HomeMy WebLinkAbout11020_General Permit_19930908r
CAMA AND DREDGE AND FILL
GENERAL
PERMIT�-
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources
in an area of environmental concern pursuant to 15 NCAC _
Type of Project Activity
PROJECT DESCRIPTION
Pier/dock) length
SKETCH
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42
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Groin length
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number
Bulkhead length
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ax. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions�JJ
Other
This permit is subject to compliance with this application, site 1
drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine,
imprisonment or civil action; and may cause the permit to be appiicant's signature
come null and void.
This permit must be on the project site and accessible to the
permit officer when the project is inspected for compliance.
applicant certifies by signing this permit that 1) this pro-
f is consistent with the local land use plan and all local
finances, and 2) a written statement has been obtained from
adjacent riparian landow`ne�5 certifying that they have no_
objections to -the proposed work. ---
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
r permit officer's signature
271
issui g date expiration date
attachments �
�77application fe
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HOMER L. BROOKS
JUDY K. BROOKS
122 PERIWINKLE DR. 354-4811
EMERALD ISLE, NC., 594
PAY T❑ THE 14
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7371
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Nations nDOLLARS
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INVITED STATES POSTAL SERVICE 111111
Official Business PENALTY FOR PRIVATE
USE TO AVOID PAYMENT
OF POSTAGE, $300
Print your name, address and ZIP Code here
�oy�r Eli. �3 �'O�l1s
SENDER:
m I also wish to receive the
;? Complete items 1 and/or 2 for additional services.
• Complete items 3, and 4a & b. following Services (for an extra (D
.52
y • Print your name and address on the reverse of this form so that we can fee): >
y return this card to you. N
• Attach this form to the front of the mailpiece, or on the back if space 1. ❑Addressee's Address N
does not permit. a
m • Write "Return Receipt Requested" on the mailpiece below the article number. 2. ❑ Restricted Delivery
• The Return Receipt will show to whom the article was delivered and the date V
c delivered. Consult postmaster for fee. N
0 3. Article Addressed to: 4a. Article Number
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6. Sig ature (Agent
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H PS Form 3811, December 1991 * U.S.G.P.O.: 1992-307-530 DOMESTIC RETURN RECEIPT
P 375 638 5014
Receipt for
Certified Mail
No Insurance Coverage Provided
Do not use for International Mail
(See Reverse)
Sent to
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Street and No o , tso_ -
P.O., State and ZIP Code
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Postage
Certified Fee
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Special Delivery Fee
Restricted Delivery Fee
Return Receipt Showing
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to Whom & Date Delivered
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Return Receipt Showin t Whom,
7
Date, and Addre dr
TOTAL Posta
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& Fees
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby
� certify that -I own property adjacent to
�2: (L V Is property
Na
located at on
(Lot, Block, Road, etc.)
in {-�-�-v L�y!� �� N . C .
(Water Body) (Town and/o County)
He has described to me as shown below the development he is
proposing at that location and I have no objections to his
proposal. I understand that a pier must be set back a minimum
distance of fifteen feet (151) from my area of riparian access
unless waived by me.
I do not -wish to waive that setback requirement.
I do wish to waive that setback requirement.
Description and/or drawing of proposed development: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
Signature
Name
Phone Number
UNITED STATES POSTAL SERVICE
Official Business PENALTY FOR PRIVATE
USE TO AVOID PAYMENT
OF POSTAGE, $300
Print your name, address and ZIP Code here
•Ofh.E'�j�l�I�l1S
^' SENDER:
m
I also wish to receive the
a • Complete items 1 and/or 2 for additional services.
H • Complete items 3, and 4a & b.
following services (for an extra
V
y • Print your name and address on the reverse of this form so that we can
fee):
i return this card to you.
> • Attach this form to the front of the mailpiece, or on the
back if space
1. ❑ Addressee's Address
rn
to
m does not permit.
a) • Write "Return Receipt Requested" on the mailpiece below the article number.
El2. Restricted Delivery
G
m
at+ • The Return Receipt will show to whom the article was delivered
and the date
Consult postmaster for fee.
t)
t delivered.
3. Article Addressed t Q �� ��1 rD
4a. Article Number
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P. U - �3U `t
4b. Service Type
❑ Registered ❑Insured
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❑ Certified ❑ COD
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El Express Mail ❑Return Receipt for
Merchandise
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7. D of DeIWery
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5. Signature (Addressee)
8. Addressee's Address (Only if requested
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and fee is paid)
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r PS F 3$11 December 1991 it U.S.G.P.0.:1992-307-530
DOMESTIC RETURN RECEIPT
orm ,
F "375 630 503
Receipt for
Certified Mail
M No Insurance Coverage Provided
Do not use for International Mail
(See Reverse)
S�`a.)N D�- Wa
C.
Street and No
5vCtw ' St
d .
3 k
P.O., State and ZIP
Code
Postage
Certified Fee
Special Delivery Fee
Restricted Delivery Fee
Return Receipt Showing
to Whom & Date Delivered
Return Re ei t Showing to Whom,
Da e's Address
L
!� •�
�e
lei
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MS
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER)
I hereby certify that -I own property adjacent to
's property
Name
located at . f ///� G!%F c �',' on
(Lot, Block, Road, etc.)
in s� �;;�_.-�'�C//���rlAi N.C.
(Water Body) (Town and/or County)
He has described to me as shown below the development he is
proposing at that location and I have no objections to his
proposal. I understand that a pier must be set back a minimum
distance of fifteen feet (151) from my area of riparian access
unless waived by me.
I do not.wish to waive that setback requirement.
I do wish to waive that setback requirement.
Description and/or drawing of proposed development: (TO BE
FILLED IN BY INDIVIDUAL PROPOSING DEVELOPMENT)
Signature
Name
Phone Number
- ,,,
CERTIFICATION OF EXEkF f10
�- FROM REQUIRING A CAMA PERMIT AU6
as authorized by the State of North Carolina, J
`� Department of Natural Resources and Community Development an as al esources ommission
in an area of environmental concern pursuant to 15 NCAC SubchapT�f''1R--'--
Applicant Name
Address
City State
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 15 NCAC 7K .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Any person who proceeds with a development without the con-
sent of a CAMA official under the mistaken assumption that the
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development.
The applicant certifies by signing this exemption that (1) the ap-
plicant has read and will abide by the conditions of this exemp-
tion, and (2) a written statement has been obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
Phone Number
Zip f
This certification of exemption from requiring a CAMA permit is
valid for 60 days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
Applicant's signature
CAMA Official's signature
Issuing date
Expiration date
c�
Attachment: 15 North Carolina Administrative Code 7K .0203