HomeMy WebLinkAbout89849A - Jones, M.❑CAMA ❑ DREDGE & FILL N9 89849 a, B C D
Previous permit
GENERAL 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:
I SA NCAC I ❑ Rules attached. ] General Permit Rules available at the following link: wwwdeq.nagov/CAMArules
Applicant Name _
Address
City
Phone # ( )
Email !
State
P
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s) _
Subdivision "'0,
City i.
Affected ❑ CW 0 EW ❑ PTA ❑ ES ❑ PTs Adj. Wtr. Body I r' t,: . (fiatJman/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. 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 length/#
Bulkhead/ Riprap length
Avg distance offshore _
Breakwater/Sill
Max distance/ length _
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
J� J_
SAV observed: yes no I
Moratorium: n/a yes no 1
Site Photos: yes no-�
Riparian Waiver Attached: yes no _
A building permit/zoning permit may be required by: 0 A\`,
Permit Conditions
(Scale: 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) Y,
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
IUv �Yti� IUyo
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONfWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: Y19 R Y'c C bizz'T T kNG�s
Address of Property:
R
Mailing Address of Owner: me —
Owner's email: C I VO C o r'YI Owner's Phone#: Sqz, oS -q1-3
� / •
Agent's Name N A Agent Phone#:Al L,}-
Agent's Email:
L
ADJACENTRIPARIANPROPERTY 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
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 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 (Choose only one
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.)=(�L/!//J/!
I DO wish to waive some/all of the 15' setback - c FI i�
Signature Aiijecent iparia Property Owner
-OR-
I DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner. V �
Typed/Printed name of ARPO: %,r/y,o r i%WeA1 :44 +1 Ae64P✓.v17 X ILL
Mailing Address of ARPO: P,0 , 8" aj (P
J f
ARPO'semail: (/�LJ�S� y�tnr<iuvKAARPO'sPhone#: '757 4J) 1a37
Date: 9/s13Po13_*waiver Is valid for up to one year from ARPO's Signature'
Revised August 2022
Sa.,th ,h �Li90
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
5
(Top portion to be completed by owner or their agent) 0:54V
Name of Property Owner: hr1 A Q Cr A R EI J J N E SQ
Address of Property: jS"UV &&6�7 .Dr-L. WC tN^^l i �_ Z 79y?
Mailing Address of Owner: S[Z.*K_e11 GL� 'et b4✓�
Owner's email: M '� A A/E-5 /do EJ Owners Phone#: S `/ U `j 0 S aJ /3`f
Agent's Name: Agent Phone#: A
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
{Bottom portion to be comptetettbythe Adjacent 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
NOT have objections to this proposal, I DO have objections to this proposal.
it you nave objections to what /s being proposed, you must notify the N.G. Division of coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
malted 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 (Choose only one
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 Hpadan access unless waived by me
(this does not apply to bulkheads or riorao 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
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:
SSetr
Typed/Printed name of ARPO: I AgELf I VOVP�j 1LPGIL by �/Iy' / r�
Mailing Address ofARPO: 537nn0 QI')OA14L- ! Or�o��� V14 %3502.
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ARPO's email:i(1I�ij D AOV2V0YU A IOARPO' Phone#: r% 52� � r? I - 3 / 00
Date: H ( I i uit -waiver is valid for up to one year from ARPO's Signature'
Revised August 2022
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