77968A_Southern Shores Civis Association Inc_20210104

'CAMA / s/DREDGE & FILL
GENERAL PERMIT - per C3 B e D
Previous per #
ew 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 , (10,0
Rules attached.
Applicant Name SlwS Giu;c Project Location: County e..
Address,53 ��;L � i r � . t � % Streei Address/ State Road) Lot #(s) ( 3
_ ve,4 �l
City_ ,:fj _ State:A)C,. ZIP -?'i41 i ! : t_
Phone # ( ) E-Mail ": act ,t ac,. f QCww,'I. 7Subdivision
l tQ ,r, C�-*,s �sCccQ.`� . 1.GG City fk& �bILS ZIP 21`1
Authorized Agent �r _
Affected Cw AW ✓PTA �tS PTS Phone # ( ) River Basin t, p17,
AEC s : OF.A HHP tti Ut3A N(A { } Adj. Wtr, BodYr.■'Gck- _,`.Gf ... ._ .in /unkn)
PWS:�
ORW: yes I no PN1A yes I ©o Closest Maj. Wtr: Body C"r • -kc L . 3D& , G4
Type of Project( Activity _ 'Re, p{c C�,,
)
Pier (dock) length (State: A)3�
Fixed Plaform(s)
Fkyating Platforms)
Finger pier(s)
Groin length
number
E
�A�%-.distance
prap length 9 �
offshore IL
max distance offshore 11
Basin, channel 1.
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Buildozin
Other
Shoreline Length i 9 ■
1—
SAV: not sure yes no & r z t/
Moratorium: a no
n,a ye, no r1
Photos: y�d no
Waver Attached: yes no
t
C'Ahk C-F nli
A building permit may be required by: lc , See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Names
Signature * Please read compliance statement on back of permit'
*qGC',.Ga 13,5--l..
Application Fee(s) Check
Permit Officer's Printed Name
Signature
}
Issuing Date Expiration Date

RECEIVED DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION[WAIVER FORM
JAN 4 2021 CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
DC% f Property Owner.
Address of Property:
e,-4
(Lot or Street #, Street or Road, City & County)
Agent's Name #: (�.n �)�q�Mailing Address: 1� li(1ti/
Agent's phone #:
I hereby certify that 1 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.
X 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 90 days of receipt of this notice. Correspondence should be mailed to 401 S.
Grim St., Ste 300, Elizabeth City, JVC, 27909. DCM representatives can also be contacted at (252) 254-
3909. 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 15' from my area of riparian access unless waived by
me. (i€ you wish to waive the setback, you must initial the appropriate blank below.)
DH I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
SC
not or Type Name tC_[)U '�,1 Cn� � ` 4
Mailing Address
1��Uo �Syyoz �J u F-IN�
City/StatelZip
(Adjacen" L72po
Owner Information;
Signature'-' ^l
-nNf) �-� � 6 � 0 1
Pmt or Type Name
Mailing Address
Y A M12
City/State/Zip
Telephone Numberl ErriairAddresTelephone Number/Email Address
I1AL�0
Date
1 2-L 10
Date --'-
*Valid for one calendar year after signature* Revised Jan. 2017

RECEIVED
1AN 4 2021
ADJACENT RIPADIVISION OF COASTAL MANAGEMENT
RIAN PROPERTY OWNER OTIF CATIONMANER FO
__ ACM -EC
Name of Property Owner _ �Z? -kkA, -) n � U( r, \\i 1 NS�oC hnya
Address of property. _
(Lot or Street #, Street or Road, City & County)
Agent's Name #: ('% % Mailing Address: _ ' D
Agent's phone #: _ `)C�)2 -C1' d `] a I
i
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.
/ 1 have no objections to this proposal. I have objections to this ro osal.
P P
ff 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 401 S.
Grifn 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
I understand that a pier, dock, mooring piSECTION
pilings, pbreakwater, 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 ro nate blank below.)
_ 1 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)
Signature tgnatui
Pnnl or Type Name Print or 1 ype Name
M4C�9f��
1�h ,
Mailing Address Mailing Address
��� S1r�eS � Z7°►Y�
city/State/Zrp
Telephone Numb r/ eil dress
---1�-X
Date
'Valid for one calendar year after Signature*
City/Slat i�p �r Q — � M9
Telep Pne MIN i 1.1 l��
1 Cma' A res�
I
--L_�
Date'
Revised Jan. 2017

RECEIVED
Gq�rrl�'v,Gli �otir,�
13�1v�G� yr Pam✓ T�L
JAN 4 2021
DCM-EC
15 �t�tL�ti/�'P �.✓ Trl-

This map is prepared
from data used for the
inventory of the real
property for tax
purposes. Primary
information sources such
as recorded deeds, plats,
wills, and other primary
public records should be
consulted for verification
of the information
13 A Soundview TRL
Southern Shores NC, 27949
Parcel: 029702960
Pin: 986805084301
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Owners: Southern Shores Civic Assoc
Inc -Primary Owner
Land Value: $3,100
Misc Value: $0
Building Value: $0
Total Value: $3,100
Tax District: Southern Shores
Subdivision: So/sh Blk 61-a Lots 26-44 Ph
2
Lot BLK-Sec: Lot: Sound Access Blk: 61-a
Sec:
Property Use: Vacant Land (Prop Owners
Association)
Building Type:

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