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Home My WebLink AboutEvans, Rod 90018C'P`°"r', DICAMA El DREDGE & FILL N9 90018 A B' cl D 114. GENERAL PERMIT Previous permit Date previous permit issued ,BNew ❑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: /� IFs I SA NCAC ; / -/) �VJ''c� ❑ Rules attached.,Q General Permit Rules available at the following link: wvvvvc1eq.nc.gov/CAMAruIes Applicant Name �106( iVt� Address I�.: +z>: C( •�%!')!`'i�.. City A ) ii+ni [. ECGI ClaState '\J C..- ZIP rf Phone # (Z< Z) '" Email �\%AYLS""� P.VCro1S In✓r�CtS Ss�f. v1 t.i'" 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 i!,• 1! _ Access Length�� Pier (dock) length �- FixedPlatform(s)^'r: Y,r�• I I Floating Platform(s) Finger pier(s) ;� `IPi- "d x SC• Total Platform area e?S2 (4 'L- Groin length/# Bulkhead/Riprap length Avg distance offshore !` Breakwater/Sill Max distance/ length Basin, channel Cubic yards Boat ramp Boathouse/ eoailift � f � � '✓ t.)� 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 Permit (Scale:; ) ❑ TAR/PAM/NEUSE/BUFFER (circle one) See note on back regarding River Basin rules ❑ See additional notes/conditions on back 's 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 Officer's PRINTED Name - Signature Application Feels) Check#/Money Order Issuing Date Expiration Date �&°`0"" QCAMA [IDREDGE & FILL 1 GENERAL PERMIT N9 90018 Previous permit Date previous permit issued A B C) D 1 J 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 `-- z` ❑ Rules attached. General Permit Rules available at the following link: vv w &Q.nc.gov/CAMArules Applicant Name I:� f- L" t Address - - D, c ' City .s _,;_�.��.StateI�ZIP Phone Email�.r,c Authorized Agent Project Location (County): !- Street Address/State Road/Lot Subdivision City .. ZIP`i Affected ❑ CW EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/mah/unk) AEC(s): ❑ OEA IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body I ORW: ves/no- PNA: ves/md" Type of Project/ Activity 414 / (Scale:. ) Shoreline Leneth / AccessLength— 0 Pier (dock) Fixed Platform(s) / i ■: E:0::::: i .. :� �■■:■::: a::v Floating Platform(s),i ■ •��!�r■■■■ mum ■■■■■ ■N Groin length/# Bulkhead/ Riprap length Avg distance offshore w�r�nw w Il �wNNW ■ IN! I Nil A building permit/zoning permit may be required by: Permit Conditions I ❑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 PR N E Name Signature *'Please read compliance statement on back of permit• Signature 4plication Feels) Check p/Money order Issuing Date - `�EXpiratlon fate 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. Address of Property: 1 '3 Z r,Ory a 'r%r Mailing Address of Owner: r3.Z V o r,-cr 0" / c Q E 2 , Z owners email: iavnvy even<�yS��Owne Phone#: 2`5 Z 'S Z `Q4S3 Agent's Name:4J{{�� 6!`g2,..�g Agent Phone#:_ 2 '2 2�}I- 1.5011, Agent's Email: !' n i.JUol 1G nc. 0 o m a i I C o w ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom portion to be completed by the Adiacent 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 descrintinn.or rlmwimn ..,eti a�...,,.,..�...,,. �.._. _-.... _ . ... V I DO NOT have objections to this proposal. I DO have objections to this proposal /f 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.) I DO wish to waive some/ail of the 15' setback Signat urIf of Adjacent i n 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: _ \} Cd �S. N. 11,,S, Mailing Address ofARPO: ARPO's email: n r J �ARPO's Phone#: Date: -.waiver is valid for up to one year from ARPO's Signature - Revised May 2021 RFCFIVFD JAn s 1 Inn bf�It«�tt�f�!e o-�•I'p.Y I L 0.0 - �F� . 0 R.FCF!VI=D AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: 12 d Lf V 4,0,i S Mailing Address: Phone Number: �� iL ��13 /1 cs� Email Address: reyans4 CI%CCVLS ant a SSO C- t'►Q7� I certify that I have authorized m V-d h�ci��-i flecLg �S IaC' Agent t Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: Z�`ifZ at my property located at )3•Z Po N4 TDr iUa i�N L, inC A a3•e-e/ County. l 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: C11 Signature �0 d C:VaKS Print or Type Name Title 30 Date RECEIyFD This certification is valid through / f JAN 31 M 0( m-MrlU i,;ITY N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM CERTIFIgD MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY (Top portion to be completed by owner or their agent) Name of Property Owner: p d Address of Property: ) -37!O w a�pt V ! j cr �2�' Mailing Address of Owner. 112 Vor 4 YJ,-f ,� h1.{ bo ,.,,4i rc 1�•'t �%iT N Owner's email: LSZ S2I "r 5,3 Owner's Phone#:r-?\.fQn __ '�V9✓) GhLI Drys Agent's Name: ".,-. fk��,_Agent Phone#: Agent's Email: vn a' L [ a f �"- ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom portion to be completed by the ,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 cr' tion or drawin with dimen io must be rovided ith this letter. I DO NOT have objections to this proposal. i DO have objections to this proposal. 1t 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 malted 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.) I DO wish to waive somelall of the 15' setback • -OR- Signature of Adjacent Riparian Property Owner I do not wish to waive the 15' setback requirement (initial the blank) Signature of Adjacent Riparian Property Owner: Typed/Printed name of ARPO: . ?OAo e /-�//�� Mailing Address of ARPO: J�es Z C urrrar m /`�.iAv+ .t'ol /C , le.-; [, NC 2 ARPO's email: �" f'/ ARPO's Phone#: Date: Z q- Z3 «waiver is valid for up to one year from ARPO's Signature' Revised May 2021 RF C.P. tV?!= D JAN 312013 DOA-PAHU CITY ............. ill Ver I-X RECf,: JAN 2 1