78153A_Cuppett, Richard_20210406

OL- ✓
�CAMA / DREDGE & FILL
B C
ENER.AL PERMIT Previous pe
rmit #
New Modification Complete Reissue Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Envnorimenxal Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC s ' Zoo
Applicant Name R 1 (, � jCLVCJ CUP Protect Location: Cotwlty
Address I LI („ C &(A 40 "5r .,eel Street Addressl State Road/ lot *(s)
City C ILW 1 44A QQ/_ State NC ZIP 2 I L i �J4y"'
Phone #f (�s `T 7 — 1p- 8 E-Mail rWLW-_ d CA&6+C? PriO •Subdivision WhA)-d inaAj
Authorized Agent (�yNCity t a*n & v1 ZIP 2 Z!
Affected CW )(EW XPTA ES PTS
AEC(s): OEA HHF IH USA WA
PWS:
ORW yes / ® PNA yes / tEo
A
Phone # ( ) River Basin rk, � pe jcLt�
Adj. Wtr. Body (��aOCL) �(. QIVtW (natr an /unkn)
C osest Mal. Wtr. Body r-a I- /lAU4U✓11'
Type of Project/ Activity Con `y i'1/ u a _ t:t_ 3 ' ,X CV b[1 al L •f T
(Scale: ! Y f 5 )
Pier (dock) length
Fined Ptatform(s)
Floating Platform(s)
Finger pter(s)
Groin length
number —
Bulkheadf Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp �/
Boathous Boathit JV x 3t
CL✓Ico ve—vec{Q
Beach Bulldozing
Othe,
��\400
�iJ
t
12.15
Shoreline Length
SAV not sure
yes
Moratorwm n/a
yes no
Photos
YeS no
Waiver Attached
yes 4
A building permit may be required by: a" C Ct t/�-✓L - - --
( Note Local Planning jurisdiction) 3
Notes/ Special Conditions Pi tP d S aAd4l dyf��Lr �
s. (tA" Please
p , L) u
Apphcat ion F ee(s )
statement on back of permit "
PI22q`7
Check X
d%
L-r44 VWA J;;Q
See note on back r egartLng River B isin t ules.
fax
Swale Loa f ftw
PernutOfhcer's Pentad Nan
Signati'qhr I �, l r i
Issuing Dite _ -_ ETtrratton date

IWNER STATEMENT
I hereby certify that I own property adjacent to h I(i d
s
(NartSe of Property Owner)
property located at ��Gw� ( S�
(Address, Lot, Block, RPACtWANK
on inn�l , N.C.
(Waterbody) (City own an or County)
The applicant has described to me, as shown below, the development proposed at the above
locatio .
X I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
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.
(Pr pe y Owner Information)
Sig rep
/? ZL4, --Z/
Prinf or Type N r�e
ion r„:7�
Ma�ing Address
gl
�it, y/State/Zip
Teleph ne Number/email address
Date
(Adjacent Propert er Information)
0-�
Signature
Lnt �7
M i�gA r ss ' l
rl h L ) N .�
City/State2ip
Telep ne Nu ber email address
D a e*
(Revised Aug. 2014)
'Valid for one calendar year after signature"

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to � pntl'4r 10h i s
(Name of Property Owner)
property located at ('GLnat S4-r ems- ('Gt-► cim , N c-
(Address, Lot, Block, RPACtWANK
on Pasluatank In N.C.Rom
(Waterbody) (City wn n or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
X I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or atfacfi pa site drawing)
0on5h,t,tcJ7'on dP a bDa-.�
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)
Signature
Print or Type Name
Mailing Address
CitylStatelZip
Telephone Number t email address
Date
*Valid for one calendar year after signature*
-- 6,
Si tur,o *
Print or Type Name
01 SS At'0 ko C'
Mailing Address
—_A<ajjua, ti( `fib-7344
citylstate/zi
Telephone Numbed email address
-- -_FfPr i 1 41 , 2C-) Z-I
Date*
(Revised Aug. 2014)

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