HomeMy WebLinkAboutBledsoe, Larry 76672Clo REDGE E FILL N9 76672ENERAL'peRnalr
Previous permit #
Date previous permit issued_
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to
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Proiect Location: Counry _ _
Street Address/ State Road/ Lot #(s)
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Phone # ( )E-Mail
Authorized Agent ztP
Affected
AEC(s):
Phone # ( )River Basin
Adi. Wtr.
Applicant Name _ -
Address
BCD
(nat /man /unkn)
Closest Mai. Wtr. Body
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LrOEA
tr PWS:
trEW
] HHF
,I PTA
:l rH
!ES
L. T UBA
! PTS
D TVA
ORW: yes / no PNA yes / no
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(Scale:)
IType of Project/ Activity,
Pier (dock) length
Fixed Platform(s)
Floatina Platform(s)
Finser pier(s)
Groin lenSth
number
Bulkhead/ Riprap len8th i
ayt distance offshore l
max distance offshore :
Boathousd Boatlift
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til:T--i--i i-+
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Beach Bulldozing
Other
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SAV: not sure
Moratorium: nla
yes
yes
yes
tt
: t-.-
A buildin8 permit may be required by:
( Note Local Planning lurisdiction)
Notes/ Special Conditions
E See note on back regarding River Basin rules
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48ent or Applicarr Printed Name
Sqnature # Please read compliance statement on back ofpermit *
Permit Olfi cer's Printed Name
Signature
Applicdion Fee(s)lssuing Date Expiration Date
ElNew EModification EComplete Reissue lPartial Reissue
State
Subdivision
8arin, channel I
cubic yards_
Boat r.mp _
Shoreline L.n8th ,'
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Check#
Stetement of Compliance and Consistency
This permit is subiect to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subiect the permittee to a fine or criminal or civil action; and may cause the permit to become
nullandvoid.
This permitmust be on the proiect site and accessible to the permit oflicer when the proiect is inspected forcompliance. The
applicant certifies bysigningthis permitthat l) 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 Coasal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coasal Management Program.
River Basin RulesApplicable ToYour Proiect:
Tar- Pamlico River Basin Buffer Rules
Neuse RiverBasin Buffer Rules
lf indicated on front of permit, your project is subiect 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 RegionalOffice (910-796-7215) for more information on howto complywith these buffer rules.
Division of Coastal Management Ofiices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
2s2-808-2808/ | -888-4RCOAST
Fax:252-247-3330
(Sewes: Carteret, Craven, Onslow -
Nonh 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: Camder, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Coumies)
E oth".'
Washington District
943 Washington Square Mall
WashinSton, NC 27889
252-946-6481
Fax:252-948-M78
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: 9 l0-395-3964
(Serves: Brunswick, New Hanover,
Onslow - South of New River lnlet-
and Pender Counties)
hft p://portal.ncdenr.org/web/cm/dcm-home
Revised 706l I 7
R E
E T RIP RI N
L A{<Y \
(Namo o
K9Ui e\6oE-
f PropertY owner
property located
cger,Y. L!
(Ad dress, LotaBlock, Ro
H(^
ad, etc.)N.C.
on tR(-T 5 !,..l+lta,?tn t
(WaterbodY)(City/Town a ndror Co unty)
The applicant has doscribed to me, as shown bel
I have no objoction to this proposal'
I have objections to this proposal'
ow, the development proposed at the above
loca
DESCRIPTION ANO/OR onnwtNe oF PROPOSE D DEVELOPMENT
(l ndlvldua I proPosing developmen'must ftll tn desirtPtion belottt or attach a site dtawlng)
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at7 \\ fl\oieuEY
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must
me.(
*
w VER ECTI N
I do wish to waive the 15' selback requirement'
\ do not wish to waive the 15' setback requirement
(Pro rty Owner lnformation)(Adj ent Prop
SiCflature 7 L.glto e
turprbfrtl
erstand that a pier, dock, mooring pilings' boat ramp'
te set oact a minimum distance of 15'from my area
liVou *iif' to waive the setback, you must initlal the a
breakwater, boathouse, lift, or groin
of rioanan access unless waived by
ppropriate blank below.)
erty Owner lnformation)
A A
,t{(R"{-Tee,.r.l^Print or TW
1b^DI xu ,bNamo
Pdnt or TYPe Namo
A\I 14^s s*aY c-e(-(
Maifing Addre
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ss .'{631tlc -
Mailing Z7 Atr-
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Telephon
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er / email addrBss
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I hereby certify that I own property adjacent to
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I omail sddtess
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'Valid for one calendar year a{1et signat ro"
(Rovised Aug. 2014)
l hereby certify that I own property adiacent to
a-
L +s.FY I RErrr Sr"oroe-
(Name of ProPertY Owner
property located at 9-t t i\osEttY Ure bt< Ku '
?*r fur Sr,,.rqlt?
(Address,Lot, Block, Road, etc.)
HqB9ti . N.C.on in
(Waterbody)(Clty/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
I have no oblection to this proposal.
I have objections to this proposal.
s
DESCRIPTI ON AND/OR DRAW]NG OF PROPOSED DEVELOPMENT
(l ndividual proposing-develoqment must fi.ll-in deseription b elow or attach a site drawing).
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WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp,
must be set back a minimum distance of 15'from my area
breakwater, boathouse, lift, or groin
of ripadan access unless waived by
me. (lf you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the "15' setback requirement.
l
*I do not wish to waive the 15' setback requirement.i
Owner lnformation)(Adjacent Property Owner lnformation)
ture
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Print or Type Name
7u t l\s'rPG-L cR6rk R).
Pint ort74 Name
rt ,'-t < u/a /Vtru, fto(
Mailino Addnss
H,ir e*; N'r 1.rr5 i .t Mailino Addresst/itbet t /
Citv/Statelz.iD'qrq - ,{r{-}3{c-tw
Teleohone Number
7ro gco
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/ email addrcss
7t n7Telephone Number / email addressj-to-Lo
Date
'Valid for one calendar year after signature'
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(Revised Aug. 2014)
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