HomeMy WebLinkAboutCarithers, Bryan 88751CoFcoAS41 N 0 ..D , " A B C D
&F�CAMA ❑ DREDGE & FILL
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s 3 Previous permit
y . GENERAL PERMIT
Date previous permit issued
❑ New ❑ Modification F-1 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 1-1 Rules attached. 1-1 General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name AA) I
Address ">. A ; ,�`.�'�,'- a f ..� � y # i ;; ; `•,r
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City "'' .. �: State ZIP
Phone # ( )
Email
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
ZIP
Affected ❑ CW ❑ EW 1-1 PTA 1-1 ES FIPTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA 1:1 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(s)
Finger pier(s)
Total Platform area
Groin len th #
g /
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp 1
Boathouse/ Boatlift
Beach Bulldozing
Other
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A building permit/zoning permit may be required by:
Permit Conditions
" ❑ TAR/PAM/NEUSE/BUFFER circle one
F-1 See note on back regarding River Basin rules
F-1 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
lvr
a
Signature "Please read compliance statement on back of permit" Sign ture
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Application Fee(s) Check #/Money Order Issuing Date Expiration Date
of -9-8751,OAS41 N A B C D
o� &FICAMA ❑ DREDGE & FILL
ac
a Previous permit
2 GENERAL PERMIT Date previous permit issued
❑ New ❑ Modification F-] 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 1-1 Rules attached. 1-1 General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # ( )
Email
State
ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
ZIP
Affected 1-1 CW 1-1 EW 1-1 PTA FIES FIPTS Adj. Wtr. Body (nat/man/unk)
AEC(s): F—] OEA F 1 ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale,, ,
Shoreline Length
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A building permit/zoning permit may be required by:
Permit Conditions
1. ,a ❑ TAR/PAM/NEUSE/BUFFER (circle one)
F-1 See note on back regarding River Basin rules
F-1 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
r
-IS
Application Fee(s) Check #/Money Order Issuing Date Expiration Date
11 piiiiiiiq� 11111111111q� ;111111111i�� III
4. IN ir
=610�7 M R
Name of Property Owner Requesting Permit:B�"A') cITT
Mailing Address: e v----
�'
Phone Number:
ir-Email Address:
I certi' thCat I 11-%Iave authorized e3 L4 I
ty
Agent Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: o C.�
�so�Pri L-1�. � --
at my property located at f -2 7
P-�
in Gf�`M L County.
I furthermore certify that / 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 Informati
ZI
Print or Type Name
Title
CL
Date
D C
I Iikll
This certification is valid through
N
ADJACENT RIPARIAN PROPERTY OWN99-STA.T�EMENT
...........
S
J(�
that I own pfoperty adjacent to 9*9
I hereby ceMy
(Name of Property - Owner)
$J )
;1 "7 VIDR:V PP.. -
Property ed at
(Address, Lot Block, Road,
g;gr�l N
on in I I -C-
ptyr(Town andior Countybody) 40
-Tb.e applicant has described to me. as shown below, the de-velopment proposed at the- aboviez",
I have no objection to fts proposal.
tnayejo
DESCRIPTION . AND/OR DRAWING OF PROPOSEO DEVELOPMENT
(Indhridual proposiryg 46-velopment must Hit ill Clescription below or aftach a site drawing)
Y
4."
VIM r4
454 41
WAIVER S TION-
............
I st be se�
el till or nr1:4n rnnU
7 reakwatzar, b0zthOUS
pffings, b i
ier dock, moorin you
i�l P 4,
area of ripadan ac:ess ur11e-qs`?'aN-ed"'.W
tack a minirmum distance Ott 'It 5' tom my a- - . 4
L.�
the czeetbacK you must initial the appropriate blarkbel
,urish to waive go 60 L 4. &O,.t�aNe tie 151 setback requiremenL e ! do wish 1. 1 %�f Lh %9 P
V'100�11 do not inish to waiVa e 151 setback requilfemerk-
----------
(Adjacallt pToperty Owner iIformafictn
?!pro
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P i rt or ype
or Type ,sae
1:2-7 '54449Z _V-e,
are
ing Ads S s Q,
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R E C F V UL,7�
NOV 0 3.�
DCiV-;MHD
ADJACENT RIPAPJAN PROPERTY OWNER§TATEMENE
I hereby certify that !own property adjacent to
$ �l�3 ,M ��� C��Its 'S
(Name of Property Owner)
property located at � � � 5 �� ��---' ���'-i ��l �' — -
(Address, Lot, Block, Road, etc.)
on in N-C-
(Waterbody) (City/Town and/or County)
The applicant has descdbed to me, as shown below, the development proposed at the above
[Of-nfion.
I have no objection to this proposal.
1, h,
-Dti-e,-c-tLo-n--s-to-tbis-pr-o-p-o-s-aL---------
DESCRIPTION ANWOR DRAWING OF PROPOSLc-D DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
X100" 900 f two
134
r �� $ J I1.�7
r4
P `�
R SEC
�TLe at.,
WAIVE -rION
I understand that . a pier, _dock, moodng pifings, breakwater, boathouse, or groin must be'set
back a minirnum 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 ware the 15t setback requirement.
I do not wish to waive the 15' setback requirement.
(Pro er Information) (Adjac�pt Propeft)�-Gwner Informat'on)
Print or Type. Name
Print or Type Name
g
Mailing Address m inAndres
e a, A AV
cityls /Z,- citylStatel-Zip
t" 1P_
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( e Teiephofle Number
e..Iephone NuTb&-
Date Da' aye R E C F V F D
(Revised 6/18/2012)
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