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Home My WebLink About87217A - Cape Colony Association#MNew ❑CAMA [IDREDGE & FILL N9 87217 �-"A% B C D Previous permit GENERAL PERMIT Date previous permit issued ❑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. M General Permit Rules available at the following link: www.deq.nc.gov/CAMArules Applicant Name Address City Phone # ( ) Email ZIP Authorized Agent Project Location (County): Street Address/State Road/Lot #(s) r.i �. ,.. I:i ur•rc rr.! 1 yr-.-• v4- ts•.rcl j;....-. Subdivision .r. fit 0,nk u-, . City ZIP Ad Wtr. Body 0 •- 4 _ Affected ❑ CW DEW ❑PTA ❑ ES ❑ PTS 4 Y ` r � (nat/fiY'a`ri/unk) AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Mal. Wtr. Body 404rrc f`e ORW: yes/no PNA: yes/no Type of Project/ Activity (Scale: N i.'>, ) Chnralina I cnofh Access Length Pier (flock) length— FixedPlatform(s) Floating Platform(s)_ Finger pier(s) Total Platform area Groin length/M Bulkhead/ RI ra len hi P P length ! -, � I Y I ; s— I I 14- F- - — - -- --� _ Avg distance offshore Breakwater/Sill- Maxdistance/length Basin, channel- Cubicyards Boat ramp Boathouse/ Boatlift Beach Bulldozing _ 4 j _tttt i Other j SAV observed - yes �of Moratorium: Moratorium ( �/a' yes nno � - - -- - Site Photos yes no i �- ------ � - - - I-- � -- - -- Riparian Waiver Attached: yes no A building permit/zoning permit may be required 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) V, Agent or Applicant PRINTED Name Permit Officer's PRINTED Name Signature "Please read compliance statement on back of permit" i Application Feels) Check U/Money Order Signature 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 Address of Property: Mailing Address of Owner: e") j12,A VC 2723, Owner's email: r.anr. r r)l ;n v U Ili oc iafi h Owner's Phone#: A ,6om Agent's Name: Agent's Email: Agent Phone#: 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 description or 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 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 J4 /j 2 6 2Z&_ Signature of djacent Riparian Property Ownner -OR- I do not wish to waive the 15' setback requirement (initial the blank) Signature of Adjacent Riparian Prnnertv Owner: Typed/Printed name of ARI Mailing Address of ARPO: ARPO'semail• jXtr 11ei1'jPhvfrnn/ronp4RPO'sPhone#: 7i ?% �LJ6 Date: I - IS -A 3 *waiver is valid for up to one year from ARPO's Signature* /3 Revised July 2021 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: Mailing Address of Owner. i� U 13liit S `/ &&- �i iil , C' .; 7`lJ Owners email/�i��fl�r-�rl h�a.55' C: Gfin;, Owners Phone#: �59 ,l'��L`L / ca' Y6� f Kt4`. /. C G.vn Agent's Name: Agent Phone#: 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 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 this letter. I DO NOT have objections to this proposal. I DO have objections to this proposal. H 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 /s 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�c_� 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: t"j C , N2, 2 Mailing Address of ARPO: PO LA L"' += i- r-3 1,-'L ARPO's email: r, �'r,am' �n'r,n a 5` ,u� nv ARPO's Phone#: Sad ysS U 7,:: 1 Date: I() 15_ .� ')I *waiver is valid for up to one year from ARPO's Signature* Revised July 2021 d- 2 '� I`� �� { e ��f '�� k� � �� A.. a. � �� ''p :.P`e 4.-q � '� '�')� �. 4l r ° 2 g- s '�' r 'e +iY, ; Cl f � � •-I�F �-�y �ii t{ V� � i .. '�ti"J'