77297_Kyle& Paula Stembridge_20200930

0 CAMA / DREDGE & FILL �p'1003 'NO 77297 A B C D
GENERAL PERMIT �� Previous permit# NIA,
>' ❑�1(jew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued NI/0
As authorized by the State of North Carolina, Department of Environmental Quality 11 ,,
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 7-R . t 2—DC) .
[Rees attached.
Applicant Name K7 le A- (felt\c. S 1-e+M 7Ylr9a Project Location: County 16.p61t�-FpeIf
Address 'J I I _r4\ of Lane- Street Address/State Road/Lot#(s) OC C S 1331
City \.0c 411 in,}00 State NC-ZIP 9.1 S 9 Co,) 1 II rs1 co--)2 /..-Av1e-
Phone#(ill) j 5 - D15*_Mail Subdivision ?Jy 1 Lb p03 N Tp TID o
Abthorized Agent (3,47 Car IiIv / A.u ti C,pnS}-. City 00 5 1')t/)'ie�1 ZIP a 4584
Affected ❑Cvb ❑EW INAA ❑ES ❑PTS Phone# ( )/ River Basin 7p g/ 17A/7
❑OEA ❑HHF ❑IH / El UBA ❑N/A
AEC(s): Adj.Wtr. Body ' y„z Cv-ee k /man /unkn)
❑ PWS:
Closest Maj.Wtr. Body Parr-1 11 C n I VC't`
ORW: yes / IS P NA yes /C
Type of Project/Activity C0/146.,/Cho", o.-c b ' A bO' p1' L,o/1 •" Zb 7(ZO' L -
lkitib
l4/A'l fix nr) - /3 ' X 13" he li 4T (9cale: j�' --9 b' )
Pier(dock)length (p'A (p 0' , i �r
Fixed Platform(s) ZG� g� Cheek ! I
Floating Platform(s) _ I ' Q
Finger pier(s) I ;_ 4f704AV )‘1
—
Groin length . .
number . `
: r to, 1
'
Bulkhead/Riprap length —"—""— — — `
avg distance offshore ; . 1 f I
I I
max distance offshore • a i
Basin,channel 113 * f,3 . ,,,_..' 11
cubic yards i
+ — c j
Boat ramp ' l , ,
Boathouse/ MP, /;71 { _.._ --..__.
Ti
Beach Bulldozing I 1
Other -$k 5 V\tr'^ 1 .,__,_.. . . . . ,�
Shoreline Length t 6 ` ! "Pt2n?(�iVr( � �'y ' IV`
SAV: not sure es no I
Moratorium: n/a yes no 'Prop *' Ii5 ° ,-1 A '
Photos: yes , ; _
Waiver Attached: ® {noJ
A building permit may be required by: gj eat�c-cov---)C (o & ..,4y . L" See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions * i7 1 as e ry+ r b o Pc \ v r t-'11 a < )jee C o r/ �)ov)4/1 1
AQ'proveU by • 4lAnTctil-i pyN . Lv't ; s fit, \ca-; r,•J 1Uwv, ,v' i-t... h-et".,s
ownc,r pvc ,, `t 4,1. a C -}i-tee✓ ot11=.40-,3 COD 9-}'1 wig no 5/ / y1-44GAGik lU,c-,1 1
Agent or icant cited Pe it Ott cer's Printed Name
Signature ee Please redd compliance statement on back of permit-a Sign ur C".--"'
3. c hk. - Zoo,o0 3tts-4- 3 s .:12-,. —202-c7 2,,9,�A-ki " -z 0
Application Fee(s) Check it 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 1 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/ I-888-4RCOAST 252-946-648 I
Fax: [phone] Fax: [phone]
(Serves:Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

411_I CAMA / ❑DREDGE & FILL �p-1.lot toe '1NO 77297 A © C D
GENERAL PERMIT Previous permit# IA IA
��-= mew `Modification ['Complete Reissue ['Partial Reissue Date previous permit issued i'}4
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 I5A NCAC 71 H „ ! c2.-UC._ .
[Rules attached.
Applicant Name K7 le A-, 1 L.L\C '"�' T"c::*pr1 \.-,r;L\9 c' Project Location: County ?-•
Address '1 1 1 &:.Ar 0 LChne Street Address/State Road/Lot#(s) z�, :4. c j 1331
City 00_4.)el5*CY1 State N -ZIP ,4 7 s q (.. _ )1( •is s1 v1(-1v (.uvId
Phone#('?I9') ►g - C-7..5 -Mail Subdivision }4),_„ licb }CI-)pcz-n ttt 4
ALthorized Agent 13017 Lax- isi1E. i A. Unil1 (pt1Si . City Oca 57 k3/)q-n ZIP 4 4 q
❑CW ❑EW [i6A ❑ES ❑PTS Phone# ( ) River Basin TA z ; i't !»
Affected ❑OEA ❑HHF 0 IH , ❑UBA ❑N/A
AEC(s): Adj.Wtr. Body rL-.a1c� ' r IC.- is /man /unkn)
❑ PWS: �' } �'��
ORW: yes //no PNA yes / no
Closest Maj.Wtr. Body , to r,-111 CO
)
Type of Project/Activity } f-11..; i G tI u,) a. 15,, a WY >Z,,'` �,," 'x ?O' 4/ -bit' fe")
I i4 i the fy) / x /?'
h.'J/4: ( ale: j"' —Lib- )
Pier(dock)length i1',w( O'
Fixed Platform(s) 11)14 �locr4� �r-�fsk i , . , I t'
Floating Platform(s) , s )-4
E
T K
Finger pier(s) —_....._. IIIi �� 0_....._.... _.._._ ; ' -
Groin length I I
number — —_ i- i- ... . .... — —
1
Bulkhead/Riprap length — �_.._ r — I—. — ____ 1-_— 1 --_ —_---
avg distance offshore I I 1 j I — r
max distance offshore ' 1 1 i
i `
Basin,channel i 13 ,.r-* 11 yst 1 i
1r 1
cubic yards ; 1 I r�; A-
Boat ramp I I r • i
Boathouse/ oatli ' j� _.... � } _..._ .
:
Beach Bulldozing -4 -I-—-.. i-__._ j ---
Other 7 ."......"--.""alI-.
L.
I L. ti-S? L,Cc" ,
Shoreline Length - i'�,0U T jj I Tx, ,,
I
I � lam' �'wt�± I '; . � ��{/�
SAV: not su� yes no I T
Moratorium: n/a yes + ' 1 l
1 .i'lc —.%,w1 ts ..._
Photos: yes I + 4 1 +. —
Waiver Attached: [vest o' I . I i I i
/ l —--
A building permit may be required by: pj,,�L.,-cc r-k Cr' .--k 7 I '�I See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions Pt 1 r • ?\40iiserin a- ,o.13r.' (i. `-.avt }7err (o r .)i ))or,a/1 y
t VI ,) \ �`I �..,1 rT1\ IC 7 KM TG'1T1 DIN . L.A V rj cv-Y-0,-\'z-: ,., .1 \::-..Wh ly' )-1.- fl-- S
t''c, k I CC.:'' � 1
i.'�W'' - ,(�'S.-'it-} �^5 � ��� O � -jr�(',/ tut l V•t�� , .. - _
Agent or Applicant Printed Name Permit Officer's Printed Name
.(i; `
Signature **Please read compliance statement on back of permit** Signat,i ---
z. eh k. .a ZOO.C22- 3( 5) 377 7:3k_9-1. -I. '._ .2 , _,......‘, r x) .. -
I i Application Fee(s) Check# 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 Rubs 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(9 I 0-796-72 1 5)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/ I-888-4RCOAST 252-946-648 I
Fax: [phone] Fax: [phone]
(Serves:Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

r
ROY COOPER
BE Governor
MICHAEL S. REGAN
Secretary
Coastal Management BRAXTON DAVIS
ENVIRONMENTAL QUALITY Director
BUFFER AUTHORIZATION CERTIFICATE
FOR PIER AND DOCKING FACILITIES ACCESS WAY
A riparian buffer authorization is required for pier and docking facilities access ways through the Tar-Pamlico &
Neuse River Riparian buffer per Division of Water Resources (DWR) regulations 15A NCAC 02B.0233 & .0259. The
Division of Coastal Management (DCM), through a Memorandum of Understanding with the Division of Water
Resources (DWR) has reviewed your project proposal and has determined that the project as proposed complies
with the aforementioned regulations.
Those activities covered by your Coastal Area Management Act (CAMA) permit have received Buffer Authorization
provided the project is constructed in a manner that continues to meet all of the conditions listed below. Failure to
comply with this Buffer Authorization may subject the property owner and the party (contractor) performing the
construction and/or land clearing to a civil penalty by DWR of up to $25,000 per day per violation.
i. Crossing is Perpendicular: Pier and docking facility access way must cross the 50 ft. riparian buffer
perpendicularly(which is defined as between 75 and 105 degrees) unless otherwise approved by DCM.The
alignment shall minimize the removal of woody vegetation to the greatest extent practicable.
z. Pervious Materials:All reasonable measures shall be taken to ensure the access way is made of pervious
materials like open-slatted wood or composite, mulch, or grass to meet the intent of the rules to the
maximum extent practicable.
3. Access Width:The width of the pier or docking facility access way shall be limited to six (6) feet.
4. Project Drawing: The drawing on the CAMA General Permit is considered the project drawing of your
property indicating the relative location of the pier or docking facility and any requested access way. This
drawing will be used to aid in compliance and monitoring efforts.
• Pre-project site conditions: Lot I 11' 1 ANA1Ae \q W IN \.t
t'fze5.
By your signature below you agree to be held responsible for meeting all of the conditions listed above and verify
that all " ormation provided is complete and accurate.
jisr2
Agent ayeame Peicet
Agent or Applicantture Issue Date
CAMA GENERAL PERMIT It: ` aq - 3
State of North Carolina I Environmental Quality I Coastal Management
Washington Office 1 943 Washington Square Mall Washington.NC 27889 1252-946-6481
Wilmington Office 1 127 Cardinal Drive Ext.Wilmington,NC 28405-3845 1 910-796-7215
Morehead City Office 1 400 Commerce Avenue Morehead City,NC 28557 1 252-808-2808

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
t.
I hereby certify that I own property adjacent to AAA t'9 q' PO ikk.0 �rkfl"��YI G 's
(Name of Property Owner) G
property located at 11. j-Obl p--Pa t PI aiita ti ap . 111 T-%t t',/1i t 1j'1`n l ,;:rig
/� (Address,Lot, Block, Road, tc.)
on ll�ftin.d l' lite>; , in V.0A r1l1( , N.C.
(Waterbody) (City/To and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal. A // IicL49
��ef
I have objections to this proposal.,,r✓, /b eoh c e4TeOJe, 74t.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT 1'b-it-beldti
(nd v dr rP-0 04,4p Reis _4 4_i on beta_w of attitrA a site art ) l6,s,,o,„01,_, Ant--8,..61-111-#1,71 '
W I 1
-
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Xi k
i__-±b-LS--- - \
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
1
(Property Owner Information) (Adjac t Prope 0 er nform on)
1
• tur" ,
Priiame `, Print or T
E! It e,,r,l /Yti � f ')/�� d/ 7 /
M In ddress Mallin A d J
Crrtat- 1• City/State/Zip
7!`? . 1'5"Le/'7
TeleP hon m Telephone er/email ddress Tele hone Number/email address
¢¢
Date / P�
J (Revised Aug. 2014)
*Valid for one calendar year after signature*

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
P-t-: ------Ha Cknli'l I
Name of Property Owner: _ flj'e. 14.- I 1,1, ___N-- . 4_,.. ,4_
Address of Property: \ ‘ .7- \ tyA `` 6 �7 C(
(Lot or Street#, Street or Road, City&C t vl r)
y)
` Mailing Address: `"11 - Vhn " fit 141�r 19031, �(
Agent's Name* V.,,('- J� t i c p i 1',k. _ ( 7
Agent's phone#: f 7$ q(N ,, I \Y 11 4 \ C_
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 trtion�DMt n = n g .
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. Contact information for DCM offices is
available at htte://www.nccoastalmanactement.nat/web/cm/staff-listing or by calling 1-888-4RCOAST.
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, or lift 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.)
I do wish to waive the 15' setback requirement.
iffiffyzi_I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Ripari r pe wner Information)
zgnature Si tore
a/ j/f.2 rl �' �-> • � Name
t-,;,-,- a/
„,, ' Na e Print or T e
„, ,,-,pe � ;�l L�%t%'�-f
III -71_44 (4 b
/�` Mailing ddress
Mailing Address � 1/11-rilq4
(` 1'� `nc. /�
firi
�ity/Sta e2i � / ' City/State/Zip
1 pr-(07/ Telephone Number/Email Address
Telephon Num r/Email Address P
g/t/S t / J `k r
Date
Date (Revised Aug. 2014)

i� it1 v •, IU
�.�u , 7
amlico .
lantation Property Owners Association
150 Clubhouse Circle, Washington, North Carolina 27889
Telephone: [phone]
September 09, 2020
Kyle & PJ Stembridge
111 Island Lane
Washington, NC 27889
Dear Mr. & Mrs. Stembridge,
We have approved your project of installing a pier, dock and boat lift conditionally. That
condition being your receipt of approval from CAMA for same. Please forward a copy of
the permit to the committee in care of the PPOA office before you begin construction.
Regards,
Kassie Adams
Administrator
Pamlico Plantation POA
'gob Cor I ‘potAiiv,c,n.) Le,
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"Y *`vpL S••lf�A�, �L� � � AXS. �y{�'R�+'
( Pamlico Plantation'Rules and Regulations Manual Procedure Number: R&R30.1.4
Architectural Modification Form Date of 16 January 2013
PPPOA Architectural Committee _'
150 Clubhouse Circle a �
Washington,NC 27889 v""�`�`t.`' ` '` a#
g � � ' F4# �
Th!s form is used when you wish to make changes or additions on occupied lots and existing structures.
This includes structural changes, exterior repainting, tree removal etc. Please refer to the Covenants for
specific;irestrictions.
Owners: O ' �� Y� '" ' Lot Number: oo
JJ �,J
Telephone: q l ({ i
We request the following ���'i � ) se( 1 i IA") e L _,10 r)0 dP.4 -)
n' 5c , 0.f . 4 . `I4L' . i ' ED
�•'_` c\ Lit � +�� ` S y s'1 . l� Y r
Attach any applicable documents to support your request (but not limited to) sketches, site plans, color
chips, etc. For tree remove<I requests, mark each tree or group of trees to be removed with a red band.
c /L.3/4h.doli:
Owner's Signature Date
Architectural,Committee Action:
Approve tQQ Disapproved: Date: q/8/
Distribution
m Owner
Li Architectural Committee
O`fce
Page , of_1_
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
I - -- � � i `
Name of Property Owner: _ � '� �- PA.U, �- el()'� A �`�j
Address of Property: - 'i`- t -A I. 'v' Vv 2"&C 1 )
(Lot or Street#, Street or Road, Cityty
Mailing Address: 111,i AInt1`J`1J rS`fr 1 ( o),Q At
Agent's Name#: �t-��i �� 1 VT,,� - � �_
( (
Agent's phone#: r �c� 'q `' `
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 dtn Cr drawing,with dimensions•`r lam.t provided-vuOr°lhis tatter.
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. Contact information
for ng 1 8tf DCM
offices
is
s ff-listin by
available at httA://www.nccoastalmanagement.net/web/ar►'U to Q
T.
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, or lift 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Riparian Property Owner Information)
tgnature Signature
f
/41 3 r rqe� Print or Type Name
Pre'or Ype Na e V
I I _1- 44,ra n
j
Mailing Address Mailing Address
l4�lL`�//,1 f ri /1�� /. t ,-1 City/State/Zip
City/Sta e/Zi/ //
!;c fa(?l Telephone Number/Email Address
um
Telephone N r/Email Address p
1 1 Date
Date (Revised Aug. 2014)

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(� 1 ll -
I hereby certify that I own property adjacent to ,�t)\ ' Pc l'r ' .;I ibt. -.>t�r( ..) dc, 's
, l (Name of Property Owner) u
property located at 1 f)-1- 0(')1 op i-b,(Yl t,()Pl tuft•-tircfL. I 1 l 1-A(Ay\r l ►, IA`)(ith'ie ) of l
(Address, Lot, Block, Road, tc.) -,
on i�Ah' d 0 rf'_-(-'_ --" , in 0thi-' itQ; Y`' , N.C.
,
(Waterbody) (City o andlor County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(lndividua r►_da to e,. msf fill mn dascrtpf oar w or attach a silt -
61} ir- t'•-p .C.� -3-7L- ,JTv/iiX ' ' _. 01'r/.-0(QJ0_7 r_.-/rt c, i
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` t.►✓( 0-- bnri_ o / .
.f eruct C-t t,_1 -
--4, --) t, %,-------
j:_t_LLS \
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
Qtur i� Signature*
Pri Jot lz j 'pe Name / `- Print or Type Name
//. :54,d/1,..,,
Ma ling Address Mailing Address
�• a- )! ,el Al 11Ri j
Ci tate City/State/Zip
!S ^� "17'
Telephon um er/email address Telephone Number/email address
Date

f
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: _ A(4 . 4- IT-Li,k --Ck4i1_,I i 4
Address of Property: \ •
(lot or Street#, Street or Road, City &C ty)
-I J , ; Mailing •Address: '"(l�. ��/f=. )J Q�/S7r i1 a i 41
Agent's Name#: ,r i 1 L471 VT_.
Agent's phone#: F:Ia (1(t:( ✓ 1 \\)Ct-4)0\4 6N (\O(.
9
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 dit moons, must be DT tM With this ten-
.i/7 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. Contact information for DCM offices is
available at http://www.nccoastalmanagement.net/web/cm/staff-listing or by calling 1-888-4RCOAST.
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, or lift 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.)
(skin :, ,-4 i L 'I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Riparian Property er Info tion)
ignature / Signature
/41 ced)'`d&
, �fi' el ( W j Print orT Name
Pr 5orYype Na e (_, Type
Cue- _ -PC
1/( :l.���.r'� ��`j _
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Mani g Address
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g 1. "lei 7l ,s y y 7.
Telephon Num r/Email Address Telephone Number/Email Address
e/t)?S. .`a4
Date (Revised Aug. 2014)

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to AAA l,f Pail to_ \. -kry'y1 's
lJ (Name of Property Owner)
property located at 711-1-Q(m1 D4- �a rr�It e��l aft lift tap, l I I 1 =1 AAA k()O lii l
� (Address,Lot, Block, Road, tc.)
���
on UtbR d fat ra , in (ty N.C.
ey) C To and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Indiviiduai proposing derretoprrrenathid *l i desciripfian bek oraOata_site d wttg)
dit.l �� - „ 1�'' 0s� -G; a� C� /Z.4'00.440.t41 d
- rocker efk,e_te._
lrrr
Aix
st-trLS— --\
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.)
' R
•
1� 7 /( i do wish to waive the 15'setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property er Info do
Signa "*/24 4- v(/ 7T G G'
Pri ame .. /nnt or T _Name
in ddress ai'n A dress.
Vag :- �',fl IJ( ��g�� (2 4n t �� 7
ci t r ir• City/S t
Telephone S email ddress Tel hone Number/email address
AP s ) .5-/a57l )
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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NC Divisive of Coastal II1gt. Habitat Impact Computer Sheet
Applicant. evy1-e �'r-^J�-•ey.
Date: q'Act IZd
General Permit 4r
Describe below the HABITAT disturbances for the application. All values should match he lame,and units of measurement
found in your Habitat rode sheet
TOTAL Sq.Ft FINAL Sq. Ft TOTAL Feet I FINAL Feet
(Applied for. (AnticipatedFaal (Applied for. (Anticipated final
DISTURB TYPE ! Disturbance total disturbance Disturbance disturbance.
Habitat Marne Choose One ncludes any Excludes ry total includes I Excludes any
anticipated restoration any anticipated j restoration and/or
restoration or and/or ship restoration or temp impact
temp impacts) impact amount) temp impacts) amount)
a
OW Dredge❑ `ill] Both 0 Other i� ! ti i � '
i I I
Dredge❑ Fill iO Both ❑ Other ❑
i I i j I
Dredge] F ll❑ Both ❑ Other ❑
Dredge Fill Both ID Other ID
• Dredge a Fill CI Both Other ❑
Dredge I Fill❑ Both ❑ Other
Dredge D Fill 0 Beth ' Other ❑
Dredge 71 Fill iJ Both ❑ Other •
Dredge D RH!O Both ❑ Other ❑
• Dredge.D FIII❑ Both ❑ Other Q
•
•
•
Dredge ri Fill 0 Both ❑ Other ❑
i j I
Dredge 7 Fill.❑ Both ] Other ❑
Dredge: Fill ri Both D Other ❑ i I
i Dredge] Fill 7 Both i I Other

4 ilek 9.
ROY COOPER NORTH CAROLINA
Governor Environmental Quality
MICHAEL S.REGAN
Secretary
BRAXTON C. DAVIS
Director
30 September 2020
Francis Cox
109 Island Lane
Washington,NC 27889
RE: General Permit No. 77297-B
Installation of pier,platform and boatlift
Dear Mr. Cox:
The Division of Coastal Management has reviewed your correspondence from the
adjacent riparian property owner notification/wavier form dated 10 September 2020 objecting to
the above referenced project. The installation of pier, platform and boatlift is consistent with
North Carolina Administrative Code 07H.1200 (See Attached). The project as proposed is
consistent with the appropriate rules and regulations of this Division. Therefore, on 30
September 2020, I issued CAMA General Permit No. 77297-B in Beaufort County, authorizing
the aforementioned project, (see attached copy of permit).
If you wish to appeal this permit decision, you must file a request with Mr. Braxton C. Davis,
Director of the Division of Coastal Management, Department of Environment and Natural
Resources at 400 Commerce Avenue, Morehead City NC 28557, within 20 days of the permit
decision. (Appropriate forms are available at the Washington Regional Office or
https://deq.nc.gov/about/divisions/coastal-management/coastal-management-permits/variances-
appeals). Please do not hesitate to contact me at(252)-948-3851 with any additional questions
you may have regarding this matter. zSince ly,
47--E---1.-
Kelly Spivey, anager
Division of Coastal Management
Washington Regional Office
Enclosures
NORTH D E QA)
Department ofEmbaumnW UuBry�
North Carolina Department of Environmental Quality I Division of Coastal Management
Washington Office 1943 Washington Square Mall I Washington,North Carolina 27889
252.946.6481