The URL can be used to link to this page

Home My WebLink About86870A Lewis, JacobMCAMA El DREDGE & FILL NU 86870 QC' A B C D GENERAL PERMIT Previous permit 3§-[I]New Date previous permit issued [:]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 s+ Address - Project Location (County): J'7"',x- '1 ' For City State ZIP Street Address/State Road/Lot #(s) Phone # ( ) Email Subdivision !' City ZIP Affected ❑ CW MEW ❑ PTA ❑' ES FAI PTS Adj. Wtr. Body f.,,n i ! .r- `,i < , i = I �(nat/man/unk) AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body 0, ORW: yes/no PNA: yes/no Type of Project/ Activity - ! (Scale: N,' ) Shoreline Length Access Length-- j i Pier (dock) length L Fixed Platform(s) —I t -- _ __ Floating Platform(s) Finger pier(s) Total Platform area __� ILL ' _. ' I � i —.~_ � e -� I - Groin length/# �— i _ - Bulkhead/ Riprap length r� Avg distance offshorei- - I t ^' - iI - -- -- -.i I _. ... Breakwater/Sill r s - �' 1 I�. h , Max distance/ length i 1_ jam. , � a>. � I k. - L ., .j . Basin, channel 1 Cubic yards I Boat ramp t V' Boathouse/Boatlik ✓—I _ — Beach Bulldozing '0" -_j_ ' Other SAV observed: yes no Moratorium: n/a yes no Site Photos: yes no - + — -- -f— f— -- - J - Riparian Waiver Attached: yes no '. 1 _ A building permit/zoning permit may be required by: Permit Conditions ❑ 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 Signature **Please read compliance statement on back of permit** ! r- Application Feels) Check #/Money Order Permit Officer's PRINTED Name Signature Issuing Date Expiration Date N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY (Top portion to be completed by owner or their agent) Name of Property Owner. A-COZ Lpa w)-5 Address of Property: �E� fu iy n 1 �'S - A) L,.LV— bcy)Q Kh'flrs' isG�cl, NC ZTris-o Mailing Address of Owner:l�(+ V'aut b 1L ". 6/ -Zsl ,dI Nc, 9'79 S-0 Owner's email: t w4stLew+i12cw(,ct''r-i Owner's Phone#: —7T7 s�gpZ� Agent's Name: ✓v0 .4 Agent Phone#: & Agent's Email: N�113 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 ho described to me, as shown on the attached drawing, the development they are proposing. A 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 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-3901. 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(alf 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 ARPy�/O: my t I t i fl /?1 do, o S+, A� A� Mailing Address of ARPO: / Sa C,gl en 4 i d . 146 tPS (h+1 C( A i ARPO's email: ARPO's Phone#:2 j ,) - I -o3e y Date: — "waiver is valid for up to one year from ARPO's Signature* Revised July 2021 ps �tw �rQecMiA �P-� 4sj t {,M � , A42- er '-Pu v4v-2C CAn��e� Para T un VC>-v Q d/a [IG 1 C�1�@��On c�ncl O-M Pu oct� �'c��•5 w { �. cl perm t -v c� Con�'�� k) ,a+ -Pc�,� e� �ev�g�c� c1 c%� (�mw1^9 ' - yl:�, A-x 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: rj, co �1 vs Address of Property: whfle.s /UeuC ulme . 75tt--J,/VC 27e/5-0 Mailing Address of Owner: S"^'ae cts •t bdve- Owner'semail: dawbRt-e, ..,t!21a,l- con Owner's Phone#: 75-"7-61S=3oLy Agent's Name: VV, Agent Phone#: ^/-4 Agent's Email: 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 forthis 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. It you nave 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 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-3901. 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/all 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: Mailing Address of ARPO: ARPO's email: ARPO's Phone#: Date: *waiver is valid for up to one year from ARPO's Signature* Revised July 2021 � '�ll�n:-: ��kiti� ��•�1 mti c �7('x,rA rvu5cc� �iw 1-";. �a no i SS�-e� w } h Cu•�.Wt � (l.�-w1�1 CN` { i�- t� f'as-u'i-i Chv't/} �tfCu;ft,•vof5 A. Signature ■ Complete items 1, 2, and 3. f Agent • Print your name and address on the reverse x d Addressee s so that we can return the card to you, 1 B by (Printed Nemec C. Date of Delivery ■ Attach this card to the back of the mailpiece, �3_ aO Z or on the front if space permits. ` ess'diI16*Chom nem 14 0 Yes F 1. Article Addressed to: D. Is delivery addresstielow: ❑ No if YES, eilvery [ 14 3 t. rL, f eS ��lf c!c Lar P i1 A`f •�'" t;" k� s Z ili�A ,VC z74 sr7 - . ., ., 3� I !! II ff ll ````ll 3. Servi Qe ❑ Prforil% mail Fxpressa II��Illl��lll�llllllfl� IIIIIIII IIIIIIII�I ❑Adultsi ❑Regfeteredmall.R Adult Slgn gelrlctsd Dellvary ❑ Istarad MtJI Rest laced p Certfled Ma ycaice�m q�lpt far 9590 9402 4603 8278 9070 59 ❑ Cart ct ail c�6d�11(erY .-Merd�andise ❑ Collect on Deon livery Restricted Delivery Signature Confirmation"" 2. Article Number R"ransfes from servlcelabe0 ,�..r, �.�i ❑Signature Confirmation 'afl Restricted Delivery Restricted Delivery ?013 1?10 0001 2001 2495 PS Form 3911 , July 2015 PSN 7530-02-000-9053 Domestic Return Receipt ( 60rmt"j POOT P(,AAI r-09 NCW -ROM Oqmp �l 6V�Avc_Uwcl N AT lsf� WWOE", LAN&' A _tv SCAT AAAA p ry Ec i of —,be ,4j zo, Lo_.vc_ 455(.4c,u4 Q56 or- IVC\,V C4 IV6 "17 IVWL Eyck'tlo I i �93 Jacob 1�10 vp f r. mww f14 ft