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Home My WebLink About89218A - Blietz, RonaldA00JUr"N❑CAMA ❑ DREDGE & FILL NO 89218 A e C D GENERAL PERMIT Previous permit a Date previous permit issued ❑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 ❑ Rules attached. ❑ General Permit Rules available at the following link: wvvvv.dgg.nc.gov/CAMAnuIes Applicant Name _ Address City Phone # ( ) Email State ZIP Authorized Agent Project Location (County): Street Address/State Road/Lot #(s) Subdivision City Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtc Body (nat/man/unk) AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body ORW: yes/no PNA: yes/no Type of Project/ Activity (Scale: ) __ k MOM Floating Platform(s) am I am Finger pler(s) B :Beach .Bulldozing_■ Other 11MEN O■■■ MOM SS■■�■E' I .■�� .. .■■■i min ..■ .E■■nME ■■■ ■■a ■ M■ ■■■■■■ �� am �a ..��_��8■Sim am iii ii►■ i�ii�iB■■■■.■��oimiBm i MS ONME 1. 1 ■.■■E�® INS ®SEEN i■n=■■■■■■ ' s:1 i 0 .� Moratorium: n/a yes no :....... ... ..SAV observed: yes no Site Photos: MEMO In MEMEMINEEMEMEME ■■■■ ■■■■■■■■n■■■■M■■►vMEEM■M GI■■= ■■ n■■■EM■mMMM■mM SOME A building permit/zoning permit may be required by: Permit Conditions C', 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 THATAPPLY 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 N/Money Order Issuing Date Expiration Date NECAMA ❑ DREDGE & FILL N9 89218 A B CDpermit JlY/ GENERAL PERMIT Date lous prevouspermitissued ❑ New El Modification El 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: I SA NCAC ❑ Rules attached. ❑ General Permit Rules available at the folloMng link:v ..deimcgov/CAMArules Applicant Name _ Address City Phone # (_ ) Email ZIP Authorized Agent Project Location (County): Street Address/State Road/Lot #(s) Suhdivision City ZIP Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk) AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body ORW: yes/no PNA: yes/no Type of Project/ Activity (Scale: ) •■■:: '■ EMEN V � No EEE■:ME �■Eo E■ ■■■ . ■■■■■■E�EOEM AEEEEE ■.�E■E■■■■■■E■�.CGO■■■■■■INE■■■■■E I:OC��®::E: I 0 EMM EE:�C CC: Total Platform area Groin length/# Bulkhead/ Riprap length Avg distance offsh e— Basin, channel ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■ ■■ ME\■ ■ ■■■ �E. EEEE ■�.:�■■ ,.■■■.■.■■ ...� .�.....■.. . ■ : ....■ .►,..0 EE■E EE ..■. EIII�aims ■■.....��■■■. A building permit/zoning permit may be required by: ❑ 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. r Agent or Applicant PRINTED Name Permit Officer's PRINTED Name (Please Signature' -Please read compliance statement on back of permit** Application Feels) Check#/Money Order Signature Issuing Date Expiration Date n. ,nii4t4{ t z. ,.;^*"v;�:�,�:x, N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM (Top �?portion to be completed by owner or their agent) Name of Property owner. rl aria%A/Id. J? 10 4,7 Address of Property: 2/ L !o/%%a &d V4op4o►. Alt .27992 Kl.,� Lx4 r. Mailing Address of Owner: 2S/o &LOVE Ts 6� .i,Qf faPn ��' It/C o2Ji32 Owner's email:Pon 1-s}Z47 h*;/.Cmr Owner's Phone#: 4/ fi'4b,2'772, r=' Agent's Name: Agent Phone#: s. .Agent's Email. ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION "' fBgjtam oortlgn to tie completed by the Adtacent Ptgoarty Owner) hereby certify that town property adjacent to the above referenced property. The permit has described to me, as shown on the attached drawing, the developm descriott; or drawing wgh dimensions must be provided with this letter. individual applying for this ant they are proposing. A 100 NOT have objections to this proposal. 1 DO have objections to this proposal ` N'you have objections to what /s being proposed, you must notdy the N.C: Division of Coastal Management (OCM) In writing within 10 days of receipt of this notice. Correspondence should be malted to 401 S. GrOn St, Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be contactodat (252) 204,3901. No response /s considered the same as no objection N you have been nodgad by Certified Unit .. WAIVER SECTION (Choose onk one) I understand that any proposed pier, dock, mooringpilings, boat ramp, breakwater, boathouse, lift, or groin must be set backs minimum distance of Whom my area of riparian access unless waived by me (_this does nQ(Iv to bulkheads or rfineo revetments). (It you wish to waive the setback, you must sign the appropriate blank below,) _ I R wish to waive sometall of the f 5' setback Signature ®/Adjacent Riparian Property Owner -OR- the 15' setback requirement (initial the blank 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: �n n i1%/ 14), )3 k t?}2 Address of Property: 212 r✓ 4 • Si nw4e , AJ6 ; 7 93 2 1?-t /X6) Mailing Address of Owner: -2-Y4 Bati� Z'S%a r,.� �� eyr}ei+ Ne . 2 793 2 Owner's email:Ror,.bl,f+Z4) 9 YrieOwner's Phone#: 2-7'7'2. 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 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 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 (Choose only one 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 -OR- Signature of Adjacent Riparian Property Owner I DO NOT wish to waive the 15' setback requirement (initial the blank) Signature of Adjacent Riparian Property Owner: (b Q&A --P� Typed/Printed name of ARPO: -bo Nr✓la (� c��CR r� l5 Mailing Address, of ARPO: `6(o� N W lo''' SE � kr Ai cxl E—L_ ?J3 act: ARPO's email: _(\ o \r\a ,*An14 yerao ARPO's Phone#: J` `" 30a (OW6 Date: b *waiver is valid for up to one year from ARPO's Signature* Revised August 2022