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HomeMy WebLinkAboutRiley, Geraldf7CAMA / ❑ DREDGE & FILL N. O 78965 A B C D GENERAL PERMIT Previous permit# 5New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality r, ^� I/ . /i r.-�, and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC � -- I M ules attaghed. Applicant Name ?r;�; }`�� I t' �� Project Location: County w ( E ' l LI ' Address %' I Il (! I I k I (I Street Address/ State Road/ Lot #(s) t / / ( (' City 1 ' i C ,:� '^Oo f jState ZlP f �'' E-Mail Phone # ()--1l�'"I� Subdivision Authorized Agent �— . 1 r o ) 7 t( � i / t Ort i city—, Z ZIP r . �I Affected ❑ CW MEW � PTA ❑ ES ❑ PTS A Affecte ❑ OEA ❑ HHF ❑ IH ElUBA El NIA ❑ PWS: ORW: yes /(no PNA yes % no Phone# O River Basin (iy1!i P '4fi l\ Adj. Wtr. Body 'r . 0"r r nat man) unkn Closest Mal. Wtr a d 1 SOON ME MENINN ::::::gin::::::ate::::::: ::'■:.■:■®:'■'■:'■'.MSEEN MSEEM MEM :SEE:=:: a■.■■■■■.:..�.■■■.....■....::..� ■q■■■■....p........®®..........� M■■■■■■■SS ■ESE■■■■MC .■■■■■MEN■ m ■ ■■■■■■ ■■■■■E■MS ..■S■■■MN■ ■M■■■■■EME MEMEME■..■ M■ME. :■ ■■■■■■■■■■ �■■■■■■■■N ■SEEM■MEN! M. no MOM MIMI �■ •SEES■■MlY■EE■HM■■■■■M.1�'.:lM��Nr'�ird■El,�fsll ■SS■eiii GC``GpSp1[t1,I'�1.`1■■S■ ,N MEMEMENE ■N.■■M. .�.......■N�.......■ ■N■■■■■S■ 0■■■■■■■■MM■■■■■■N�■■......■� NM■■■M■®�■■...... MMEMMM. ■M■■S■■N ...... MEN :'M:�: .:C ::::::::::::m .MEN ■ Agent or Applicant Printed Name Sin ture "Please read compliance statement on back of permit" Application Fee(s) Check # Permit Officer s Printed Nam %, Sign tur Issuing Date Expi ation Date 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) priorto 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, certifythatthis project is consistent with 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 Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215) for more information on howto comply with these buffer rules. Division of Coastal Management Offices Morehead City Headquarters 400 Commerce Ave Morehead City, NC 28557 252-808-2808/ I-888-4RCOAST Fax: 252-247-3330 (Serves: Carteret, Craven, Onslow, - North of New River Inlet- and Pamlico Counties) Elizabeth City District 401 S. Griffin St. Ste. 300 Elizabeth City, NC 27909 252-264-3901 Fax:252-264-3723 (Serves: Camden, Chowan, Currituck, Dare, Gates, Pasquotank and Perquimans 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 910-796-7215 Fax:910-395-3964 (Serves: Brunswick, New Hanover, Onslow - South of New River Inlet - and Pender Counties) http://portal.ncdenr.org/web/cm/dcm-home Revised 7/06/ 17 Name of Property Owner Requesting Permit: q U 2,4A L\, W 'e — �--a` Lit - I� I certify that I have authorized EZ 000,1< Sa�u Agent SContrator1 Mailing Address: Phone Number: Email Address: to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: at my property located at in Cad--2(0 County. CI-1-ir1a nl�,k S�skeyvt 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: 14��1( Signature Print or Type Name (i(j)!)t?1,f — Title 2 / 7,1 1 7A2D Date This certification is valid through I hereby certify that I own property adjacent to )t �` CChA o ` K� 11U . 's n (Name of Property Owner) property located at 11 `i LL/ al rw T L R Ct C (� n (Address, L Block, oad, etc.) on n rrli� �� S�fC'S l_ (� n/a , in r\2 r�D k C N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above locatiop. I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development must fill in description below or attach a site drawing) y0 oU Ey , S4 0C.IZ C WAIVER SECTION understand that a 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. (If you wish to waive the setback, you must Initial the appropriate blank below.) I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. Telephone Number/email address y Dare I1 'J tj U o&Q. IoUo' or IU' W (�L !JJt Mailing Address City/State/Zipp '�,-A -?w.— - Telephone Number/email address Or1 MAr_ are 10 Date* (Revised Aug. 2014) 'Valid for one calendar year after signature` I hereby certify that I own property adjacent to property located at 1 I `i (� C ,Address,L�t,,Block, on v (y�1 g6fesz fanl11 , in �U;ne (Waterbody) (C of Property and/or I N.C. Th applicant has described to me, as shown below, the development proposed at the above to d0 Vf �- I have no objection to this proposal: I have objections to this proposal. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT (Individual proposing development'musf fill in description below 'or attaah' a-slte drawing) L hCxtp.l'� rr( J:-'T4 f l q � z-elly�` y /v lt.; cl f -k) J WAIVER SECTION understand that a 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. (If you wish to waive the setback, you must Initial the appropriate blank below.) I do wish to waive the 15' setback requirement. t .J I do not wish to waive the 15' setback requirement. (Property owner Information) — Signature 1�nk Print or Tx •a Name r1y 1,0 41 nu r („f-'ele Date address *Valid for one calendar year after signature* (Ad ent ro erty Owner Information) 1 i,ggrrla i r * r lam- ���ciUN J Print or Type Name Tele hon Number/email address Dat-,� — (Revised Aug. 2014) 2