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Home My WebLink About89856A - Van Buren°`ta"ru ❑LAMA ❑ DREDGE & FILL No 89856 A B C D GENERAL PERMIT Previous permit Date previous permit issued O 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: 15A NCAC - ❑ Rules attached. 19 General Permit Rules available at the following link: www.deq.nc.goy/CAMAruIe$ Applicant Name Address City State ZIP Phone #(/i- Email _ - k O t Authorized Agent Project Location (County): Street Address/State Road/Lot #(s) Subdivision City_ Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/mwVunk) AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body ORW: yes/no, PNA: yes/no Type of Project/ Activity (Scale: ) Shoreline Lenmh Access Length i- ,_- ..,'�_- I- -_ -, - t `i"" >i• t _ 1.- _ Pier (dock) length I ..� Fixed Platform(s) f If 4 Floating Platform(s) s I - - -�- I l - Fingerpier(s) I Total Platform area t _ _ Groin length/# Bulkhead/ Riprap length Avg distance offshore '- _T _ _.f_- _ -__...._ i Breakwater/Sill Max distance/ lengthBasin, channel Cubicyards Boat ramp T Boathouse/ Boatlift I \ C Beach Bulldozing Other SAV observed: yes no Moratorium: n/a no r, yes Site Photos: Riparian Waiver Attached: yes no A building permit/zoning permit may be required by: (--\ rlft'vd (An ( C,:; Permit Conditions ❑ TAWPAM/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 PRINTED Name Signature **Please read compliance statement on back of permit** Application Fee(s) Check #/Money Order Signature Issuing Date Expiration Date RECEI\/ED N.C. DIVISION OF COASTAL MANAGEMENT ' 4 2023 ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM SEP CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY (Top portion to be completed by owner or their agent) DCIV —EC Name of Property Owner Address of Property: %r Mailing Address of Owner: :�?/ q e SUt CTh L'_/ U SS o rve- t 4 �k ( 4 1/ ,4 a 3r/ '1� Owner's email: /ifu r),r A&A 6' LAO%L o-n Owner's Phone#: -76 %- 4-Zn % —66 7 Agent's Name:)-&K& /r//PiineLOnS uC�uoAgentPhone#: at- ".33 6-3j3 Agent's Email: 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 forthis permit has described to me, as shown on the attached drawing, the development they are proposing. A n t`1A V 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 somelall of the 15' setback Signature of A djaggnt Riparian Propbrly 00ner -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: Owe- G�. /7 1 1 Mailing Address of ARPO: i j f [_dGe wcu r" Scd i / oA A) .;1 29 -7'1 ARPO's email: ARPO's Phone#: ,�5a3 — aU5? " gUy3 Date: *waiver is valid for up to one year from ARPO's Signature* Revised July 2021 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 try owner or their agent) Name of Property Owner. Y /-] Address of Property: SEP 1 4 2023 ®!. M-EC Mailing Address of Owner. � ,5otx?% On }} V4 qea Owner's email: �- LGr Owner's Phone#: 7fi 7- �Ro l `-/ 1 I Agent's Name: do/e6 Mkirl.t Ev ��nCfIYIC Dn l Agent Phone#:__2 5�2 -^ 33 j "'w3(✓� Agent's Email: J&yde f t n Cj p rt e r it ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION Bottom ooftton to be eomolated by the Ad' ant Pro ert Owner) I hereby certify that I own property ad)arentto the above referenced property. The individual applying for this ponnit has d cribed to me, as shown on the attached tlrawing, the develgpment They are proposing. q descri do r 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 objectfons to whot Is being proposed, you must notify the N.C. Division of Coastal Management (DCM) in writing wffhin f0 days orreceip[ of th/s notice. Correspondence should be mailed to 401 S. Griffin St., Ste. 300, E/izabeth City, NC, 27809. DCM representatives can also be noticontacted at (252) 264-3901. No response is Considered the same as no objection if you have been Ned 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.) ,//Q' I DO wish to waive sometall of the 15' setback // 11 All /�, J/1 -OR. signatNre of Adjacent ftipar' n.Eropeny Owner I do not wish to waive the 15' setback requirement (initial the blank 7� �) sue Signature of Adjacent Riparian Property Owner: Typed/printed name of ARPO: Mailing Address ofARPO: ( S� U01rR ARP Date: emalL'1(0 ) t ,4&O'sPhone#: CcS r� � r Cum Date: �� " % •waiver is valid for up to one year from ARPO's Signature - Revised July 2021 y 00 a,� !-%- "'71 er G ^. 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