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Home My WebLink About89109A - Nizankiewicz, David❑CAMA ❑ DREDGE & FILL GENERAL PERMIT ❑New ❑ Modification []Complete Reissue ❑ Partial Reissue N° 89109 A : B C D Previous permit Date previous permit issued 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 ( ) Z E 1 Z. Q "_� ❑ Rules attached. ❑General Permit Rules available at the following link: w .deq.nc.gov/CAMArules Applicant Name )Ct-V tr_) N , ;Z "A " C' t f- I, 1 4-;T Address 1-r' 'Ix ('n,,,/rz s;b a r(< h11'/w.. City -� f -( : r �' State t'� f_ ZIP !-I :) Phone # (_) -i t '( ._ 3.4 J "?, Email Affected ❑ CW t' EW ❑ PTA ❑ ES ❑ PTS AEC(s): ❑OEA ❑IHA ❑UW SPIMA ❑PWS ORW: yes(nb PNA: yes/no Authorized Agent Act 'i-.(1,=,<1 `ri d,a•.i o, o. V-, Project Location (County): O 11y v 1-)G> r c:'" Street Address/State Road/Lot#(s) i.i g E_ t'I �n+I-,l i-,,<t (. iJ1r'�t JP. Subdivision rl (a T ,;tc" r^t City C I.) rt A. U C kL ZIP Adj. Wtr. Body r^nv, nA �" C r, r 1l 11, C_L K c.L.J (na�6arj/unk) 1 .. Closest Mal. Wtr. Body C' yk— Il.3 c u.V.rI Type of Project/ Activity I (Scale:l' 31 .71 I. Access LengthI'-- Pier (dock)length 1 Fixed Platform(s) Floating Platform(s) AJI L f ,, � 1 � � � ++ � p J _. Finger pier(s) ,� I I Total Platform area M tt--- G t � I T I Groin length/# 77 Bulkhead/ Riprap length 1 ---2.— - - — - i Avg distance offshore � Breakwater/Sill _ -— I Max distance/length `` -- �- ,f., Basin, j 0 channel. r Cubic yards Boat ramp I — Boathouse/Boatllft f._—I Beach Bulldozing Other SAV observed: Yes no �' r ) I t ., � 1. _ } Moratorium: n/a yes no J.F4 Site Photos: _ 1 —-�--- 'i— --- — - - yes no - _ I RiparianWaiverAttached: :ves no A building permit/zoning permit may be required by: Permit ❑ 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 THATAPPLYTO THIS PROJECTAND REVIEWED COMPLIANCE STATEMENT. (Please Initial) Agent or Applicant PRINTED Name Permit Officer's PRINTED Name Signature *'Please read compliance statement on back of permit" Application Feels) Check k/Money Order Signature 1a.�f. Issuing Date Expiration Date AGENT AUTHORIZATION FOR LAMA PERMIT;APPLiCATION Name of Property Owner Requesting Permit: V / �7 4-r-V16 7 Mailing Address: Phone Number: Email Address: I certify that I have authorized �vRRI'UC 7- ZY72' /V/ 2�AN11 Adent l '%q1z , CD/`1 to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: OcA -2 at my property located at , 5,5- )E &xlyllly� z3/�elk' RA ' in C 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: Sign re 2 "9 vl L /V 2f�i✓>� 1 w z Print or Type Name � vl/Nf?Z _ Title Date This certification is valid through t Revfsed Mar: 2016 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: J ca v d J U 5 A `^ a 2u ,� Ki e L i s Address of Property: j 3 5 F. c a4w as 1x,� Mailing Address of Owner: m s t� Owner's email: �20.jjn9 Aw1f.M Owner's Phone#: Lrl �� `f�7`'S`t73 Agent's Name: hCtl) Agent Phone#: 6 -'2 7 C 3 Agent's Email: Jh�(Cge+�l;. ��1 50 1(`I0� Cd M 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 noury me rv.c:. urvtwurr ur 4uaara, 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 nparian 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/ail of the 15' setback , ) Signature of Adjacent rian Property Owner -OR- I do not wish to waive the 15' setback requirement (initial the blank) Signature of Adjacent Riparian Property Owner: r Typed/Printed name of ARPO: c, t ; r� L._ Mailing Address of ARPO: t 1 j=- CMG n V�� ARPO's email: �- z el i i (Ad yd j,r,, No " ARPO's Phone#. Date: 410 "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:'D \/ < <i `i J V S a a% '�, � 2-(,VA; e W', r z Address of Property: 7a� Cc vAvc c b 14) �)r L vrr Mailing Address of Owner: SG V 1 C as a boo t ) Owner's email. Q , a i (5(a gv}a \,t Owner's Phone# 73 rt Agent's Name: `�Lf�rv�l0.A ( Agent Phone#: S� `7 Agent's Email: ?hC'fcltayl c�i5t@ r10+1N C0m 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. 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' s a _pR_ Sign al ure of Adjacent Rrpanan Property Owner I do not wish to waive the 15' setback requirement (initial the blank) Signature of Adjacent Riparian Property O Typed/Printed name of ARPO: Mailing Address of ARPO: 1 ') ARPO's email: ARPO's Phone#: Date: �� le `� •waiver is valid for up to one year from ARPO's Signature" Revised July 2021, U J J �J co W 4- J 4-J co O m U N J t o Z r' 3Ln U Cl) m N �o ��LO co U ITW mo N L. Q U U t6 mU c > Z N_ 1 ZU-�� (1) W m M DT- UN U m m Boat Lift Piling Embedment �7' above Dock _4' of water -Average ",,,-12' minimum embedment .� �\ v.��AM '}wi- tii � � ✓l� J� s �9.. -y� �1+kTf-� Y� . YS FV r1 t `"i �" aw 'r , v � :✓. ' •± �, � x • 7�„ � ri. ��- 11 .' u >. �� '�� % �. . I' {di '' b� q�qp�; Yq �,�� . Y � � ]� � � i� , ?. r� �, �� ,,.� �•'� , 1 �, � t