78534A_Lister, Dale & Kimberly_20200305

12X
ICAMA / 3DREDGE & FILL
GENERAL PERMIT
New ❑Modification El Complete Reissue ❑Partial Reissue
N9 78534 CA)
Previous permit #
Date previous permit issued_
B C D
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 i b3, . 11 i
E Rules'attached.
Applicant Name j I 4 k im be J lly : s4 t f Project Location: County,
Address �'\''�'-,�)61 U&bAl R;L't Street Address/ State Road/ Lot #(s) I �1) ram. C 7S•)G
City V1 L, O- i Pa r l� State ZIP ii(;�; d
Phone # (3a) E-Mail (`I 'der l6'c�;;� %�a/ �n•C Subdivision
Authorized Agent
City K„ :HS Is61A ZIP `ISC
Affected ❑ CW YEW EYPTA pts ❑ PTS Phone # ( ) River Basin %<+G,
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body , �, )
(L �x� � (nat �tnan /unkn
❑ PWS:
ORW: yes t' no ;. PNA yes /" no Closest Maj. Wtr. Body
Type of Project/ Activity } .. , ,� F
Ul - Qo x 1 a' ;-srk-F r,—P. (Scale: j
Pier (dock) length _S' X
l
Fixed Platform(s) I ( r 1 r _ . J A I I I ,
Shoreline Length i 54G I N
SAV: not sure yes no _
Moratorium: n/no - -- — - - - -
�� _. �......-...._........ - - _._.._ .............._.. .__ ._....... ..._.L........_.............
Photos: no
Waiver Attached: yes no
A building permit m y e required by: C c;i i .+Lc k C;:k-,+\/ El See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions �IJ(, �Ihr r_ jG Jr vleuj& s' k .. L..-wk•_,.-I sc,hcJt+e it VA4., Lh
l �
CC i 7Al, ,I_ 1,, i 1 f
J
Agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit"
It��
Application Fee(s) Check #
l o hC) it
Permit Officer's Printed Na
Signature '
Issuing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I) prior to 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 Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules Other:
Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject 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 Regional Office (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ 1-888-4RCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax: [phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ 17

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date Z— Z— ZQ
Name ofPropertyOwner Applying for Permit:
t L1—
Mailing Address:
I certify that I have authorized (agent) a: C (�,7SQy to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) e a� at *
at (my property located at) 3 %
This certification/is valid thru (date) (-/—
z-?-7o
Property Owner Signature Date

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTiFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner: i)a /c 4. L I S4 r-
Address of Property: /JF A1444S (sand d. .
(Lot or Street #, Street or Road, City & County) 7950
Agent's Name #: Mailing Address:
Agent's phone #:---+ ~—
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.
CLW1I 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.
Grif in 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.)
LW I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Information)
Signature
�ICA-c k. L�
Print or Type Name
C;)SGcl 2/11t
MailiAddress
R.
7y
City/State/Zip
7S7-Gy/- �33G
Telephone Numb�r/Email Address
(Adjacent Property Owner Information)
Signature*
Catkeviv►e- L . �UtlllaMS
Print or Type Name
q 7.21 tl d lerAvInu6
Mailing Address
V1rgihla" Beam, VA 03g62
City/ ate/Zip
15 7- 4q7- 2476
Telephone Number/Email Address
02 - 02- - 26? b
Date Date
'Valid for one calendar year after signature' Revised Jan. 2017

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PHONE [phone] EMAIL- INFOOSHOREUNEDC.COM
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PROJECT LOCATION: CAPSIES CREEK PROPOSED BULKHEAD, RAMP, PIER, UF7S
FOR: DALE LISTER PURPOSE: BOATING ACCESS
139 KNOTTS ISLAND ROAD DATUM: MLW 0,00'
KNOTTS ISLAND, NC 27950 [DATE 12/5/2019 SHEET 1 OF 1

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PHONE: [phone] EMAIL• INFOOSHOREUNEDC.COM
PROJECT LOCATION: CAPSIES CREEK
FOR: DALE LISTER
139 KNOTTS ISLAND ROAD
KNOTTS ISLAND, NC 27950
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DATE 12/5/2019 SHEET 1 OF 1

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner: �q/ `�r( /sL—
Address of Property:
Agent's Name #:
Agent's phone #:
(Lot or Street #, Street or Road, City & County)
Mailing Address:
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.
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
79.5"6'
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.) Received
I do wish to waive the 15' setback requirement. FEr3 2 6
� do not wish to waive the 15' setback requirement. DCtVl� tY' C
Information)
Signature
/
Print or Type Name
Maili1 9 Address �.A
III
City/State/Zip /
Telephone Number / Email Address
(Adjacent Property Owner Information)
*Sigature*
,�50 yid r/z
Print or Type Name
Mailing Address
City/StatoZip
Telephone Number / Email Address
— 4
Date Dale*
*Valid for one calendar year after signature*
Revised Jan. 2017

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NOTES.
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T)A "TM s eHONN ARE HOR¢aNTAL GRouHo wsrANCEs
SURVEY & SITE PLAN FOR
}.) THIS PROPERTY IS LOOTED IN FLOOD ZONE 'A', •SHADED X',A"AEIi)'PS
BHWrN ON FSMA IMP —El J131pOWWR DATED DE -ER 11 -11 MID
DALE LISTER EL
SU9.IECTTOCHAMGE 9YFEWL
}.)THIS IS A SITE PUTT ONLY(NOT A SJFMr) WED ON RECORDED
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1805 West City Drive, Unit E, Sizabeth City, NC 27909
6.) WETLVIDS SHLMM ON THIS SITE ARE BAKED ON LINE NARKED IN THE FIELD
PREVIOIJSLV
TEL 252.m 621.5030—timons.com
FOR RESTORATION WE TO LAND DISTURBANCE TINT HAp
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PROPOSED
DWELLING
CONSULTATION SERVICES PROVIDED BY:
SHORELINE DESIGN CONSULTANTS LLC.
PHONE: [phone] EMAIL, INFOOSHORELINEDC.COM
PROJECT LOCATION: CAPSIES CREEK
FOR: DALE LISTER
139 KNOTTS ISLAND ROAD
KNOTTS ISLAND, NC 27950
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DATE 12/5/2019 SHEET 1 OF 1

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■ Complete Items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the maiipiece,
or on the front if space permits.
1. Article Addressed tZ
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9590 9402 5571 9274 0443 72
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7019 1640 0000 2869 9039
PS Form 3811, July 2015 PSN 7530-02-000-9053
❑ Agent
B. Received by (Printed Name) I C. Date of Delivery
inter`,, C_ R61114s 1 12-/- Ay
D. Is delivery address different from hem 1? O Yee
If YES, enter delivery address below: 09 No
3. Service Type
❑ Priority Mall Express®
❑ Adult Signature
❑ Registered MaHTM
Adult Si Mail® Restricted Delivery
❑ Reeotered Mall Restricted
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❑ Certified Mall Restricted Delivery
l7 Rat for
❑ Collect on Delivery
❑ Collect on Delivery Restricted Delivery
Merchandise
❑ Signature ConlinnationT"
❑ insured Mail
O Signature Confirmation
❑ Insured Mall Restricted Delivery
Restricted Delivery
Domestic Return Receipt
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2/25/2020
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�CICC I C d P s r(C h i-Cafn)IC
Parcel ID Number
Global PIN
Number
Apt/Unit/Suite
Street Direction
Street Name
Street Type
Street Suffix Direction
city
Subdivision
Legal Description
Township
Owner Name 1
Owner Name 2
Owner Name 3
Billing Address
Billing Address Continued
Billing City
Billing State
Billing ZIP Code
Acreage (Legal)
Acreage GIS
Tax Value: Land
Tax Value: Buildin s
Tax Value: Total
Tax Value: Deferred
Last Sale Date
Last Sale Price
Qualified Sale?
Deed Book
Deed Page
Plat Cabinet
Plat Slide
Data Date
Owner Name 4
Owner Name 5
Owner Name 6
Owner Name 7
Owner Name 8
Owner Name 9
Owner Name 10
3075000003A0000
)003-32-6322
139
KNOTTS ISLAND
RD
KNOTTS ISLAND
PARCEL I CORRECTED SUBD OF PROPERTY MATTIE G CAPPS EST
FRUITVILLE ML
LISTER DALE
LISTER, KIMBERLY
2884 BLUEBILL DR
VIRGINIA BEACH
VA
23456
11.72
11.6
132700
D
132700
D
2018-01-12
310000
Y
1430
882
M
75
2020-02-25
https://currituckncgov.com/Freeance/Client/PublicAccessl/printFrame.html 1/1

Currituck County GIS Online Mapping
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Currituck County GIS
[phone]
www.co.currituck.nc.us/Geographic-Information-Services.cfm
This map should be used for general reference purposes only.
Currituck County assumes no legal liability for the information
shown on this map.
Addresses
Communities
Ayd lett
Ba rco
Coinjxk
Corol la
Currituck
Gibbs i floods
Grandy
Harbinger
Jarvisburg
Knotts Island
tvia pie
btoycck
Point Harbor
Poplar Branch
Pbvells Point
S ha.v boro
Sligo
Wate rl t Iy
County Boundary
- State
-- County
Streets
Major Streets
— Arte ria I_Pri nc i pa I
Arteiial_Major
Collector -Major
Parcel Land Hooks
Parcels
Currituck County
Aerial Photography (2016
ERed: Band_t
Green- Band_2
Blue: Band-3

3/2/2020
C ..7.... .,.I Pn�...,lc Tn•.Llt
Parcel ID Number t
Global PIN t
Number 1
Apt/Unit/Suite
Street Direction
Street Name
Street e
Street Suffix Direction
City
Subdivision
Legal Description
Township
Owner Name 1
Owner Name 2
Owner Name 3
Billing Address
Billing Address Continued
Billing City
Billing State
Billing ZIP Code
Acreage (Legal) 1
Acreage GIS 1
Tax Value: Land 1
Tax Value: Buildin s
Tax Value: Total 1
Tax Value: Deferred
Last Sale Date
Last Sale Price
Qualified Sale?
Deed Book 1
Deed Page
Plat Cabinet
Plat Slide
Data Date
Owner Name 4
Owner Name 5
Owner Name 6
Owner Name 7
Owner Name 8
Owner Name 9
Owner Name 10
https://currituckncgov.com/Freeance/Client/PublicAccessl /printFrame.html
75000003A0000
D3-32-6322
9
JOTTS ISLAND
:fIyiyMl.`11I: MV
LRCEL 1 CORRECTED SUBD OF PROPERTY MATTIE G CAPPS EST
tUITVILLE ML
STER,DALE
STER, KIMBERLY
;84 BLUEBILL DR
IRGINIA BEACH
k
1456
.72
..6
M00
12700
)18-01-12
10000
430
62
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S
020-03-02
https://currituckncgov.com/Freeance/ClienUPublicAccessl/printFrame.html 1/1

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