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Home My WebLink About89304A - Kluchinsky, Aunika&dtauT41O❑CAMA ❑ DREDGE & FILL N9 89304 A�B C D GENERAL PERMIT Previous permit Date previous permit issued ffNew ❑ 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: I SA NCAC ' I-( I - ' ; ❑ Rules attached. ❑ General Permit Rules available at the following link: vw vcleq.nc.gov/CAMArules n- Applicant Name .&..k>�='=-`�'-.1� 1�.� n I K r 4� iy Address = G E'<= , - n i City P. '' State ✓ ZIP Phone # (y_'`-) - ! Z v Email -A it Authorized Agent ',!j `1 Project Location (County): Street Address/State Road/Lot #(s) Subdivision city Affected ❑ CW ❑ EW ❑ PTA rE�] ES ❑ pTS Adj. Wtr. Body it °` - ;(nagmantunk) AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body :7 i, - _ .. t i ORW: yes/no! PNA: yes/no Type of Project/ Activity 3 1 r, y ' F (Scale:,VT" ) Shnrelina lanvth Access Length Pier (dock) length Fixed Pla4or(s) ■■::■■■■■Floating MEMO :■■■ :�® :�■�. Platform(s) i■■ M Finger pier(s) M Elm Total Platform area■■■■■■■■■■■■: Groin length/# Riprap length Avg distance offshore - I'�ME distance/ length lasin, channel Cubic yards !oat ramp ■�■ ■■■■�:%■■■■:■■ ■■■■■■■■■■I■.�I■:i■�■■■■■■mME ■■■Bulkhead/ ME■■■ � ■■i■:::■■■::Max N■■■■a■■■■■�■ ■■■■ - •■®p■;�.. .per .::::::�::::� A building permit/zoning permit may be required by: .I C ., Permit Conditions ❑ TARMAM/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) Agent or Applicant PRINTED Name - - Permit Officer's PRINTED Name Signature -*Please read compliance statement on back of permit" Application Fees) Check N/Money Order Signature Issuing Date Expiration Date AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: 8 U (\Z k A 1l L U C.- H ZA)S k, Mailing Address: �36 "EAcc- )i4ygly N0Q('6t,K VA z3so2 Phone Number: 14L( 3 s Z? — OLo Z Li Email Address: clkluc h I tj� K�jq 01 01,,�C(Cc,,, I certify that I have authorized r j7 4 t/ t Li Agent40 ontractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits t,necessary for the following proposed development: -� 32 �f` ICI t_iZ_/IOy tJ WDEC 1:�fin- r^� �t/�t Tt7T,�L at my property located at �Sc� t I}0e,f d 11 U L n L401 N- A-) County. I furthermore certify that l 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: .n S��ig)Jnature IG L-t r�� tt'n PS--LLta,� t n -Yk Print or Type Name— Titie Date This certification is valid through M C_ 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: _ '-s �"r I i� G 'j4 i u C I\ I n S Address of Property: I ( _S tr j i rj�g Mailing Address of Owner. _ 3G� �rYct(X N!y GYz n; r �.)b IZ F'^ IC Ip I :Y S0 ?i 'Talc") .. G-dM Owners email: G �{ jt,r�, -t S jLy owner's Phone#: q14.3 —5 _ Zy 'L z,y Agent's Name: Q� 1r- 7� %( ;� j r 0 � i"L T Agent Phone#: 2-52 -Zc-Z -7o Zj3 Agent's Email: .4. 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. jktj DO NOT have objections to this proposal. _ 1 DO have objections to this proposal. e N.C. Divisionof coastal Management (DCM) in writing within 610 days of receipt of this notust ce.thCorrespondence 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 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' sethank -OR- Stgnature ol'Adlacent Riparian Property Owner c! I do not wish to waive the 15' setback requirement (initial the blank) i'�#Signsture of Adjacent Riparian Property Owner: kypediPrinted name of ARPO: biV4 4rt,t" gC Alt OflLCayld OK, Mai ling Address qfARPO: (OSI 8RL, 5✓}- GT- C SdP2�i�*�t_ V4 Z332'Z > ARPO's email: EoneiAl lebralke '7aRPO's Phone#: 7S7 Pr'1 LJ�.ne'i 'Date: c% � •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 - RFT1JM,ffiEIPT REQUESTED DELIVERv (Top portion to be completed by owner or their agent) Namo al Propery Owner _;� w ri { itic4 1=. ilr ::. V� I rt5 Kc{ _ Address of Property: Mailing Address of Omer r7st ��-_',.fit tt U,, t- a C:vJs pho Qwnersemail: GIG �:t..7 �ry4+_O,wneiSPhonap'$2C" '&LY Aganrs Name: �C�168L>T7 'I ),£7l Agent Prover.' Z-T 2 -"46 2 1s'7Z�% Agent Ems:b IL.••r,�- .�,.'.cs cc»x. ADJACENT RIRIPPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom Portion to be cohnillitted by the Adi t Pir,,i Cwhe) I hereby otnify fiat i own properly adjacent W the Solve referenced property. Tim individual applying for this permit has described to me.. as shown on the attached drowning. the develapment they are proposing, 8 desanproowdmwino with dimensions, musthe Provided walf,th left f� �.r0� �j I.L_ I DO NOT have obiecaons to INS proposal. _ I DO have oblecoons to this proposal. +renegemenr (ipcuJ In wnllrrp widdn f0 days o/ receipt of tMs notice. Correspondence should be ma0ed m 401 S. Gdtfin SE Ste. 200, Elizabeth CRY, NC, 27909, Doltreprssenrariws can also be conbrctad+f 052) 26"001, No nsporrsa Is cansidoord She a+me as no objection It you have been nod0edby Cergpod MeO. WAIVER SECTION I understand that any proposed pier, dock. mowing pfings. boat ramp. breakwater boathouse. ii 1, or groin must be set bark a mirimum distance of 15' tram my Xpa of riparian access unless viewed by me (this does not apply to bulkh fads or rlvap reveInentay/1 I A (If yo4 wish to� the setback, you must sion the appropriate blank below I DO wish to waive somalail of the 15 setback ! i 1 pR. Sgnature a!A conf Riparian Properly Owner C4 do not wish to wane me t5' Setback reouiremenl (initial the NSdKi.. "slgnaivre of Adjacent Riparian Property Owner yb—d1PrIntsd name of Aill _,y_�,r'±rv'�'a, �GJ'i2�ff� r O� 42 [f Meiling Addnae /of ARPO: ,L Q 4 �h} 1JARPD'a email: �1P-b�a.'P� r7y..D/,t (r+n Phon PO's e6: 757-YS1 ,IyDate: y{ _,•wahis, is valid for up to one year from ARPO's Signature' Revised July 2021 16x16 Deck 10x 16 yir OOF — 4.5x16 Lower Platform AOOCR Total Length 48 Ft. 16x16 Deck (D x lD NI? Qabp 4.5x16 Lower Platform I�,AQOEP, 5.5x 32 Ft Pier --( N 00 4 N d n C w - CL /! N - 0 '9 C X` CL Q ' cr .n a, a C n N � ._ o X cu K 0c K G1 O