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Home My WebLink About87286A - VanErt, Martia and Gregory❑DREDGE & FILL N9 87286 A B C C Previous permit 3 3 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. /- General Permit Rules available at the following link: wmmdea.nc.gov/CAMArules Applicant Name _ Address City '. Phone # (_ ) Email Affected ❑CW AEC(s): ❑ OEA ORW: yes/no State ZIP ❑EW ❑PTA ❑IHA ❑UW PNA: yes/no Type of Project/ Activity ❑ES ❑PTS ❑ SPIMA ❑ PWS Authorized Agent Project Location (County): Street Address/State Road/Lot #(s) - Subdivision ri City Adj. Wtr. Body Closest Maj. Wtr. Body (Scale: j Access Length Pier (dock) length Fixed Platform(s) ■■ ■u■ •�'��11■111�1■� MOM 1C..■1��111�■■11.111 Floating Platform(s) !1��11 '1111111'�1�1111 1 3�' It Total Platform area Bulkhead/....: Avg sGroin Basin,�Ia1I, bic yards Boat ramp Boathouse/ Boatlift ■ . . ■�r■■ ME mom 1C11��11:�1■■1' : 1 ■� ■■1 ■om �■ ■■■ ■■ ' ��■■■■■ �C � ■ l� ■■■�®,�iiiii�i�j�il ill SEEM • ■■ 1111111 109 1111 9 1�� C ■ ■ 1C�1CC�I i m MIN:: 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 I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)J. Agent or Applicant PRINTED Name Permit Officer's PRINTED Name Signature --Please read compliance statement on back of permit" Signature 14 k t6. k Cr vs r p'> #a49 LA Application Feels) Che, ck fl/Money Order Issuing Date Expiration Date ' �M$ia'&lA- V M4TT,?sbA ��3a-1)A RTA`11A) AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: r ' L'! do Mailing Address: boa OWndEe I�P JeJr-nt'o n" N' C , Phone Number: hV�ry)Q- 'l 9` 4 (2d J ao3 -73�31 —1(�� Email Address: rnKU4h �QtYc COm I certify that I have authorized y4�d✓ ��S��trro ✓ LLl 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: I 11. ti uri keR/a!p� at my property located at aOa k )t4nAee Dr. F A6>nt6h, All C 1 a793c-2 in Chbtocm County. I furthermore certify that I am authorized to grant, and do in fact grant permission to Division df 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: )�/ c Eu� Signature Print or Type Name Title I LU I aoa Date This certification is valid through 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: _.. 46 r1 16." Q.Q_((1X LL.�� Le _ Mailing Address of Owner: o269, i_ iry�AI. &tl -x Owner's email: Mk L/Q h 9 fig/6VInA! J'. Wr(!5wner's Phone#:,24A- ^r7Si�' �o9��e I ') ao�_ 133 Agent's Name: 1 ,' l i,/ d Sc. ✓ &-i C*z Zr6 d L(L Agent Phone#: 7S J_ - ? 3Z-0 y7- Agent's Email: 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 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. ,4�_ 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.) _ �y I DO wish to waive some/all of the 15' setback r// /i/ /_ / / „ / Signafure 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: Ukjrj 4- JOo J /r 11 x.vf I r Mailing Address of ARPO: 201Y ,Au Jci &Y n�.'✓�_ of Al. [ L1/q 7 ARPO's email: ARPO's Phone#: 2.T - 749' 576 Date: 3/t0/Zy *waiver is valid for up to one year from ARPO's Signature* 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 Ownei Owner's email: M ky a rip it-1 Qrnc1 Qbin Owner's Phone#: 025`24901 `4964 dell U 3-7a7- F(/44 Agent's Name: ✓LCL Agent Phone#: 2-S2`737-CZYZ 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. zx:—, 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 ZL4� Signature bf Adjacent Rip er -OR- I do not wish to waive the 15' setback requirement (initial the blank) Signature of Adjacent Ripar!E Typed/Printed name of ARI Mailing Address of ARPO: ARPO's email: rCaLZ42 � ' �MARPO's Phone#: 3��2�i !�ej Date: st (6 (Z� *waiver is valid for up to one year from ARPO's Signature* Revised July 2021