73776A_Ansell, Daniel & Kerry_20190806

CAMA / DREDGE & FILL NO. 73776 A B C D
GENERAL PERMIT Previous permit# O
flNew -Modification ❑Complete Reissue El Partial Reissue 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 15A NCAC
cE Rules attached.
Applicant Name D11111,0e k AASE Ke r r- 4 till e / ( Project Location: County r 4
Address
City /- rn J:� e t State N C ZIP y>
Phone # ( °` )923' (oS E-Mail L +1Ae 4 - Q
Authorized Agent
Affected ❑ CW 177EW PTA t-ES 1�-PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
ORW: yes /t -0 PNA yes / n�c
Street Address/ State Road/ Lot #(s) L o y 4 ,50
Subdivision H -i Q r a r E s fi e S S e y
City yq _' j A r a s__- ZIP 2-7S y 3
Phone # ( - ) - River Basin
Adj. Wtr. Body P- — /., `,k z ­ ^ d nat /mom an /unkn)
Closest Maj. Wtr. Body —1-6 a /' ` ' S o ^ ':� -
11
Asin
-ating Platform(s)
length
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Age or App t
7
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
*
Pef•mitOfficer's Printed Name
Sjgnature
Issuing ate Expira on Date

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: 5415,3 TCtwtlrc o D07 (44c,/4s -Dare
Agent's Name #:
Agent's phone #:
(Lot or Street #, Street or Road, City & County)
Mailing
Address:
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.
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 [phone]. 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 sign the appropriate blank below.)
I do wish to waive the 15' setback requirement.
c/ 012 1 do not wish to waive the 15' setback requirement.
Prope y er I f ation)
Signature
v11L�
Print or Type Name
(Adjacent Property Owner Information)
Sig ature
Print or Type Name

Mailing Address
Mailing Address
City/State/Zip
Telephone Number/Email Address
Date
*Valid for one calendar year after signature`
City/State/Zip
Telephone Number/Email Address
Date *
Tro SCj FvIKY1ea�
Revised 2017

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner: 11.,hi &— 1 -�-
S
Address of Property: S1 (9 3 -eicts- -NavC-
Agent's Name #:
Agent's phone #:
(Lot or Street #, Street or Road, City & County)
Mailing
Address:
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.
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 [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION
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 sign the appropriate blank below.)
(Prope r I r a ion)
Signature
l SL
Print or Type Name
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Adjacent Property O ne Information)
Signa re
ol
Print or Type Name

Mailing Address
Mailing Address
City/State/Zip
City/State/Zip
Telephone Number / Email Address Telephone Number / Email Address
Date Date*
*Valid for one calendar year after signature* Revised 2017

1
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This map is prepared
from data used for the
inventory of the real
�J
property for tax
purposes. Primary
information sources such
as recorded deeds, plats,
wills, and other primary
_
public records should be
t�
consulted for verification
of the information
contained in this map.
r
r`
56183 Pamlico DR
Hatteras NC, 27943
Parcel: 016121000
Pin: 959518216277
1aat4e+-ems I ,v c
�'1 gar 3
169.26
125
:32.36
s.
.a
16.69
119.32
119.52 - `
'E
Owners: Ansell, Daniel
Ansell, Kerry Ann
Building Value: $348,000
Land Value: $225,300
Misc Value: $10,000
Total Value: $583,300
Ib
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Tax District: Hatteras
Subdivision: Hatteras Estates Sec 1
Lot BLK-Sec: Lot: 49 Blk: Sec: 1
Property Use: Residential
Building Type: Beach Contemporary
Year Built: 1997

Ka_ y3`

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NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: ANSELL
Date: 8/6/19
Permit #: 73776A
Describe below 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)
SHORELINE
Dredge ElFill ® Both ElOther ❑
190
190
SHALLOW
BOTTOM
Dredge ❑ Fill ® Both ❑ Other ❑
380
380
HIGH GROUND
Dredge ❑ Fill ❑ Both ❑ Other ®
3800
3800
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 :: 1-8 8-4RCOAST :. wva w.nccoastaimanagernent.net revised. 02,,03.110