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Home My WebLink About87011A - Rose, Terry��*°``OAST',&❑CAM❑ DREDGE & FILL N9 87011 A B C D GENERAL PERMIT Previous permit a 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: 15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules Applicant Name _ Address City Phone # ( ) State ZIP Project Location (County): Street Address/State Road/Lot #(s) Subdivision City Affected ❑ CW MEW ❑ PTA ❑ ES ❑ PTS Ad!. Wtr. Body (nat/man/unk) AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body ' ORW: yes/np. PNA: yes/no Type of Project/ Activity (Scale: ) Shoreline Length Access Length Pier (dock) length Fixed Platform(s) ® ■■ on■■■moon ■■■■■N■oi�Ll■■. E�EE::�E�EEEE■mm■.�■E■..E■. �■N■ Floating Platform(s) INEENEECE E..EEE.. ■E m.■... SEEN so 0 Total Platform area E.�.■...m .E.EE.EEE length/# .EGroin ..�■■....� Pill ■■■ o EEEEE® �■®� E�.E.EEEE.�EE..�EE�mEE. �o■■ Cmom clE E aEE�EEm�iNEEEBulkhead/ :.Eo 0 NONE 0 ■.. JOE f �L.�..,�■.L..ml� NUMENON E loolammil N n■o�mmm■mo■� o■■■■■■■i�■■ M0 ::� ■EEEEE .::: E EE000 A building permit/zoning permit maybe required by: Permit Conditions ❑ TARIPAM/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 Agent or Applicant PRINTED Name Permit Officer's PRINTED Name Signature *'Please read compliance statement on back of permit" Signature Application Feels) Check it/Money Order Issuing Date Expiration Date AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: %[-)- 3 116s � Mailing Address: f E!�(�'@� r ' t"k AC_ ^d% `Ct11L1( Phone Number: Email Address: I certify that I have authorized lat4 an Y� Oeie_ Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: 116 4-4 ?�,*I ye4Gj at my property located at a! ! 41 in Cy&A6Lh County. I furthermore certify that I 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:,, r4r irr, Signature Q 1 ✓' LA.J 11e��' _ rint or Type Name Title �r 0 `7 r Date This certification is valid through J I Iq_I l— RECEIVED NOV 13 2023 0CM-EC 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: _ Address of Property: t Mailing Address of Owner: Owners email: Agent's Name: lyzat1 Qi -5AM e- Owner's Phone#: n C- ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom portion to be completed by the Adiacent Property Owner) RECEIVE® NOV 13 2023 I hereby certify that I own property adjacentto the above referenced property. The individual applying forthis permit has rjerscribed to me, as shown on the attached drawing, the development they are proposing. A descriotiotYor 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 or coaster Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 401 S. Grfffrn 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' sQ c Signature of Adjacent Riparian Propert 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: 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 RECEIVED N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM NOV 13 2023 CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY (Top portion to be completed by owner or their agent) DCM-EC Name of Property Owner. 4 elr, `l e's If— c+ � � Address of Property: I a k �L�291 "A4ti �] { �]��• r C :X i Mailing Address of Owner: Owners email: Owner's Phone#: Agent's Name: I & 41d&-N l V tCAr f n e-- Agent Phone#: �s°L-33 � — �� Agent's Email: I �f y Lle/1 rv04,- 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 some 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 sion the appropriate blank below.) I DO wish to waive some/all of the 15' setback V Signature of Adjacent Riparian Property ner -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: Mailing Address of ARPO: ARPO's email: ARPO's Phone#: Date: *waiver is valid for up to one year from ARPO's Signature* Revised July 2021 RECEIVE[. NOV 13 2023 ®CM -EC RECEIVED AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Mailing Address: I NOV 13 2023 ®CM -EC 'Ter'�3 I 'm Phone Number. Email Address: I certify that I have authorized lay1l ®n Yr' ar% eie- Agent i Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: at my property located at (i - l t. �rfe-' D in 04> h County. I furthermore certify that I 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:., Signature, 4(Z_ Print Name Title Date This certification is valid through / Or? /� RECEIVED N.C. DIVISION OF COASTAL MANAGEMENT NOV 13 2023 ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY /ten n /� (Top portion to be completed by owner or their agent) ®CM -EC Name of Property Owner: Address of Property: !L nc � Q5 Mailing Address of Owner: 510'ry, i e— Owner's email: Owner's Phone#: /e Agent's Name: ICI�rT J%'Ki�rm e.- Agent Phone : x �r 3� Agent's Email: I c.N er► 0-xl--f A Q. 1kl4 +/ 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 forthis permit has d Kribed 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 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 wner -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: 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 RECEIVE® N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM NOV 13 2023 CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY !� (Top porrttiio-n to be completed by owner or their agent) DCM-EC Name of Property Owner: I,L Rose - Name of Property: III rws@..h^4&r )m- S�%Ork Mailing Address of Owner: Owner's email: Agent's Name: Icy. &h MA/ i Q-- Agent's Email: Owner's Phone#: 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 I DO NOT have objections to this proposal. I DO have objections to this proposal. ff 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.) �► /r //q//I I DO wish to waive some/all of the 16 setback Signature of Adjacent Riparian Property w r -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: Mailing Address ofARPO: ARPO's email: Date:_ ARPO's Phone#: 'waiver is valid for up to one year from ARPO's Signature' Revised July 2021 RECEIVE® NOV 13 2023 ®CM -EC r-- \ � � / ®D[ ! A � C. �t t+ttJilF. i N ' `VJ t •4.Aa • �� 1 . r s v� I �, M" IL 1