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.
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�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
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Agent or Applicant Printed Name
Jpfico.ti
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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)