78688A_Pitonyak, George_20200831

)(CAMA / (DREDGE & FILL_ N 9 78688 Q Br4CC D
GENERAL 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 I SA NCAC �� . j (U��
/�► n Rules attached.
Applicant Name 010J. ge, -_`_1-roV1I(�- Project Location: County _ _ � (We. -
Address
-3 9 1 Qj T y + �,h,Qf J Street Address/ State Road/ Lot #(s) �j Z i�� �.lU�,�►,
I_ -
City--ik-t t -�' —� --- State NC ZIP 21_`1.4q
1 l-�" V- i..a�VI G�.I 6 •C, l �'r
Phone # (Q)ti_'' 3/v�jE-Mail _ Subdivision K-1' j rl < q< Z3
Authorized Agent_�}'._�? 4L-f� _��rLiM4� i~1 M�'jG{1tioCity 1� F'� ti r1Q.ylJl� ZIP 2'�'�'y
Cw )(EW ;APTA AES Phone # 5 River Basin
Affected �Q }Q,y► -
AEC(s): OEA HHF _ IH 'USA WA AA I_..
PWS: LK
ORW: yes / no PNA yes / no
Adl. Mr. Body rV, 6Lr1 MW/man jun n)
Closest Mal. Wtr. Body A i h i'_ ✓►'t 2Ytz J t'li
Type of Project/ Activity ('i Yk 5 t V u C-A1 D v%, v V 1 AV at) Ifd 1/ ZV VVNk v - WkV ✓l u PVC P& 41'-Lt
�i L« �.t ✓� �- a A Auflf2 t CK i 5 b r U V9 UAAQM (Scale: M T `J )
Pier (dock) length
FixedPlatform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number OV
- }
Bulkhead, length.
r►
avg distance offshore
max distance offshore
i
Basin, channel
cubic yards yr 0
Boat ramp
Boathouse/ Boatlift___M ` _ XX CIA ✓
V i� J*
Beach Bulldozing
Other
Shoreline Length -- }�_-_ --
SAV: not sure yes
Moratorium: nJa yes no
Photos: es no
Waiver Attached: yes
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
D&0_ See note on back regarding River Basin rules.
I
00, Lc e ((IJ Y
t Print a Permit Officer's Printed Name
S' a ** Please read compliance statement on back of permit ** Signature
$40o.©i✓ __K,3vC)t. ej'-s i 12 2)
Application Fee(s) Check # Issuing Date
12i 3% 1 U
Expiration Date
I

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Per M:
Mal* Adches;
v z-
I 3'that 1 have authoaiad (agent) D + 6 3j2 �/arm/led)
do ad on RW
befialt for the propose of applying for and obumung an LAMA Pen li s rocamry ID
hvuU or construct (ac th*) S P Fe - n l P f s i2
7--
at (my pmp M boated at) lz4 f L
Tim aa-tification is valid thru (date) � Z
Property Owner Sigmume

DIVISION OF COASTAL MANAGEMENT ,
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
t_
Name of Property Owner: ------------ Z
Address of Property: 39 V�1L r L C'
(Lot or Street s, Street or Road, City & County
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 mus�be provided ±gthis letter.
�lv have no objections to this proposal. I have objections to this proposal.
ff you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCA) in writing within 70 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 15from my area of riparian access unless waived by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
(`I�A I do wish to waive the 15' setback requirement.
__-_ I do not wish to waive the 15' setback requirement
(Pro rty Owner Info ion}
- - ----- --------- ---
Signature
Print or Tyo Name
_�_�y�� _______________
Mailing Addres
t 7-fiq4�-t.16_7-V�
City/State rp
2_`-29 S-1.36 ------
Telephone Number / Emai! Address
2v
Date
*valid for one calendar year after signature*
en t roperty Owner
Information)
��`J--------
Signature*
-Aan--- Til-mob---------
Print or Type Name
------------
Mailing
Address
r
-kl
city/Scat ip
_ 7Q_3-36 � - 03 _RVTUAS-22;
S-2
Telephone Number / Email Address
Fa e z
te r
Revised Jan. 2017

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICAT1o"AIVER FORM
CERTIFIEp MAIL R1gN RI����gt1EiSTEQ or NANp OELtVER£D
9 r
Nana of Property Owner- --1_1- on-\4�1��------------ -----
Address of Property: y �rLi CSk/ - 7
(Lot a Stre N. Street or pond, rty 8 Corn
Agent's Name e:
Agent s phone >X
Malting Address -
I hereby cert)fy that t won Property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the deveiWnlerrt
they are/proposing. A descriotzon or drawing. vvfrtt d►mensians Lae provided watt this tetter-
-�::- have no obj�eMals 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 Abriagemmt
(DC" in writing within 10 days of receipt of this notice. Correspondence should be mailed to I01 S.
Gr ifltn St, Ste 300 Elizabeth City, NC, 27909. D CM representatives can also be contacted at (252) 264-
3W1. Na tee once is considered the same as no objection if you have been notified by Coed MatiL
l understand that a pier, dock, mooring pilings,
boat ra ON
roin
must be set back a minimum distance of 15 from my area of riparian access uniess waived by
me. If you wish to waive the setback, you must finial the appropriate blank below.)
0
I do wish to waive the 15' setback requirement
I do not wish to waive the 15 setback requirement
(Pro rty Owner Infoftrrati
-ignature�
Pnn(or T Name
_3 -vs -I V+-1�-----------
Marling Address
rty/Seat
Telephone Number / Emar! Address
Date nature*
*Vatic for one calendar year after sig
Adjacent Prop 0 tier Information)
"gnat -- —` -
t t
Print or Type Name
Maikng Address
hnal-11A'SaI42-t-0
City/Statwop
L�-J -CSO i
Telephone Number / Emad Address
�S 2� 20 z 0
Dale*
Revised Jan. 2017

400
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