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Home My WebLink About89830A - Uperti-Patti° °°'�❑CAMA ❑ DREDGE & FILL N° 89830 A B C D GENERAL PERMIT Previous permit s 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 ' ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nayov/CAMArules Applicant Name Address City State Phone # ( ) Email Affected ❑ CW ❑ EW ❑ PTA AEC(s): ❑ OEA ❑ IHA ❑ UW 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/k Bulkhead/ Riprap length Avg distance offshore Breakwater/Sill Max distance/ length Basin, channel Cubic yards Boat ramp Boathouse/ Boatlift Beach Bulldozing Other SAV observed: yes no Moratorium: 'n/a yes no Site Photos: yes no — Riparian Waiver Attached: yes nor A building permit/zoning permit may be required Permit Conditions Authorized Agent Project Location (County): ZIP Street Address/State Road/Lot #(s) ❑ ES ❑ PTS ❑SPIMA ❑PWS i� Subdivision City '— Adj. Wtr. Body (nat/pan/unk) Closest Mal. Wtr. Body (Scale: ) ❑ 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** Application Feels) Check #/Money Order Signature Issuing Date Expiration Date AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS Name of Property Owner Applying for Permit: Mailing address: 0/?--i-`,Zf=-7/-/ C� >- 2-7909 Telephone Number: 2.r2 r-Zc)%-,-M( " I certify that I have authorized ' /1 ahY 2s� — `y'-V )(agent/contractor), to act on my behalf, for the purpose of applying and obtaining all CAAMA permits necessary for the proposed development of at my property located at L�/ ✓� '� This certification is valid through (Property Owner Information) nature Print Tyfib Name ambL Title, co. owner or trustee for property Dat Telephone Number Email Address v (date). DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED Name of Property Owner: Address of Property: L — (Lot or Street #, Street or Road, City S County) Agent's Name #: ILL411w1IQ "f'44f6/S6ilingAddress: U i�H bPe LEE f� Agent's phone#:1nIb'toS7a"�22oII / �� 271q% 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 drawin the develo ment they are proposing. r Yti4 rt�t a r ii (. —_ I have no objections to this proposal. I have objections to this proposal. If you have objections to what is being proposed, you must notify the 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 a 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. (if you wish to waive the setback, you must sign the appropriate blank below.) (Property Owner Information) Signature Print 4e hbme �l 441 pil lk V ISA �rrr e Mailing Address I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Adjacent Property Owner Information) Signature*. A( -AN 5 �>VT'56,AJ Print or Type Name ') I} Mailing Address U2et6�e 1� C . IJC 2?ylxf 1j�1�a, , u c FS`/�� 4% City/State/Zip City/st—at p aS� rX Ig t��l�u .r C�cyvlu�l. (,q3:�yo(o"9��t ds�,.�tsonG�Msh,�a Telephone Number/ ail Address Telephone Number /EmallAddress Date *Valid for one calendar year after signature* 7�13/a3 Date* Revised 2017 DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED Name of Property Owner. Address of Property: (Lot or Street #, Street or Road, Ci(y & County) 2-7110q 1 � Agent's Name M to L t'11wt It o f f 6ASiMailing Address: US ('i N-)L Agent'sphone#: ille"d ., NL 27-14 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 drawin the develo ment they are proposing. 9 i�'�K$Jt7&Rd ' ifcr4 s i ed i � I have no objections to this proposal. I have objections to this proposal. If you have objections to what Is being proposed, you must notify the Division of Coastal Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 401 S. Gruen St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264- 3901 Me response is considered the same as no objection if you have been notified by Certified Mail. WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me. (If you wish tow ' e the setback, you must sign the appropriate blank below.) 1 do wish to waive the 15' setback requirement. I do not wish to waive the 16' setback requirement. (Property Owner Information) Sfgnatzire &-Vto tT �--- print ornn eN me ti't�1, V" I lk Mailing Address :LU x1$, (1, J c 2I9 oq City/State/Zip 2,�D - -I 18 e M u r�i @ c yvhtra i . Telephone Number/ f4mad Address C,tgA Dare Valid for one calendar year after signature' (AdjacenVroperty Owner Information) Signature* p �t/cr j]rBcJn Print or Type Name ti �rePzewe)v� Dr. Mailing Address R-4 2 A L -14 01,4 d i90 9 City/State2ip d5d Telephone Number / Email Address 7ate*-I-a3 Revised 2017 � 3a p 0 1 A 1 e v S4-6IO� %A �I.