71238_Richard Greist & Kimberly Constock_20181016

ItCAMA / F:1 DREDGE & FILL
GENERAL PERMIT
[,•New El Modification ❑Complete Reissue El Partial Reissue
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 I SA NCAC
Applicant Name Q1 c Vw l C-s 15't , ('a,"Jo C
Address j'U Goys d ti3y
City State VvV ZIP SUv13
Phone # ( ) E-Mail
Authorized Agent :T.l .. 1 lc r sl
Affected ❑ Cw YEw X PTA M ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
ORW: yes /% PNA yes / +C:"/
N271238 C
Previous permit #
Date previous permit issued
B C D
II Rules attached.
Project Location: County �v,le-
Street Address/ State Road/ Lot #(s) j Ip QIUcC + .
Loi ti %c,
Subdivision f t tt iz S
City Grp cl-I ZIP"�L'1-C+��
Phone # ( ) River Basin �1 k
Adj. Wtr. Body C bo— d,4 nay y (nat /man /unkn)
Closest Maj. Wtr. Body Cv 1 V, a
S' . ure ** Please read compliance statement on back of permit S
Application Fee(s) Check# Issuing Date Expiration Date

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: & f 4e
Date:
Permit #: :7 H , \ t UCH
Describe belo'W the HABITAT disturbances'for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
Dredge ❑ Fill Both ❑ Other ❑
0
' 0)C
Sho ( 4-
Dredge ❑ Fill Both ❑ Other ❑
3
3 L
Dredge ❑ Fill ❑ Both ❑ Other
5 D� ✓
Sow
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
252-808-2808 :: 1-388-4RCOAST :: www.nccoastalmanagernent.net revised: 02/03/10

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 9 )15 11 ej
'Same of Property Owner Applying for Permit:
j
Mailing Address: 2
Q Zi. �j13••jC. ���" )�
I certify, that I have authorized (agent) to act on my
behalf, for the purpose of applying for and obtaining a CAMA Permits necessary to
install or construct (activity) >
at (mv property located at) �ZIJC�N" C',� `� f V
This certification is valid thru (date)
�kicp"a—b !�� - A L� �-
Property Owner Signature Date

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL RETURN RECEIPT. REQUESTED cr HAND DELIVERED
Name of Property Cv,,ner
Address of Property:
•
I hereoy certify that I own pf ;� —; adjacent 1,0 the ace: referenced property. The indiv'Cual
applying for this permit hP;, des=''red to me as shown on to attached drawing the development
they are propcsi^g F. descrictic^cr drawing. with dime^s cnczmust be provfded with this letter.
i jj;'%e n0 }i;ZCTIOns :J ih15 `sections to this proposal.
If you have objections to ��hat is being proposed. you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 401 S.
Griffin St., Ste 300, Elizab;,2th City, NC, 27909 DCM represewat'ves can also be contacted at (252; 264•
3901. No response is co.?sidered the same as no objection ifr,have been notified by Certified Maii.
WAIVER SEi:—'C''`t
^�C'r mooring bCathouse ft or ^'_;r
1 unce-stand and tha.+ a p,e; .
muss ce set back a minimum distance 5 access unless waive:
.ou wish to i' s ihe-setback. must initial e ,:ate b a —I --.
I do to .salve the 191 se'.Uac-C v_• emen,t
do not . sr .o waive the 15'
Property Owner Information)
grin. or Tv,ne Name
^,'a%i,7g ; Tess
-37
(pd1nt Prop caner Information)
Re✓isec Jars 2017

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner:
Address of Property:
(Lot or Street #, Street or Road, City & County)
Agent's Name Pa Mailing Address30' 11��
Agent's phone #: �� ��� ��4 ) 0 —
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
V/1"I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 401 S.
Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901 No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
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.
(Property ne Information)
4J
Sid rutt 11re
R-
Printr Type Name
Mailing Addr ss
City/State ip
Telephone Number/Email Address
(Adjacen Property Owner In rmation)
W1i7ature M 1(
3dlr folut
Print or Type NarTfe
.ale-/s4c/
Mailing Address
�� x
City/State/Zip
Telephone Number / Email Address
I -ter) �
Date Dare *
'Valid for one calendar year after signature' Revised Jan. 2017

9
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