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38869_LACEY, DOROTHY_20040628
CAMA / ❑ DREDGE & FILL GENERAL PERMIT Previous permit# '—New Modification CComplete Reissue ]Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environment and Natural Resources and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC El Rules attached. Applicant Name nco cli,y t d0 y Project Location: County —T Address 1•ln. V- " "r . E _ Street Address/ State Road/ Lot #(s) City_ h o fir, + State rI ZIP Phone # ( { =) � ` 031 Fax # ( ) Authorized Agent t � r I,^'- ; r. u r r S / f 9; - Affected ❑ CW ❑ EW © PTA d ES 2 PTS AEC(s): ❑ OEA - HHF ElIH ❑ USA ❑ N/A ❑ PWS: ❑FC: ORW: yes / no PNA / no Crit. Hab. yes / no Subdivision City ZIP Phone # ( ) River Basin Adj. Wtr. Body 1 (tat�man /unkn) Closest Maj. Wtr. Body NONE .W. :..NEESE ME ..INN MESSINESS! EN91M MEMO mom INN Milo EME111111111011 111111 mom 1011111111111111111 LNO 11111110111111 01111111111111111 ME RUNNE OEM 11111111RAN NEESE ONE ON 1111 ENO MEMO 111 ON MEESE MEN mom mmimmomm M NOW moommom r Agent or Applicant Printed Name Signature Please read compliance statement on back of permit Application Fee(s)' Check # Permit Officer's Signature Issuing Date Expiration Date f. Planning Jurisdiction Rover File Name Statement of Compliance and Consistency This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void. This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The applicant certifies by signing this permit that 1) prior to undertaking any activities authorized by this permit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian landowner(s) . The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available information and belief, certifythat this project is consistentwith the North Carolina Coastal Management Program. River Basin Rules Applicable To Your Project: ❑ Tar - Pamlico River Basin Buffer Rules ❑ Other: ❑ Neuse River Basin Buffer Rules If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of Water Quality. Contact the Division of Water Quality at the Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-395-3900) for more information on how to comply with thesebuffer rules. Division of Coastal Management Offices Central Office Mailing Address: 1638 Mail Service Center Raleigh, NC 27699-1638 Location: Parker -Lincoln Building 2728 Capital Blvd. Raleigh, NC 27604 919-733-2293 / 1-888-4RCOAST Fax:919-733-1495 Elizabeth City District 1367 U.S. 17 South Elizabeth City, NC 27909 252-264-3901 Fax:252-264-3723 (Serves: Camden, Chowan, Currituck, Dare, Gates, Pasquotank and Perquimans Counties) Morehead City District 151-B Hwy. 24 Hestron Plaza II Morehead City, NC 28557 202-808-2808 Fax: 252-247-3330 (Serves: Carteret, Craven, Onslow -above New River Inlet- and Pamlico Counties) Washington District 943 Washington Square Mall Washington, NC 27889 252-946-6481 Fax: 252-948-0478 (Serves: Beaufort, Bertie, Hertford, Hyde, Tyrrell and Washington Counties) Wilmington District 127 Cardinal Drive Ext. Wilmington, NC 28405-3845 910-395-3900 Fax:910-350-2004 (Serves: Brunswick, New Hanover, Onslow -below New River Inlet- and Pender Counties) www.nccoastalmanagement.net Revised 10/05/01 DOROTHY L. LACEY a?c� —009 205 STAR HILL DR. CAPE CARTERET, NC 28584 EEO 1820 66-19/530 NC 62 Dade �2Cc Ll I $ /(c. p0 — „ .... 6 a,� �e.�. BankofAmerica � ACH R/T 053000196 NP Memo vin �i> r�1�' 1:0IS 3000�L96,: 000668 3960 2011- L poi st�r�N;ll ►fie;✓� � CIA oec, __ ..__... _1_L L — Li - A-L-- -A--A.hz - - - - -- l Nis I ; Ur P4 ff ft" M GRAs�S © i �S �A� a;► � �, JQ f,e Cp. RkeRe% NC A55A �1Aler�.;p1 = ►cro�uew-C-Rnowz - �, �ClCl1)S IN Gw� �J� F�CSQ, ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to Dggcfh j L,. LAC-e i is (Name of Property Owner) property located at dy5 �fRR 0,tI iJe (Lot, Block, Road, etc.) on Pe'+J jj g OQ eN . C . .e k , i n Cry k�.R�� Co , — Ci�(� 2 e Rai , ('l aterbody) (Town and/or County) SHe has described to me as shown below, the developmentshe is proposing at that location, and, I have no objections to hteproposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (To be filled in by individual proposing development) UL� Signatur6 Print or Type Name J- 1 3 V _q Telephone Number �1i71D� I — --- _ P2choAh F.. I _ (� ABC MFMSi DR, 10 6LjkA Re}fi1N,Nj w`Ail q+ fY1RN-mp%&e-C„Lklo"-' ((W,0,1+P\ = ictvgL,,e *-C►_,ectrz. Row to FP-AftS 4 t�u i, Jckwn c j ac f St�R-N;11 Dp-,Ve- C:A042.C� NC, �05 �trate. ta�,11 �,J� C,�,� CAt��ztte-t', NC a55��1 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT 1 hereby certify that I own property adjacent to &i,d7-IYY �� CK-2 is (Name of Property Owner) property located at J.��,o� U%Q (Lot, Block, Road, etc.) _ on? � 1 i'C-V CICEDL in CAKC CA K 1 Ek�/ ; C& XTEke-j , N.C. (Waterbody) (Town and/or County) SHe has described to me as shown below, the developmentshe is proposing at that location, and, I have no objections to he&proposal. ------------------------------------------------------------------------------------------------------------------ DESCRIPTION AN-D/OR DRAWPgG OF PROPOSED DEVELOPMENT (To be filled in by individual proposing development) --------------------- -------------------------------------------------------- -- ----------------- Si ature •v �� r�� � �S a n Print or Tyre 2c -6 a� Telephone Number i'Jt7/q