, NC 27889
252-946-648L
Fax [phone]
(Serves: Beaufort, Craven - north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Wilmington District
L27 Ca.dinal Drive Ext. Wilmington, NC 28405-3845
910-796-72t5
Fax: [phone]
(Serves: Brunswick, New Hanover and Pender Counties)
hfip:llp ortal.ncden r.org/web/cm/dcm-home Revised 5/01/2021
N9 88605 ABCD
Previous permit
Date previous permit issued
I Partial Reissue
fu authorized by the Sate of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concem pursuant to:
l-l Rules attached. f] Cene.al Permit Rules available at the following link: www.deo.nc.gov/CAMArulesI5A NCAC
Applicant Name Authorized Agent
Address Proiect Location (County):
City State ZIP Street Address/Sote Road/Lot #(s)
Subdivision
City ztP
Affected cw
AEC(s): !oen
ORW: yes/no
EW E*o
IHA UW
PNA: yes/no
Ert
f]snrvra
!ers
!rws
Adj. Wtr. Body
Closest Maj. Wt.. Body
Type of Project/ Activity
(Scale: )
Shoreline Length _
Access Len4h db
Pier (dock) length
Fixed Platform(s) _
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length _
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
-
Boathouse/ Boatlift
Beach Bulldozing
other
-
SAV observed:
Moratorium: n/a
Site Photos:
Riparian Waiver Attached:
Abuildingpermit/zoningpermitmayberequiredby:
Permit Conditions
t-i**i-
yes no
yes no
yes noyes no
f] ravramr.rEUSUBUFFER (cir<re one)
l-l s"" note on back regarding River Basin rules
See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RUTES AND CONDITIONS THAT APPTY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT.(Please lnitial)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature i+Please read compliance statement on back of permiti+Signature
Application Fee(s)Check #/Money Order lssuing Date Expiration Date
ECATTNE EDREDGE&FILL
GENER/AL PERMIT
Phone#(-)-
E-otl
Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit 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: 1) 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 from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(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 Neuse River Basin Buffer Rules
lf 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 I cation within that River Basin. These buffer rules are enforced by the
NC Division of Water Resour questions, please contact the Division of Water Resources at the
Washington Regional Offi
Notes/Additional Permit
(2s2-946 or the Wilmington Regional Office (910-796-7215).
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
proiect area and disposed of in an appropriate upland location.
Division of Coestal Manasement Offices
Morehead City Headquarters
400 Commerce Ave Morehead city, Nc 28557
252-808-2808/ 1-888-4RCOAST Fax: [phone]
(Serves: carteret, Craven - south of the Neuse River, Onslow
Counties)
Elizabeth City District
401 s. Griffin St. Ste.300
Elizabeth CiW NC 27909
252-264-390L
(Serves: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford,
Pasquotank and Perquimans Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
9to-796-7275
Fax: [phone]
(Serves: Brunswick, New Hanover and Pender Counties)
http://po rta l. ncdenr.orglweb/cm/dcm-home Revised 6/01/2021
d
Washington District
943 Washington Square Mall Washington, NC 27889
252-946-6481
Faxt 252-948-047I
(Serves: Beaufort, Craven - north of the Neuse Rivec Hyde, Pamlico,
Tyrrell and Washington Counties)
a Comphte itrns 1, 2, and 3.
I Print your nslfls snd addess on the l€velso
so thal $,€ can rEtum tio card to you.
I Attach this cdd to tl€ back of lho mailplece,
or on the ftont lf
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COMPLE|E THIS SECTION ON OEUVEFY
SENDERj COMPL6-7E IH,S SECzOru
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by owner or their age nt)
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Owner's email:
Agent's tlame Agent phone#: 2-\}-6clO -79<1
Agent's
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(gottom portion to be )
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 pioposing. A
description or drawinq, with dimensions. must be provided with this letter
+- I DO NOT have objections to this proposal. I DO have objections to this proposat.
If you have to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice.Corrgspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 28557. DCM representatiyes can also be contacted
at [phone].IVo response is conside red 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). (lf you wish to waive the setback, you musi siqn
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property Owner
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I do not wish to waive the 15' setback requirement (initial the blank)K?
nt"o"pers*rtGffiffi,@1 7q 7
Signature of Adjacent Riparian Property Owner:r*t-, L PUtk-rz,t
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-t. fA , l, ,'.lt STyped/Printed name of ARPO:l{r{'t L
Mailing Address of ARPO
ARPO's email:
1 .L,">ll >&Jr' 5r
t.<:lskt cil2i frir I . -, ,,-'ARpO,s phone#: > '-1 rJ - '1 9 u -g. )Jl
p to one year from ARPO's Signature*
IDate: :--''-: *waiver is valid for u
Revised May 2021
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(ToP pii*ion
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Nami of Property Owner:
Address of ProPertY:
Mailing
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USPS TRACKI.IG #
5590 lqE? ?q57 e055 qth? ll
United States
Postal Service
ll| llill llll llt[filffiil]ffil lffiIl ;:,
First-Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
. Sender: Please print your name, address, and ZIP+4o in this box.
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I Complete ltcms 1 , 2, and 3.
t Print your name and address on lhe rsve6e
so that we can return the cad to you.
r Attach this card to the back of the mailplece,
or on the front il space permlts.
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If YES,
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delivery address below:
COMPLETE 7HIS SECTION ON DELIVERY
3. S€wico Type
tr Adult Slgnalul€
El Adu[ Slgnatu6 fidld.d Erollvory
tr C6rtlfi6d Mall Rautnod DCirry
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on Detivery ReBtric{Ed Deliv6ry
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PS Form 3811, Juty 2o2o psN 7530-02-ooo-90s3 Domestic Return Feceipt
SENDER: CoMPLETE THts SEcTloN
AGENT AUTHORTZATTON FORI{ FOB PERMIT APPLTCAT|oNS
Name of Property OwnerApplying for Permit:Kett'7 L'DluqP:
Mailing address:
\ oa C q9o6r* 2ilT Svarf,
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Telephone Number:S4o- *ro- G2"3t
I certify that I have authorized '?AAc*"r (Xz(b{(agenUcontractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of ifll\L3t{ E+t&o
at my property located at \ \ot, Sfaasz:
This certification is valid through
Owner lnformation)
(Eu,f ?td tzp,
Print or Type Name
(i$,r.P
Title,co. owner or trustee for property
Date
5 iedetT ntL 2Se'o
(date).
EmailAddress
Telephone Number
N,C. OIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED IVAIL . RETURN RECEIPT REQUESTED OT HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner
Address of Property:
It L. fur //,ns
ttbb S<r, 6a-le Da-t tt
Mailing Address of owner:Z \) 2*. Sf n()rok(d Q ac 28s57
owner's email: tellv. Lal|k"rJ l2Qrrrs/'ll lc6wneis Phone#: ;ttb- |tfu-D3/
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion lo be completed bv the Adiacent Propertv Owner)
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). (lf you wish to waive the setback, you EglSiE
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Propefty Owner
-oR-
I do not wish to waive the 15' setback requirement (initial the blank)
roperty Owner:
I
Signature of Adjacent Riparian P
Typed/Printed name of ARPO:,+a,c{/oL
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J0{tS>.lo h C,I
f 1){,J ."^- hmt"***.f/0 -le o Irtll
p to one year from ARPO's Signature'
ARPO's email:
Date:*waiver is valid for u
Revised May 2021
Agent s Name: _Agent Phone#:_
Agent's Email:
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
descriotion or drawino. with dimensions. must be Drovided with this letter.
Y , oo NoT have objections to this proposal.
-
| Do have objections to this proposal.-f*
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 [phone]. /Vo response is considered the same as no objection if you have been notified by
Cedified Mail.
Mailing Address of ARPO:,L"
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