20072115 Ver 1_Major Variance_20071213

OFFICE USE ONLY: Date Received Request #
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality ,,,,
"General" Major Variance Application Form -
From the Neuse and Tar-Pamlico Riparian Buffer Protection Rules for residential structures
on existing lots within the coastal counties as deftned by the Coastal Area Management Act
(As approved by the Water Quality Committee of the Environmental Management Commission on 5/9/2001)
Please identify which Riparian Area Protection Rule applies.
Neuse River Basin: Nutrient Sensitive Waters Management Strategy
Protection and Maintenance of Riparian Areas Rule (15A NCAC .0233)
^ Tar-Pamlico River Basin: Nutrient Sensitive Waters Management
Strategy Protection and Maintenance of Riparian Areas Rule (15A
NCAC .0259)
NOTE:
To constitute a complete application, all of the information requested in this form
must be provided. Incomplete applications will be returned to the applicant. The
original and two copies of the completed "General" Variance Application Form and
any attachments must be sent fo the DWQ 401/Wetlands Certification Unit, 1650 Mail
Service Center, Raleigh, NC 27699-?650, 919-733-1786 to constitute a complete
submittal. This form maybe photocopied for use as an original.
Part 1: General Information
(Please include attachments if the room provided is insufficient.)
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1. Applic 's namAe,(th corporation`, individual, a ,~,w_/h~o o ns the roperty): DEkk_ rvAi~i~~luAIJTY
~5~~=~-~d.._ ~" ~ ~G~J ~ l~ ~l~t-~ N ~ O u w~Tl ANDS AND STORMWATER BRANCtI
2. Print Owner/Signing Offj.~ial (person
Name: ~1lrrLvi ~
Title: _~ $
Street address: _f~'
City, State, Zip: _~1/'e
Telephone: ~0~) .~tf7-
Fax: ;.~v~; ~5,~.
3. Contact person why
Name:
Telephone:
Fax:
Email:
[l~G' 132011=
sible for the roperty and its compliance)
a~ ~~~~ h ~-use,

"General" Variance Application Form
Version 1: May 2001

4. Project Name (Subdivision, facility, or establishment name -consistent with project name on
plans, s ecifications, letters, operatio a d maintenance agreements, etc.): .
~~ ~"' Q~ /S try D cn 171 ~ ~~~n^~ -~'% hvt _ Son../-r ~ /
5. Project Location:
Street address:
City, State, Zip:
County:
Latitude/longitude:
6. Directions to site from nearest major intersection (Also, attach an 8'/ x 11 copy of the portion
of the USGS topographic map indicating the location of the site): _ ~ .
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7. Stream to be impacted by the proposed activity:
Stream name (for uLnnamed streams label as "UT" to the nearest named stream):
e~l- [ ~ Ci''.P~K
Stream classification [as identified within the Schedule of Classifications 15A NCAC 2B
.0315 (Neuse) or .0316 {Tar-Pamlico)]: ~ (,? uJ - //S i11 _
8. Which of the following permits/approvals will be required or have been received already for
this project?
Required: Received: Date received
~~- e ~ 7' ~ 997
Permit Type:
CAMA Major
CAMA Minor
401 Certification/404 Permit
On-site Wastewater Permit
Active Connection to Sanitary Sewer System
NPDES Permit (including stormwater)
Non-discharge Permit
Water Supply Watershed Variance
Others (specify) sJ°/15if£ WQSfieYV~C~e-/'
Part 2: Proposed Activity
(Please include attachments if the room provided is insufficient.l
o~ rDt ¢iit~t ~rm r ~-
Description of proposed activity [Also, please attach a map of sufficient detail (such as a plat
map or site plan) to accurately delineate the boundaries of the land to be utilized in carrying
out the activity, the location and dimension of any disturbance in the riparian buffers
associated with the activity, and the extent of riparian buffers on the land. Include the area
of buffer impact in ftZ.: ~ _
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2. State reasons why this plan for the proposed activity cannot be practically accomplished,
reduced or reconfigured to better minimize or eliminate disturbance to the riparian buffers:
"General" Variance Application Form, page 2
Version 1: May 2001

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a,~~erna~.c~s ~ /occt~t~,,., a~ fl1.i-~rv~osed ac~~v~~ies ~,v~ft~r~t.+ ~ ~
3. Description of any best management practices to be used to control impacts associated with
the proposed activity (i.e., control of runoff from impervious surfaces to provide diffuse flow,
re-planing vegetation or enhancement of existing vegetation, etc.): ,
~ih n~ ~~-~ ~ rem ~f ~,r~u~ c>l,'S~rir~t r,Ge s W Gi lie Y~eStzt~
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4
(2) How these difficulties or hardships result from conditions that are unique to the property

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Part 3: Deed Restrictions
By your signature in Part 5 of this application, you certify that all structural stormwater best
management practices required by this variance shall be located in recorded stormwater
easements, that the easements will run with the land, that the easements cannot be changed or
deleted without concurrence from the State, and that the easements will be recorded prior to the
sale of any lot.
Part 4: Agent Authorization
If you wish to designate submittal authority to another individual or firm so that they may provide
information on your behalf, please coralplete this section:
Designated agent (individual or firm):
Mailing address: __~
City, State, Zip: _ _ __~____
Telephone: ____
"General" Variance Application Form, page 3
Version 1: May 2001
~ re.L~ w'a~Gr czu~a-~ ~fr~m envira~,i~vwtr~ i~,tl y sensi~i-~t~. ar~e~S.
Please provide an explanation of the following:
(1) The practical difficulties or hardships that would result from the strict application of this
(3) If economic hardship is the major consideration, then include a specific explanation of the
economic hardships and the proportion of the hardship to the entire value of the project.
lfnfh.rn~t .-I' 2 Wit) Q i'Y- i n m/ rJ.P n owl i/A rcGf/YI_.G¢/ ~? no rin/~,~

Fax:
Small:
Part 5: Applicant's Certification
I, ~~c1~rrJ ~~n LiQUSe f/ (print or type name of person
listed in Part I, Item 2), certify that the information included on this permit application form is
correct, that the project will be constructed in conformance with the approved plans and that the
deed restrictions in accordance with Part 5 of this form will be recorded with all required permit
conditions.
Signature:
Date:
Title:
NC Division of Water Oua(ity (DWQ}
401 Wetlands Certification Unit
2321 Crabtree Blvd. (LOCATION)
1650 Mail Service Center {iVIAI!_iNG ADDRESS]
Raleigh, NC 27699-1850
(919}733-9726(phonej
http:!lh2o.enr.state.nc.uslncwetlands/
RALEIGH REGULATORY FIELD OFFICE
US Army Corps of Engineers
6508 Falls of the Neuse Road. Suite 120
Raleigh, North Carolina 27615
General Number: (919} 876-8441
httpa/www.saw.usace.army.miilwetlandslregtoi.~r htm
WASHINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
Post Office Box 1000
Washington, North Carolina 27889-1000
General Number {252] 975-1616
httpa!www.saw.usace.army.miii~~wetiandstregtcur htm
Washington District Office
Division of Coastal Management
943 Washington Squars Mall
Washington, NC 27889
phone' 252!946-6481
Morehead City District Office
Division of Coastai Management
151-B Highway 24
Morehead City, NC 28557
phone: [phone]
"General° Variance Application Form, page 4
Version 1: May 2001