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Home My WebLink About88843C - Blakely, Dodieja°FcOAST41I ❑CAMA ❑ DREDGE & FILL N9 88843 A B c. D y Previous permit GENERAL PERMIT T ❑New ❑Modification [:]Complete Reissue ❑Partial Reissue Date previous permit issued 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 cc.�._k )o 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/noPNA: yes/no Type of Project/ Activity (Scale: Shoreline Length Access Length 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: yes no Moratorium: n/a yes no Site Photos: yes no Riparian Waiver Attached: yes no A building permit/zoning permit may be required by: �t��yf� l (:VZ< e�' ( r��.N �1 :A s Dtf�c o r iQnr` �nxsrc� t ; ❑ TAR/PAM/NEUSE/BUFFER (circle one) Permit Condition -. �_.�� t ,, :•,,+ . ❑ 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 Signature "Please read compliance statement on back of permit" Permit Officer's PRINTED Name Signature Application Feels) Check #/Money Order Issuing Date Expiration Date ,1*jW 41NEICAMA El DREDGE & FILL N9 88843 A B C' D 4 = GENERAL PERMIT Previous permit J 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 i 4-0 . I i ; ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules Applicant Name Address City State Phone # ( ) Email Affected ❑ CW ❑ EW ❑ PTA AEC(s): ❑ OEA ❑ IHA ❑ UW ORW: yes/no • PNA: yes/no Type of Project/ Activity Shoreline Length Access Length Pier (dock) length Fixed Platform(s) Floating Platform(s) Finger pier(s) Total Platform area Groin length/# Bulkhead/ Riprap length I (d Avg distance offshore Breakwater/Sill Max distance/ length Basin, channel Cubic yards Boat ramp Boathouse/ Boatlift Beach Bulldozing Other Authorized Agent ` k. Project Location (County): ZIP Street Address/State Road/Lot #(s) Subdivision City ES ❑ PTS Adj. Wtr. Body ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body P nat/man/unk) (Scale: i" = ( ,,, ) I i SAV observed: yes no Moratorium: n/a yes no I E i Site Photos: yes no Riparian Waiver Attached: yes no t 1 r � A building permit/zoning permit may be required by: ��t..• ' ,?f ❑ TAR/PAM/NEUSE/BUFFER (circle one) Permit Conditions ❑ See note on back regarding River Basin rules ElSee 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 Feels) Check #/Money Order Issuing Date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: � o � f,� I L—' Mailing Address: 1 Phone Number: Email Address: �" r I certify that I have authorized i�- 5 � fps c:cj ' cf �i r Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA p . rmits j_ necessary for the following proposed development: at my property locate at ine 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 evaluating information related to this permit application. Property Owner Information: Signature �- I ck Q� Print or Type Name / 0 VJ A) Title RECEIVE® Date This certification is valid through I I Clip k.—., � _tj S I hereby certify that I own property adjacent to "7 property located at �J (Waterbody) P perty Owner) Addr s, tot Block, Road, etc.) . N.C. in (Cityftown an or County) the development proposed at the above PP The applicant has described to me, as shown below, ij locatio I have no objection to this proposal. I have obiecti�rtso�i�is��op�sal-- - ---- --- DESCR1PT1ON AND1OR pRAWING OF PROPOSED DEVELOPMENT ` a1 osing development must tilt in description below or attach- a site drawing) (Individual proposing. p it o t, �ZPO ,, I )NAIvt=_R SEci1.0N .be set boath--- I understand that a per, .dock, mooring pilings, breakwaanras°unless�wai ed'by met (If you back a minimum distance of 15' from my area of ripa k below.) wish to waive the setback, you must initial the appropriate blan I do wish to waive the 15' setback requirement. _ I do not wish to waive the 15' setback requirement_ kAdjacant Pfoperty Own r In or ation) ('Property Owner Information)Pr �i // iZ {3��G i Print or iflame Print or Type Name �4mr fits Mailing Address ! � �' a Cii. /Sete ip City/Stat.. 1p c Telepho Numb(�cc Telephone Number Date RECF-7IVF Dais (Revised 6/18/g012) ')CM-IViHD CITY T- hereby cerbiv that 0 umn pr�a� ° adliau-001 le — ��i�►trt N�'aa+cary Read meted a -.— C . --� " (Address, Lo Block, Road, etc.) r' N.C. (Waterbody) (city/Town and/or County The applicant has described to me, as shown below, the development proposed at the above locatio I have no objection to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT ELO M a site drawing/ flrrdividual proposing development must fill in deseripbon be/ zri 001 f I C., '�� a i 103 i t� es`r�tN� gwlK�� WAIV=R SECTION _ rein must be set _ I understand that a pierd of 15' fromn y a`rea of P anr=ess°unlesstwaved by me- (If you back a minimum distance wish to wave the setback, you must initial the appropriate priate bkinkbelow.) I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement (Adjacent Property n�er Infe�r�yration) (property Owner Information} w7r - - - - Sig" ere SYgratur'e print or Type Name Print or Type Name ' = -- 0 ►(0/�/ <<4�n7tif l,!3 /�. � � Mailing Addrsss rViailin Addressal (Je ipd Cify State/Z p 5— 1161 e♦ I W ZP d - - Te" hone Nu ber Telephone Number�t- a,. Date RECEAN C Date (Revised 6110012) KID 0 L! 2022 DCM-10HI) CIT°°' U N N O N W c. N A N O z