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Home My WebLink About87047A - Green"UWXVhN[2CAMA ❑ DREDGE & FILL GENERAL PERMIT New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue lY 9 87047 A B C D Previous permit Date previous permit issued 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: Applicant Name City Phone # I—) Email ❑ Rules attached. ❑ General Permit Rules available at the following link: wwwdeo nc gov/CAMAndes Authorized Agent , .. J !'t-. F `I"- ``-u'-+� Project Location (County): t State ZIP Street Address/State Road/Lot #(s) City 4- Cyl ,. 'I �' C %: ZIP -2'. -7 C2 2' -' 1 Affected ❑ CW E]EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (" r t) ;t" �.= "-7 r. . j (m5t/jnan/unk) AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPI MA ❑ PINS Closest Maj. Wtr. Body ( a 4'cl ORW: yes/mt)) PNA: yes/no Type of Project/ Activity (Scale:jjl`) Shoreline Length Fixed Platform(s) Floating Platform(s) Finger pler(s) Total Platform area Groin length/#'' ■■ ■B■■I■il■■■■ Bulkhead/ Riprap length Avg distance offshore Max distance/ fength Basin, channel I: ® ■■ fi■■■■■■ak a■■ N■■ ��■■N mass ®�� ...�N...C...� ■.■...1:00 : ■,!■■ MEN ®iii�liiii`i�iiii■Itl�/...�� ailNo /■.. 0 .B.■!1■�■. a ■.11�■■..�■■�1.. A building permit/zoning permit may be required by: t t ru- 1 R 6>1 )k4 \ 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) 1,%• L 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 AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit 1 �LnVlrLS Cj, Mailing Address: Phone Number: Email Address: ,Do c„aler1,YH iz b L'at,� :act n.G a,41a3 I certify that I have authorized I CI r7 a er , mar t 4 F` i Agent /Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMAI permits necessary for the following proposed development: l fJD l (I at my property located at in U41r'4 kGL County. .!, I - -A_ GI G- I furthermore certify that 1 am authorized to grant, and do in fact grant permission to Division of Coastal Management staff, the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information related to this permit application. Property Owner Information: lI me2t, Jl //- nature Print or Type Name Llt�nc/ Title Date This certification is valid through 6f) / d� / ';�� 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: -Tkovy%co (,Peen Address of Property: =JL f2b Vic- ar)cfa3 Mailing Address of Owner: _5g/yi2 Owner's email: A//) Owners Phone#: Agent's Name: IN del% ^%ourf n e Tnc Agent Phone# Ia -33 1- &3 j 3 e Agent's Email: (%n ky%!Lt ^'rre 42 Ne4kyyt�� ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom portion to be completed by the Adjacent Property Owner) I hereby certify that 1 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 thie 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 now 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 �iy9�, -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: G(i" f4 -a S' 'waiver is valid for up to one year from ARPO's Signature' L t%n Revised July2021 �� eWe ►(tesa6rw d. &j. IIaS ECZ. e;�y nc art r1BG 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: Tko✓"ck5 &,een Address of Property: tooa 1-,c44erl; W rib ✓ c at) ka3 Mailing Address of Owner: SBMC Owners email: nlif Owners Phone#: Agent's Name: la�i+%cyine, irA� Agent Phone#: al-P-331-6313 Agent's Email: IC�r dEn rvtetr.„E p ftYJfV✓�� 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 has described to me, as shown on the attached drawing, the development they are proposing. A V I DO NOT have objections to this proposal. 1 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 ff you have been notified by Certified Mail. WAIVER SECTION 1 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 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. , Typed/Printed name of ARPO:ST ..�//"r1�� '5 r 000 r. pqnq Mailing Address of ARPO: —4"I �r YU'.'fih 1V HllAb of 'l� Z? f ` 3 ��y.�Ceid v z ARPO's email: (�c E'kew:flv,2e.byx (� . ;4`t- ARPO's Phone#: Date: ( A7_ -waiver Is valid for up to one year from ARPO's Signature" ILz#ad*e% Wwr7n0,JnC. Revised July2021 �� ts0e J2es4bw� p &,y. II d S �I;z.e;41 nc. arl�let'9 IVA TT - I all i F T- ki I l { p�, t