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Home My WebLink AboutPenbrooke, Teresa 88661C'o*ICOAST4, ,. ❑CAMA ElDREDGE & FILL 9 88661, A B C D ffii �R 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 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.gov/CAMArules Applicant Name Address City State ZIP Phone # ( ) Email Authorized Agent 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 Shoreline Length Access Length Pier (dock) length Fixed Platform(s) Floating Platform Finger pier(s) Total Platform are Groin length/#_ Bulkhead/ Riprap Avg distance offsl Breakwater/Sill _ Max distance/ ler Basin, channel _ Cubic yards Boat ramp Boathouse/ Boatl Beach Bulldozing Other SAV observed: Moratorium: n Site Photos: Riparian Waiver < A building permit/zoning permit may be required by: Permit Conditions (Scale,: r', ❑ 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" Application Feels) Signature Check #/Money Order Issuing Date Expiration Date N°``°"S'"1 ❑CAMA ❑ DREDGE & FILL N9 88661 A B C D 0 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 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.gov/CAMArules Applicant Name Authorized Agent Address Project Location (County): City State ZIP Street Address/State Road/Lot #(s) Phone # (_ ) Email Subdivision City ZIP 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 Shoreline Length Access Length Pier (dock) length Fixed Platform(s) Floating Platform Finger pier(s) _ Total Platform are Groin length/# _ Bulkhead/ Riprap Avg distance offs[ Breakwater/Sill _ Max distance/ ler Basin, channel Cubic yards Boat ramp Boathouse/ Boatl Beach Bulldozing Other SAV observed: Moratorium: n Site Photos: Riparian WaiverF A building permit/zoning permit may be required by: Permit Conditions (Scaler. ) .;il ❑ 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" Application Feels) Signature Check #/Money Order Issuing Date Expiration Date ry IIW� Ilk lT V 4 AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION" Name of Property Owner Requesting Permit:s�, Mailing Address:�� 1�' 4- GJ-4�4'-- '2--� Phone Number: -�' , - S 5 m,. Email Address:�`� 6 c� f �� VY�I (.r�C"'►n I certify that I have authorized �-- �1.�� "�� ►�` l`�S l VLF l� Agent ! Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: 6ocV k, eim, e ic at my property located at in ( '0- County. 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 -T-eL - Per. Print or Type Name Title Date RECFI\.A This certification is valid through ,JUL 0 N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY (Top portion to be completed by owner or their agent) Name of Property Owner: l ov t%sn L - V-�(21.y C . Address of Property: kr oU, � IA I e +� c Uci Mailing AddressofOwner: �G�1111 Owner's email^t ��,A6-c(+( rZc�1. l 4' Owner's Phone#: I/-1 f r Agent's Name: (� 1� ✓; , ��YY ; �'" Agent Phone#: �� Agent's Email: �.. �� i� f i4 W?1(J �9 rf,\ c I c c1 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 description or drawing, with dimensions, must be provided with this letter. r 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.C. Division 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 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 15from 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 some/all of the 15' setback"i ' NA Signature of Adjacent Riparian operty er -OR- I do not wish to waive the 15' setback requirement (initial the blank) Signature of Adjacent Riparian Property Owner: r"7 Typed/Printed name ofARPO: K l 1 ns f) Mailing Address of ARPO: Lj (t _ 6d (1r `:) Q-Z: vy-) ARPO's email• C M Qi, ARPO's Phone#: y03 "Ll �J ,A Date: "waiver is valid for up t r °��' ARPO's Signature" Revised May 2021 Jul.. () A 2022 DCM-il\AHD CITY N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY (Top portion to be completed by owner or their agent) Name of Property Owner: --Qr/'PSr, L Address of Property: Mailing Address of Owner: Owner's email: �Ynab C P Owner's Phone#: Agent's Name: lk ✓11 �s �� t T� Agent Phone#: 01� 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 description or drawing with dimensions, must be provided with this letter. 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.C. Division 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 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 sign the appropriate blank below.) r I DO wish to waive some/all of the 15' setback Signature of Adjacent Riparian Property Owner -OR- I do not wish to waive the 15' setback requirement (initial the blank) Signature of Adjacent Riparian Property Owner: Typed/Printed name of ARPO: Mailing Address of ARP ��)G'� 1'C1 U Il'�;� C' (t�z`�rl,/�� ARPO's email: 9 i•' ( ( 0/A�RPO's Phone#: ;�,, l Date: I� ' L *waiver is valid for up to one year from ARPO's Signature* Revised May 2021 JIJI... 06 2022 DCM-MHD CITY NA,60 b- I 4� VED i JUL 0 6 2022 ®CM-MHD CITY Eel 11 I TkoKluy A-- Lt. A Elyfozr4 Ali 1) K'sil f, A FRI CAN RFCEIN/ED J U [ fl r, ? 0 2 2 DCM-MHD CITY