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HomeMy WebLinkAboutSmith, Roy�� _ �QA4WI5REDGE & FILL No. 76369 A B / C / D � GANERAL PERMIT Previous permit `/ ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality % / /y /' , and the Coastal Resour s Commission in an rea ofenvironmental concern pursuant to 15A NCAC / C' `[ ❑R les attached. Applicant Name, 1 � I -fl�'t i� Project Location: County _,✓ ,,e � GzIP Phone # (it )Q2 E-Mail Authorized Agent , U j f,i et-" Affected C CW jrqN -B'nA --❑ES ❑ PTS AEC(s): ❑OEA ❑HHF ❑IH ❑UBA ❑N/A ❑ PWS: ORW: no PNA yes / no ) Street Address/ State Road/ Lot #(s) City Phone # O Riv r Basin r Adj. Wtr. Body 0 o/� a man Closest Maj. Wtr. Body Uu vtii Type of Project/ Activity ■ ■ ■■■■ro ■■■■ lC ■!i■■� ■��r ■■■■■ ■ ■■� E :CME CCU u ::� Emairs ... .. —_--_.■■■.....�. MOON ....I�. ■■■■��i�i■■iui■�■�■■■.::.:■: ■■■■■■■■■■��n NONE iii■�iiMEN 0i�■iiN■iii ■■ ■ ■ ■ ■■■ ■■■■■ ■■ ■■■■■ONE ■■■■■■ i MEMO is I 0 roe 0 No .■E.■.........E.�■v..■.........9E.. • ■■ ■ ■■ ■■■.�nw n■■■ ■■ ■■.■ so ■;: :E.� : CSC' :_iN:! MESS■:■ IN! _ •¢ 1 u_ r 1 . 1'1 fi of i _ I i I 1 i i + w I P [ + i �20/,1MA / 'DREDGE &FILL No. 76369 A B D "GENERAL PERMIT Previous permit# 1 ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environmental Quality ��� and the Coastal Resou�rt�Is Commission in an rea of environmental concern pursuant to 15A NCAC / (/ C.� `�( r /� ❑ Ryles attached. Applicant NameT l U / ln' i- Project Location: County C_ _,V 2 Phone# , )0-2136 E-Mail Authorized Agent r CA) f , e Affected E]CW e-15& ,&PTA ­i7ES ❑ PTS A Affecte 71 OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PWS: ORW: A611-0) PNA yes / n ) Street Address/ State Road/ Lot #(s) 11 b. C�Cl« City z� Phone # O Riv r Basin Adj. Wtr. Body 0 G�t/ta Closest Maj. Wtr. Body MOM 0— MEMO ME MEN ■■■■■■■■■ ■■110 N ■■ ■� ■■■N�II ■■■■■®■■■ ■■■■■■■moos■ ■o■s■s i■■ ..■■■..■■■. ■■■■■ ON m■■■ ::: :::• •MIND .::�::: : :: ..�.. .■■ �■■■ m■■a■■■m■■s■■■ MEN I/ w mom 0 PAN 0 o■ . .:....:.■■■ No ENE ,■■M .H■.. ME ME Ej ■■ moms ■�:olril� C('Oa ad foc+l Agent or Applicant Printed Name Jpfico.ti Ree( read compliance statement on backof perO Gheck# 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 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 how to comply with these buffer rules. Division of Coastal Management Offices Morehead City Headquarters 400 Commerce Ave Morehead City, NC 28557 252-808-2808/ 1-888ARCOAST 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, INC 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 AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Plod d Mailing Address: BN 12 33 Gac-nec AL Phone Number: 9 )9 - R 10- ZI 310 Email Address:--Ti r'c Q S re,lA� I I *o.t I. cap') I certify that I have authorized j rr5-tl) Cleve / Rde er� co,0 Agent / Contractor to act on my behalf, for the purpose of applying for and Rep o�btaining all CAMA permits Il necessary for the following proposed development: e 'O✓.Ivvn _Irjeyi at my property located at I I (� C AeOL t n Irt R IyrA in C,-, gce-- 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: Signature Print or Type Name Title Date This certification is valid through / / �' � r ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to R At a -i „r , 3m 14\-N 's (Name of Property Owner) property located at (Address, Lot, lockt,Roa , etc.) on ILO in c t�In N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above locatio 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 bellow or attach a site draw/n ) Virg/' n C EV r z� I I I g wu Ced4xc;.<� WAI ER SECTION i I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin must beset 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. (Prope Owner Information) Signature T„a. Print or Type Name P.O. PYix I Z33 Mailing Addre%tss l-,ocr+cc C. 2752°I City/State/Zip 01101- $ _ ZI Flo Telenhone Numberl email address Date *Valid for one calendar year after signature' (Adjacent Property (*vner Information) 3 -Z2C"F- mr-1 email address (Revised Aug. 2014) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to Rr d-T nr, ( ame of Property Owner) property located at �)) Pn�r� �� ✓J on ILO (Addrein. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above location T. 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 W;A,� V;rYI 61"J C G"• Cec�rx`c• I WAI ER SECTION k \ I 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. erty Owner I formation) (Adjacent Property Owner Information) 7" Signature Signature —rnn. S' rn l'("1'1 t'rc..lcl;n W FGFAr% Print or Type Name Print or Type Na e P. D. Fox I Z3 25 �'a.-r Mailing Address Mailing Address (Crnnct k ZZ-52a1 SPl ,a AI(. Z-2S710 City/State/Zip City/State/Zip °ll01 S10-ZI Telephone Number/email address Telephone Number/email address y lol 1�� -i l 01 1707-0 Date Date* "Valid for one calendar year after signature* (Revised Aug. 2014)