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HomeMy WebLinkAbout89859A - SettlesN° QGQCG ]CAMA 0 DREDGE & FILL ^ B c D a GENERAL PERMIT Previous permit 3 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 I' 15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: wwwdeq nc gov/CAMArules Applicant Name h Address I City States ZIP Phone#('—i) Email 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 (Scale: ) ...............r Access Length Pier (dock) length Fixed Platform(s) i � i i I l- � i i Floating Platform(s) EiS j Finger piers) Total Platform area Groin length/# Bulkhead/Riprap length -ri I "= �— -C� a- I— i— —�—- Avgdistanceoffshore —� Breakwater/Sill 1 Max distance/length Basin, channel Cubicyards I I T 1 f Boat ramp Boathouse/Boatlift I I "'a i } I Beach Bulldozing Other SAV observed: yes no Moratorium: n/a yes no I "">"' I� -_ j 0 Site Photos: yes na ------�- -r- Riparian Waiver Attached: ves no 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 Permit Officer's PRINTED Name Signature **Please read compliance statement on back of permit** Signature r. Application Feels) Check #/Money Order Issuing Date Expiration Date 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: Ar"i D ; Address of Property: Mailing Address of Owner: Owner's email: C:4L, nL aZgP 57P4 Owner's Phone#: f LSr`-t - L' 1 �� Agent's Name: (GtAEl1Prt tq&d-Jgtr 37.11C-- Agent Phone#as 1�-3a' ' 112313 Agent's Email: 14q Wdo'n rV1fA �e� F✓IA•�• Coen, 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 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 revelments). (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 f5' setback requirement (initial the blank) Signature of Adjacent Riparian Property Owner: Typed/Printed name of ARPO: Mailing Address of ARPO: ARPO's email: Date: ARPO's Phone#: 'waiver is valid for up to one year from ARPO's Signature' Revised July 2021 ZO-989804HVOUH 9908$ 9ZBEZ VA'3NV3dVS3HO d31131 W03 OIVd 30V1Sod'S'n N \ Fc { y qq 4i -n U- ® O- Ln s� `p .D a O r ru Ln 0 N 0 n, m s � m 9o9e P1' Yt �- t woo « NULL _ i _ z Luiu w F-- J d mit w n �c V r[. `V\l rI V., NI hl� rcr' rcitt' tea 9T hh65 h990 0L29 O'Lz0 6996 A! N A AG 49 x i � r +I hrR r R F y 1t i PC v U) .Q c O N 77 O C I AK oTo o Q N 0 Q m m v Z