76801A_Davis, Ray_20200803

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kAMA / ADREDGE i FILL NN O 7680 t B C D
,1!NERAL PERMIT Previous permit #
_New :Modification Complete Reissue 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
attached.
Applicant Name_ Qmel-_.S�
City ckfs� Statf;_V& _ ZIPS (�-
Phone #—
Authorized Agent 9r , k_ QyAL,�c Js
'I CW
DtW i2'PTA �_-45l t:,PTS
Affected
AEC(s): OEA
U HHP a IH USA 71 N/A
PWS:
ORW: yes / nd
PNA yes / no
Project Location: County__lC.44r J&CjG
Street Address/ State Road/ Lot
Subdivision-WN-1 ctC
zip
Phone # (_ _ �) River Basin
Adj. Wtr. Body _Cc-n�. L vy <',_JJn' t4'.4- natunkn)
Closest Maj. Wtr. Body__C«�lc,_�'�-�
Type of Project/ Activity ; ,F _ N�<,, Dc.,.l aJ M: f
(Scale: j,•. Zd' )
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)_— _
Groin length _
number
ulkhea Riprapkngth _�— _ at.rrswol - ` i. _ -
avg distance offshore k
max distance offshore —
Basin, channel
Shoreline Length
SAV: not sure yes / rws �t � • _
}
Moratorium: a} yes no L�4�/$'
Photos /Oy
nofC.P
Waiver Attached: yes
A buildingpermit may be required b :
P Y e9 Y t_,crt 111Z4k rrzK See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
Agent �!�Iiclr Printed Na e
Signature Please read compliance statement on back of permit
kc_.w _ _
Application Fee(s) Check #
Permit Officer's Printed Name
Signature
_<3 - 3_:_�. -_-__— ___ _____�-3-�_cv
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit
Mailing Address A. 1-7 I-L I. , —
C
Phone Number: _ `757 — 3`7 "' 3 3 7
Email Address: r~ --
I certify that I have authorized C"L (�L.
�1�. L
agent ! Contractor
to act on my Cehalf for the purpose of apptymg for and obtaining all CAMA permits
necessary for the following proposed development
Stmy WOPWty located at 007e K� t 7ti��e c.E
in 62WAV c. ic._ county
1 furthermore certify that I am authonzed to grant, and do in fact grant permission to
Division of Coastal Management staff the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating in related t0 this
pArmrt aoplicatron.
property Owner information-
, �
S;gnat�,,
nt or Type Nerve
D w iu e t'2
rft
J 7 1_ a l_ d40,90
Dare
This certifecat►on is valid through .'6 1

tom- SWANSai&" baatll�l�hrr6s�pmaN.aElm
8oblwt davis Sion o!
V*W- July 21, 20M at &12 PM
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ADJACENT RIPARIAN PROPERTY
l l`*19bY certify that I own property ad,acent to
Propwv located a( /OZ OL'.•..0 t_ Y Of OwrW) s
on _,�. /r.�„ �c S,+„�c; (Addre", Lot, Bock, Road, sm.)
Off) (Clty/Town and/or Countyi
N;
Tre aap,;camt has descrit3e to me, as shown glow tt'.e developmeftt proposes' a'. t'te above
�CBt.q�
_ have no oc+ection tto this Fropo.gp
'lave objections to MIS proposal
DESCRIPTION AND OR DRAWING Of PROPOSED DEVELOPMENT
(rndivtdual proposing doveloprnent must till in description below or attach a site drawing)
r
Q any\ • 1,
0' qti
1 �; I
WAIVER SECTION i
understand that a pier, dock mooring pangs goat rarrp Greakwater boathouse ift 01 groin
must be set back a minimum distance of 15 <rom my area of ^par,ar access un ess wa vec ay
r'le Of you wish to wave the setbacK YOL must Initial the appropriate oianK below
_14�04 1 00 wrsn to waive the 15' setnacK requ,rerren;
_ : do not wish to wave the 15' setback requirement
(Property Owner information) (Adjacent Property Owner Information)
Srfinmature
Pramc or T
Y _7
M !. A r
C.ty to M=327-3-3-7
7
Oret�rrone Number./"r7 &dd,ess
Signature •
Pant or Type Name
Mas:ng Address
C C 2 715-jr-
CrryrSfare2tio
T 9tophone Number /emaN. 's
`'/Gkd for 000 Cale-idar year alter s4gna•we• (Reviused Aug 2014)

Currituck County GIS Online Mapping
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www.co.currituck.nc.us/Geographic-information-Services.cfm
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Major Streets
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Parcel Land Nooks
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Currituck County
10
Aerial Photography (2016
WRod: Band_1
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This map should be used for general reference purposes only.
Currituck County assumes no legal liability for the information
shown on this map.

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