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Home My WebLink About87278A - Otts, BlainAtom tx EICAMA ] DREDGE & FILL N9 87278 A B C D GENERAL PERMIT Date previous permit issued j; [11 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 i` Rules attached. General Permit Rules available at the following link: www.deq.nc.gov/CAMArules Applicant Name Address City State ZIP Phone # ( ) Email Affected ❑ CW ❑ EW ❑ PTA ❑ ES PTS AEC(s): ❑OEA ❑IHA ❑UW SPIMA ❑PWS ORW: yes/noPNA: yes/no Authorized Agent Project Location (County): Street Address/State Road/Lot #(s) Subdivision City Adj. Wtr. Body Closest Mal. Wtr. Body Type of Project/ Activity 1- , -. \ „f ,...�t, r•I, A zl. `.,,=.hr-n,lc �e�.•.t.. (Scale: is Access Length - Pier(dock)length - Fixed Platform(s) _ •�.. r _ A _.. Floating Platform(s) _) _ 1 i�i-8 ir..__. ___._ i- Finger pler(s) _ Total Platform area- i Groinlength/# - Bulkhead/ Riprap length 1 �I t Avg distance offshore -= } ) t\ � -� _ — -f - Breakwater/Sill ?' ="( '{! Max distance/ length '7- . i - I Basin, channel '•� -1--� -- ry Cubic yards Boat ramps r Boathouse/ Boatlift i Beach Bulldozing - - \l_ A Other _ i {� •--1 �''' SAV observed: yes no t E �s 1 f Moratorium: n/a - yes no Site Photos: yes no Rioarian Waiver Attached: ves into' 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 JAM 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 Application Feels) Check#/Money Order Issuing Date Expiration Date RECEIVED E,j.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATiON/VUAIVER FORM CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY MAR 0 2026 (Top porfion to be completed by owner or their agent; D C M A E C Name of Property Owner 13 h A 1 9, 0-4-11 S Address of Properly 105 12ijAYFR jRruB T <(-A2a1?y'ru G:11 0(1 MailiMAddress ofOwner- . IDS QuAK9Z 'JA 4112A BFTN b1TY 0(d Owner's email: J 6 oVVs ) 7 19 9me' 1 • oou Owners Phonett: 1 'a 4 2� 3t 2. 4619 Agent Phoneme (9rj) bKb- r,343 Agents Name: � o a kTLAxO r,Al h(; k) AgenPs Email: I A,i A r yr a rr V1 e A 6 A M a' 1• k +✓n ADJACENT RIPARIAN PROPERTY OWHER'S CERTIFICATION (Bottom portion to be completed by the Adjacent Property Owner) I hereby certify that I own property adjacentto the above referenced property_ The individual applying forthts permit has described to me, as shy on the attached drawing, the development they are proposing. A _ _ _ ...:a6 aFie T-ff— t, $ G� — ✓ 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 inns, notify fire tU C. Division of Coastal Management (DCIUQ in writing wWn 10 days of receipt of this notfce Correspondence should .be matted to 408 S. Griffin St, Ste. 300, Fj&abefh City, NC, 27909. DGM representatives can also be contacted at (252) 26d•3901. No msgtonse fs cORsfdered the same as no objection if you have been notified by Gerdfled 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 16 from my area of riparian access unless waived by me (this does not apply to bulkheads or riprap revetments)- (Ifyou wish to waive the setback you must sign the appropriate blank below_) I DO wish to waive some/all of the 15' setback — StG�� Sfgnature ofAdjacent Rip an Property Owner -0R- I do not wish to waive the 16 setback requirement (initial the blank) Signature of Adjacent Riparian Property Owner. Typed/Printed name of ARPO_ Mailing Address of ARPO: ARPO's small: ARPO's Phone#: Date- _ _ Nvaiver is valid for up to one year from ARPO's Signature Revised July 2021 id.c. DivIS1ON OF COASTAL MANAGEMENT R E C E N"" .. ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONRIVAIVER FORM CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY MAR 1 S 2024 (Top portion to be completed by owner or their agent) Name of Property Owner: 'S up k e- v`r-r$ Address of Property: toy QjWG2 ta(JI 6l.t2a6U, L 6'11 Mailing Address of Owner: 10 S Q,2 a lift Q ®R'vra 6141A121 L i +'r , , d & Owner's email: 16 044-6 ii N�rvA,,1 o c Owners Phone#: Agent Phone#: to*p i i 19) L s 6 b 34'� Agent's Name: l o9&. Ne,u wAKbbd Agent's Email: 1�4JaAMav°Ne Y bQ'' A&O- ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom portion to be comoleted by the Adjacent Pro arty Owner) I herebv certify that I own property adjacentto 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 nctny Fite'".- tnvrsron yr wd�zdf Management (DCf,9f 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) 254-3901. NO response is considered the same es e70 objection if You have been nofified 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 net 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 somefall of the 15' setba Signature of Adjacq4t Riparian Property Owner -OR- 1 do not wish to waive the 15' setback requirement (initial the blank) Signature of Adjacent Riparian Property Owner. i yped/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 Q, r) ` 1 r W z� Q- I, I I I �u P A 'I 4 0.4;1J z 0