Kennedy, Charles 78849C

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Fre*a{is psmlt #
Bate previau* permit iasu€d
PraiertLgeaaen: eaunry
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�LNFiR 'N�. PERMIT
Previous parmlt # _
VNew , Modification 71Complete Reissue OPartial Reissue date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality r a = t s'
and the Coastal Resources Commission in an rea, of environmental concern pursuant to I SA NCAC e,—„�,_- f,
i F Rule attached
a
Applicant Name` " % (`r ��) _-- Prolett Location County ti i
t L E
Address Street Address/ State Road/ Lot #(s)
A d'
City ��.— State ZIPL
Nk,—
Phone # (` ) ' / * � E-Mail - - —'-- Subdivision � fw
Authorized Agent ___ _ City [ ; a r ZIP j,;f
... ...a 6
cw S, Cyf to )fig opt Phone# ()�— River Basin �u�PI �tl�f f t
AEC(s)Affectea COCA {14HP y171H i:",UdA FIN/A Adj. Wtr. Body (_a'aS .:..( t' __ l = ft�`nat "'afJunkm)
3RW, yes t'oo) pNA yes Closest Mal. Wtr. Body
type of Projtertt/ Activity
(Scale: )
Pier (dock) lerigth
Fixed Platforms) _ ,_.
(✓ 1 c°`r
Floating Platform(s)
Finger Pieria)
Groin length
number
Bulkhead) Ihprap length____
avg distance offshore
max distance of shore- _
.. ..
:.
Basin, channel
cubit yards
Boat ramp. _ , ,.
.?
Boathoutb/Boadift
a
Beach BuiNozl tg
Other
Shoreline Length
SAY: not SUN yes_-
Mbrataitans Ma yes
Photos: yes no
Waiver Attached: yea no.
A building permit may be riqulred by:
See note on back regarding RWer Basin rules.
( Note Local planning jurisdiction)
�
r
Notes/ Speclal Conditions
I
r I
9�m�1 as read caa��enton — - _...__. _.._...
t or t Pn d arse
back of permit "as"
.,,,r, ,4¢�. P ..,.#
Application Pee(sl Check#

�CFE
/ ❑DREDGE & FILL J V` No �78849 A B © D
RAL PERMIT Previous permit#
NeModification ❑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 © %-r
Rule attached.
Applicant Name Cldec, Project Location: County
Address 6 f Ve- Street Address/ State Road/ Lot #(s)
'-ssq--ur�
Phone#(A)p�C �j'o�/�`( E-Mail
Authorized Agent /
Affected ❑CW PTA El ES ❑PTS
AEC(s): Ll OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes PNA yes l(no)
Type of Project/ Activity 9> o DPIJP �M+
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ itiprap length
avg distance offsht
max distance offsh
Basin, channel
cubic
Boat rampBoathou \
Beach
OtherBuly�
l
i
i
i
Shoreline Length i L, I
SAV: not sure yes n
Moratorium: n/a yes no
Photos: yes )1red
Waiver Attached: yes
A building permit may be r by:
( Note Local Planning jurisdiction)
Subdivision -G+O /j I
City P4— ZIPS 1- �/_
Phone # (_) River Basin c✓�; lY DGf �i
Adj. Wtr. Body GFP, / /(na a unkn)
Closest Maj. Wtc Body A/P l�i,+ A 1 i&!�
—1-2. „ I•. ,
vAgent or kppKant Printed Name / Permit Officer's
Si ature ** Please read compliance statementon backof permit's' Signa r
l(n �
AlSplication Fee(s) Check# ISsui Date
(Scale:
u
"If
❑ See note on back regarding River Basin rules.

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 1) 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, certifythatthis project is consistentwith the North CarolinaCoastal Management Program.
River Basin Rules 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 (910-796-7215) for more information on how to complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

N
AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: dr<i-alec, -O _ 2�-f
Mailing Address: GAS /eft �_ �Q� _.�1�•—
Phone Number; �3�— 02% 77V-
Email Address:
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: �K�77t / liiy� Bcx"f ''4r -r
At thy property located at
in County,
U�-v STB-10T dU
i furthermore certify that 1 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:
Signature
Print or Type Nafig
/7 Title
Date
This certification is valid through — I
RECEIVED
FEB 11 2021
DCM-MHD CITY

t',
J•�

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner. (�h Pr! �eJ fir, wnQ2y ;Z
Address of Property: _[ �S C,L-i) 5%!a/U % (rJ ^21fi -
(Lot or Street #, Street or Road, City & County) CC{ rrrr-rr)
Agent's Name #: r% 1 �}tLoMailing 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 must be provided with this letter.
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. Correspondence should be malted to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405.3845. DCM representatives can also be contacted at [phone]. No response is
considered the some as no objection if you have been notified by Certified Mall,
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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)
Sire
(I )IA12(cz5 nrh%��/
Print or Type Name
cfc,a eAs?rjymaJ CRto-k (7�
Mailing Address
City/State/Zlp
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Telephone Number
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Dale
(Adjacent Property Owner Information)
Signature
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Print or Type Name
6,tq 7-0er L 2-
Mailing Address [ /
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City/State2ip
Telephone Number
Dale
Revised 8/19/2012

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CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: 0)4('1e5
Address of Property: L-i)
(Lot or Street #, Street or Road, City & County) '&,tr-rerz'r'
Agent's Name#: 1/u ilor— 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 must be Provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to whatis being proposed, youmustnotifythe Division ofCoastalManagement(DCM)in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405.3845. DCM representatives can also be contacted at [phone]. No response is
WAIVER SECTION
1 understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access untess 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)
Signature
Print or Type Name
9�a FASrrll)A-J (24zk )L
Mailing Address
3c-li,4ptoar ;c�
City/StatelZip
Z Q 73
Telephon Number
,4 ( 7�L)
(Adjacent Property Owner Information)
Signature
Print or Type Name
PO
Mailing Address
,"zc ��� , NC CA6
City/State/Zip
Telephone Number
Date Date
Revised 6118/2012

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