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Home My WebLink About87295A - Rich, Simon#r]New ❑CAMA ❑ DREDGE & FILL N9 87295 A B C ❑ 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 1 it I I ❑ Rules attached. Jq General Permit Rules available at the following link: www.deq.nagov/CAMArulas Applicant Name _ Address City Phone # I—) Email j State ZIP .) :I ri z i Authorized Agent Project Location (County): Street Address/State Road/ Subdivision City Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ pTS Adj. Wtr. Body (nat/man/unk) AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Win Body ORW: yes/no.- PNA: yes/no ' Type of Project/ Activity (Scale: ) Access Length Pier (dock) length Fixed Platform(s) a a am IC: :::':: ■. a ■Finger . Floating Platform(s) pier(s) IN Total Platform area Groin length/4 Riprap length Max distance/ length Basin, channel Beach Bulldozing a L aaBulkhead/ ' a �.. C f .W ■■ ■■■ SENSE ■ ■.� C':: � :=:0 '� .�...C■ .■■.....■■....... ■�ME IN A building permit/zoning permit maybe 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. G. Agent or Applicant PRINTED Name Permit Officer's PRINTED Name Signature "Please read comdliance statement or Backof permit'• Signature Application Feels) \ Check fl/Money Order Issuing Date �49+a`alA i88'416bR, W84XIIN 0$1a91A) (Please Initial) Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: S) O 1 A CV) Mailing Address: ► ()2 CO<-b�'n C} tL--6 e v-\-c, -\ Ij C 2-779 Phone Number: C25Z� 3 �gy rp Email Address: E—D I certify that I have authorized Lrll�/o d,� �wS�t,w✓ i Ll 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 Cl2 C6r,D�v� L' k Q ^�^ Lf C 7) in C�Aoj.iAv,, County. 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: Signature i 7v*-aA Yam) , C`^- Print or Type Name Title 3 1 1612�Z`{ Date This certification is valid through 1< 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: qimnn R6rh C-:> 1bno a tom`;kil Address of Property: 1 n9 rnrhin CA Fd,ntnn MC, 27ov9, n '1 d Rtnfoq Mailing Address of Owner: +nP r...h:n r, F:dpnlnn uc 27o32 11nited Rta1Pc Owner's email. c'mnn(@ehnrgP nP1 Owner's Phone#: (259),su-4846 Agent's Name: Agent's Email: Agent 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 forthis 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 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 15from 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 �o 01/ Srgnarare Of Acrjacenr repanan rropeny owner I do not wish to waive the 15' setback requirement (initial the blank) Signature of Adjacent Riparian Property Owner: —Zx�y- 4.. f Typed/Printed name of ARPO: faun[- �5f `r ► y 1 _ - ' t �1 Mailing Address -of��A�RPO: �no/�1 �c ��i�ynv� t t t.C�V�TD/��+ NC 2 3` ARPO's email: k [))> �LS�� IoyAkR�O's Phone#: �LSZ 32 J �cn5 Date: *waiver is valid for up to one year from ARPO's Signature* Revised July 2021 L 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: 10P rnrhin rt, Frlpninn Nr. 97XA2 I ldiwi ciaiPg Mailing Address of Owner: 109 rnrh'n n FdPntnn N(1 97o3P I In Ind RtntPc Owner's email: cimnn(a)PhnrgP nPt Owner's Phone#: (2s2) w-4a45 Agent's Name: Agent's Email: Agent 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 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. VioI 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 /� - G / 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: < E eAI E L - apE�T/FS ACC N/�G/Hrr f C U�&SSo MA! �k� Typed/Printed name of ARPO: REH6 Ey-1/?r - LOR PEEPT/ES LLB Mailing Address of ARP//O: 2/� nLfi✓1)FC hRIVV ARPO'semail:We_1,11ESS'oA/e9M ARPO'sPhone#: ;S1 3,37 41el Date: 31(Z2 ZIOLZI 'waiver is valid for up to one year from ARPO's Signature" Revised July 2021 iir/RwF'F. ,' ,�. rrF" f w: c.k � �s CC � YeT� f ; r e I�`•t 4 it its/ �1P �i. l� � � i( '^ �� S i a x d� Y � .myµ+ �HH �" A e � �t �Nr LLLi� � i� � Y'� _'.11�i.�„ a 4 � q Y 5, k',� �! �1 � � � � _ � - �� 9� / A ��f L � 1 J � r ¢a -y ��'t 1'�f .k �� ` � SIG alb{ _I _ '' �`g-t.rtr�{ � � � � � y � f �} ft fN F �'�� j - . y,,�p ,.. �� i�� la � � �� d a f�7s, � r'-'�k Ys} t��- ka rM i M � '` n �'pir�' vY w � ` - a; rs`i� i l�s iri r �; w, 1 �' 4 5 cv� rv�� 5°�i+Y� �lveat" + Y' "'�°L, Y'�.,ii, ` r�fi' W, - 'd. .. 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