76842A_Campbell, Kevin & Janet_20200813

VICAMA / ADREDGE & FILL
PENERAL PERMIT Previous permit# B C
"'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., �U _7-q. /I C"O, ';W
I ,,ules artach4d.
Applicant Name f-'etl�, Project Location: County (QI
—, �-kck
Address JCIQ_�- i;06+ jkwoc,6 . Street Address/ State Road/ Lot #(s)Wao Albrzcp
City Paiter State PA( ZIP JCCq9
Phone # (70) 210 - 7j06 E-Mail C"h e q.1oft,djyision if -,;,j C,,vc_ 13eCC
Authorized Agent r City COTC, I le- ZIP a,79, J
CW 4W -"PTA AS PTS Phone # f River Basin Fw;r,40to�
Affected OEA HHF Ili USA N A _W
AEC(s): Adj. Wtr. Body &Oc k jolt�-
PWS: (nat /O/unkn)
ORW: yes 1. PNA yes no Closest Maj, Wtr. Body Ct4r ;+%c
Type of Project/ Activity Jllo'r"'i o AV�>
Fier (dock) length
Fined
Finger pier(s)'_
Groin length
number
tfk9Y pip-P l-&,
avg distance offshore .2
max distance offshore oil
Basin, channel
cubic yards
Bat ramp 12' it
Boathouse/ Boadift
Beach Bulldozing
Other
64� V C 4
4
(Scale- 1) T�
P"At�t•`ctf) iCk tfl
V
Shoreline Length 6e
SAV: not sure yes
Moratorium: -IN
Moratorium:low ono
noo
Photos:
yes Waiver Attached: ? no
A building permit maybe required by: ('14LI-Vili.emu li2;e See note on back regarding River Basin rules,
Note Local Planning jurisdiction)
Notes/ Special Conditions (7- -Xc
;7( ;0 CLY- �a L-AW (4
_ed 3
Agent or , tcant Prin Name
swU't_e ease read iimplianceWatement on back of permit
It Or',id.,tro 161 �
" ;A r f- a!
Permit Officer's Pnnted
7
Signature
)1P. - 1�_ �o

AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Re,�.V
Mailing Address: /O a'1 9&" 0 —��---
P ate.) P D. 140 3 g
Phone Number: l - Tail - A9 0 - 7�&H to
Email Address: C.aMobeLL 40100 2.o0M►m42fr%�-�. yet
I certify that I have authorized ���� 0 "1��•w•�a•�•? ,
Agent / Contra or
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
.
necessary for the following proposed development: .n.[19 e.�.y.A Q 30'
,.•.. �. _I.F111111111111111 14 M. - a...,_ .
at my property located at
in
County.
1 furthermore certify that J am authorized 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 information related to this
permit application.
Property Owner Information: ,
Y f I
rgn ure
A'� i
Print or Type Na'me
Title
Date
This certification is valid through /

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NTIFIcATIONIWAIVER FORM
CER 71FIED MAIL-- - 2UES ED or HAND DELIVERED
Name of Property Owner
Address of Property. CA 0 1
(Lot or Street Street or Road, City & COMM
Agent's Name #: s 1 Mailing Address: r J I'
tr
r 7,
Agent's phone
iwaiii6w- - —
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
[ with dimensions, a � I Wided with this letter
they are proposing. tsfi���� -
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 Divxmn of coastal Management
(DCAI) in writing within 10 days of receipt of this notice. Correspondence should be matted to 401 S.
Grifrin St, Ste 300, Effrabeth City, NC, 27909. DCM representatives can also be co at (252) 264-
3901. No response is considered the same as no ob -ionjection if you have been notWed?ZCer~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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15, setback requirement,
(pn*erty owner Information)
Sign�atl`ure-
PA
pnni or Type Name
/0-
r,,�
Mailing Ad*ew
citylstatalzip
� - 7�,l - �v(2 - Z�-Yi
Telephone Numberl Emad Address
Dole
-VaW for om C*Mdw yew after stgnaturt*
print or Type Name
1-11,
r
Va-din-9 Ad*OSS
cky&-tatelzip
70c/
Telephone Number I Emal Address
pcue
Revised Jan. 2017

CHVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIMAIPROR�EURN RECE PT REQUESTOWNER ION ED FORM
CERTIFIED
I hereby certify that l own property adjacent to
(Name of Property Owner)
property located at ��-j.�-D
(Address, Lot, Block, Road, etc.)
r e4i _ N.C.
on — -
Nltaterbody) in (city/Town and/or County)
Agent's Name #: _y,L�_�
U� Mailing Address: a 46—
r-
Agent's phone #:-
He/She has described to m-3 as shown below the development he/she is proposing at that location,
and I have no objections to the proposal. ------- _-_
-----------
DESCRIPTIO'A AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
ou must notify the Division of Coastal Management
if you have objections to what is being proposed, y
(DCM) in writing within 10 clays of receipt of this notice. Correspondence should be mailed to 7367 US
17 South, Elizabeth City, NC, 27909. DCM representatives can also be contacted at [phone]. No
response is considered the same as no objection if Du have been notified by Certified Mail.
(Property Owner Information)
Signature
Re..
Print or Type NameIn
..
Mailing Address
City/Stafelzip -
�
Telephone Number
y-13-e?O
Date
W
roperty wner Information)
Print or pe Name
Mailing Address
7
ChylStafe;'Zip
Telephone Number
Date

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