78680A_Passante, Joe_20200515

zSCAMA / ODREDGE & FILL 9 78680 B C D
GENERAL PERMIT Previous permit # �J
�gNew l Modcation UComplete 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 anviron ent^nl concern pur -suant to I SA 1`I kC i i I i A
1( Rules attached.
Applicant Name �R��©j SSCI �P Project Location: County---cam,A C",
Address_�� 3 , y E(Q jJ p f tee— Street Address/ State Road/ Lot #(s)
City--_�State N-C ZIPS ? f3 _1 «.,C i+-c_i .
Phone # 450 -Mail Subdivision
Authorized Agent --�L.� t�jl�et t MC4 (, 4 e City _ ,,. ZIP j
Affected 3 CW XEW VPTA N ES ❑ 1Trs Phone # ( ) _ River Basin _ N f
O OEA C HHF -1H USA N/A
AEC(s): PNS: Adj. Wtr. Body 'CLan�_ (nat-/ a unkn
u `
Closest MalWtr. Body
ORW: yes/ . . � PNQ yes (� z
0
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s) .-r•
Finger pier(s)
_
_ _ -- �.._ �_
t
Groin length
_putnber
Akhe Riprap length
avg distance offshore 2
max distance offshore
Basin, channel
cubic yards
goat ramp
Boathouse/ Boatilft
Beach Bulldozing
Other
f
,
E
Shoreline Length i
�1
SAV: not sure yes
Moratorium: /a yes no i _
i �.�
l
Photos' ye nn ' 0 . ,tom . �} J�.
s �
Waiver Attached: yes C3 --:-L—
A building permit may be required by: 8A Fti C11 l ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction) Notes/ Special Conditions t ) 2-0%/tm;t of
(Scale:11 i .— L{ () 4 )
!3W:.
Agent or t Printed me
Signature ** PI ad compliance statement on back of permit**
1w (7)(A _ 11 sS
Application Fee(�s --- --- Check #
----
Permiit ficc'err'ssPPrir ted Name
Si atur
1t� .2_.--
Issuing Da E irari n Date

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: J-O e ?&5san �?—
Mailing address: 113 ge•+ghtS�R
am den, t�C <9761a 1
Telephone Number: a 5 a - 501n - ! g 5(0
I certify that I have authorized Ear-ha{�¢rs j+%�r ine (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of (1S�a�1 AT20U1L 1�LV V�
'bud V--,r mad
at my property located at
This certification is valid through KCVtakh C a 0C W (date).
(Property Owner Information)
Signature
Print or Type Name
O uo t'ttr
Title, co. owner or trustee for property
L.9 / Z, D -
Date
a sa - 5aoo 1 g 5co
Telephone Number
o SSa��e
Email Ad r

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
I hereby certify that I own property adjacent to � Le- fitSSCA (1 .S
property located at
N
(Name of Property Owner)
(Project Site: Address, Lot, Block, Road, etc.)
on arld-) -�y in 0 8,Mdcrl N.C.
(Waterbody) (CitylTown and/or County)
Agent's Name #; _ �h5h+�� ers (�%�� n G Mailing Address: I a15a
Agent's phone #: �5� a
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal_
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
ins- I1 1L341 Vtr"� l JV�4Neo-a
If you have objections to what is being proposed, you must notify the Division of Coastal
Management (DC" in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 1367 US 17 South, Elizabeth City, NC, 27909. DCM representatives can also be contectedat
[phone]. No response is considered the same as no objection if you have been notified by
Certified Mail.
(Pr rty Ownoorr Information)
1
S" tt ature 1 o e } �&SCo l —
Print or Type Name
ilk WIndw hi•S -Dv-.
Mailing Addres T�T
cityrstateZp
Telephone Number/Email Address
,S lf%-Zo
Date
'Valid for one calendar year after signature'
(Adjacent Property Owpor Information)
Signature*
�OnCLld. /a,- I'41argarei' yten my -
Print or Type Name
AJiAdv i tl61HS 1!. r-.
Mailing Address
�a Mdal, w a7�a l
City/State/Zip
dsa-asp-3s;-
Telephone Number IEmail Address
0�0 _
Date'

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
I hereby certify that I own property adjacent to �. Le- r CtSSOlr1 s
(Name of Property Owner)
property located at
(Project Site: Address, Lot, Block, Road, etc.)
on br13-1 }o E`asq uotz}nK�,ver in _ 0 a..n1d e�
N.C.
(Waterbody)
Agent's Name #: [X+h, `k�ws NkWf f R
Agent's phone #:a5
(Ctty/Town and/or County)
Mailing Address: lay a. FL°"'' da= ►� d .
rZi.beti- .i�u ,NC Or[olocl
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must M irr desrrfpt/an below or attach a site drawing]
1134 i Vm 1 wit e�t�
If you have objections to what is being proposed, you must notify the Division of Coastal
Management (DOW in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 1367 US 47 South, Elizabeth City, NC, Z7909. 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.
(Prope;Vy Owner Information)
Signature
doe Lsat,14-
Print or Type Name
_111 W I'A 41
4p o ki, -Dv,.
Mailing Address
#.YAdtl1,NC
a�aa►
CitylStallw p
Telephone Number
/ Email Address
/
JP
2-0
Date
"Valid for one calendar year after signature"
(A ' nt Props Owner Information)
A'11(-,t f
Signature*
-bA�Id 0 }s tic Dom
Print or Type Name
!aP t�."Raoad S+.
Mailing Address
City/StatelZip
Asa- 331-
Telephone !Number! Email Address
� /I 3i ZQ2 0
Date'

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