72555A_Keith & Sara Houff_20190213

PVAMA / --' DREDGE & FILL NO. 72555 B C D
GENERAL PPRMIT Previous permit # / S 4 j
ew ❑Modification PComplete Reissue El Partial Reissue Date previous permit issued jr 1 7
As authorized by the State of North Carolina, Department of Environmental Quality f7 2
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC �
ules attached.
Applicant Name K 9 `1 n S a f e u� Project Location: County r
Address / 3 3
City /f / / U a ✓ I /4/jState H ZIP Z % yY
Phone # G) �% y8- S y b' % E-Mail �•^� 9 rt4 a�. `��``
Authorized Agent
Affected ❑ CW Jj EW WPTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes no� PNA yes / o
Street Address/ State Road/ Lot #(s) L y f / 3
3 3"7 [=a4 /-c Z)r,
Subdivision
City Al /I 1q / // Jt ZIP 2_ 79 11 k
Phone # River Basin jVq Sq u -+A
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Adj. Wtr. Body it o. nat an unkn
Closest Maj. Wtr. Body ��m G f "��c- Sa �^ , 4
Type of Project/ Activity
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AgenW Applicant Prino N e
Signature "'Please read compliance stap6m6nt on back of permit
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Application Fee(s) Check #
Permi icer's Printed Name
Sign e J
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Issuing Date
Expiration Date

/ DREDGE &FILL
()71501 B C D
iLAMA
CEIVEF PERMIT
Previous permit#
f/lNew [,]Modification L.]Complete Reissue ["!Partial Reissue
Date previous permit issued _
Environmental
As authorized by the State of North Carolina, Department of Quality
14,
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 2
rcxuf.
Applicant Name_.
Motesattached.
�t� i
Project Location: County.__...
Address 3.3 r j._. _ _............ __...
Street Address/ State Road/ Lot #(s).F"}/ /
1_dem.e..1.s State ._t4c, ZIP
Phone #
Subdivision
Authorized Agent
City ..✓. ZIP _41
Affected C3 Cw l f W C i PTA FI ES C1 PTS
Phone # { ._.� w) .__ .. _. a River Basin P�����1
O C i OEA HHF E 11H CJ USA CJ N/A
AEC s :
Ad'. Wtr. Bod C �=+ � �. " riot /in
I y ( an�'unkn)
s
u Pws;
ORW: es I o PNA es / F' 0
y �. y
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Closest Maj. Wtr. Body.
Type of Project/ Activity (i," c, 1 c �t; f
._.. ! X�
(Scale:
Pier (dock) length
€
f
Fixed Platforms)
Floating Platform(s)
Finger pler(s)
Groin length
number
....
Bulkhead/ Riprap length
avg distance offshore
-
f
max distance offshore
,
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:.... _....
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Basin, channel
t .._ ..... .........r... _� �._ �_....
Shoreline Length_ l _ �.
_..._
SAV. not sure yes
S 33 £
Moratorium: yes no I
� i. l
Photos: L' S no ..
s
Waiver Attached: yes rho ---
A building permit may be required by:� 1J C See note on back regarding River Basin rules.
( Nate Local Punning Jurisdiction)
Notes/ Special Conditions
Agent or Applicant rint08 Name
1.11111-11.1111 11
Signature "Please read compliancest,�t r��ntonbackofpermit"
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Appkatlon Fee(s) C eck #
ti
Perm Officer's Printed Name
Signa re
Issu-ate Expiration Date

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RE I URN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner: e�,L11
Address otF'roperty: U7CA .... .�.t3"C .._..._._.e..._...,_.. .....
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(Lot or Street #, Street or Road, City & County)
Agent's Name Mailing Address:
Agent's phone #: Or
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. Adescrjpign ar drawing, with dimensions, must be provided with this letter.
1 have no objections to this proposal, t have objections to this proposal.
It you have objections to what is being proposed, you must notify the Division of Coastal
Management (RCM) 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 [phone]. No response is considered the some as no objection Ifyou have been
notifled by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat tamp, 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 mus n the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
- Z/
Signalare Signalnre•
Print or Type Name
Marling Address
C� -Z 27 p )
Print or Type Name
Marline Address
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