Bryan, LuAnn 80088C

As authorized by the State of North Carolina, Depaftment of Environmental Quality
andtheCoastalResourcesCommissioninanareaofenvironmentalconcernPursuanttol5ANCAC
Appl icant Name
NcAMA/ trDREDGE & FILL
GENER/AL PERMIT
ENew EModification IComplete Reissue EPartial Reissue
ztP
Phone # ( )-e-yait
Authorized Agent c
ICW T]EW NPTA
NOEA NHHF NIH
tr PWS:_
Project Location: County_
N980088 A B c D
Previous permit #_
Date previous permit issued
Street Address/ State Roadi Lot #(s)
Subdivision
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Phone # ( )River Basin
Adj. Wtr (nat /man /unkn)
Closest Mal. Wtr. Body
Address
Affected
AEC(s):
trES
N UBA
N PTS
trN/A
ORW: yes / no PNA yes / no
)a
(Scale:
Type of ProjecU Activity
Pier (dock) lengh
Fixed Platform(s)
Floating Platform(s)
Groin length
number
Bulkhead/ Riprap length _
avg distance ofthore_
max distance offshore - l'
Basin, channel
)
-t
l
Finger pier(s)
t
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cubic yards
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1*1-
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes
Moratorium: nla yes
Photos: yes
Waiver Attached: yes
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A building permit may be required by:
( Note Local Planning Jurisdiction)
E S"" note on back regarding River Basin rules.
Notes/ Special Conditions
--
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit **
PermitOfficer's Printed Name
Signature
Application Fee(s)Check #lssuing Date Expiration Date
city- state
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Statement of Compliance and Consistency
This permit is subiect to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subiect the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must beon the project site and accessibletothe permit olficerwhenthe prolect is inspected forcompliance. The
applicant certilies by signing this permit that l) prior to undertaking any activities authorized by this permit, the aPPlicant will
confer with appropriate local authorities to confirm that this proiect 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 adiacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and beliet certifythatthis proiect is consistent with the North CarolinaCoastal Management Program.
River Basin Rules Applicable To Your Proiect:
af-Pamlico River Basin Buffer Rules E oth..'
River Basin Buffer Rules
lf indicated on front of permit, your proiect is sub,ect to the Environmental ManaSement 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 Olfice (252-946-6481) or the
Wilmington Regional Office (9 l0-796-72 I 5) for more information on howto complywith these buffer rules.
Division of Coastal Management Ofiices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
2s2-808-2808/ r -888-4RCOAST
Fax [phone]
(Serves: Carteret, Craven, Onslow -
Nonh of New River lnlet- and Pamlico
Counties)
Elizabeth CitLDistrict
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-390t
Fax:,252-264-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Warhintton District
943 Washington Square Mall
Washington, NC 27889
2s2-946-U8t
Fax: [phone]
(Serves: Beaufon, Bertie, Hertford, Hyde,
Tyrrell and washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
9t0-796-7215
Fax: 9 l0-395-3964
(Serves: Brunswick, New Hanover,
Onslow - South of New River lnlet-
and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ I 7
N.C. DIVISION OF COASTAL MANAGEMEN'I
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIF IED MAIL . RETURN RECEIPT REOUESTED oT HAND DELIVERY
(Top portion to be completed by owner or their agent)
L.^h s. -B r\an
Aa o B\ddos Rd.
Mailing Address of Owner ?oB z€7 Vs^caJ.dr,t Nc..- 2s SsL
Owner's email:
Agent's Name:
Agents Email:
Owner's Phone#:XzX -1'15 -?sso
Agent Phone#:_
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom oortion to ba 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 proposi ng. A
d cn rrtion or d ino. with dimen sions must he nrdvi with this letter
I OO NOT have objections to this proposal. _ I DO have objections to this proposal
ff you have obiections lo what is being proposed, you must notify the N.C. Diy'tsion ot Coastat
Management (DCM) in w tlng within 10 days of rccelpt ot this notics. Correspondence should be
mailed to 4(N Commerce Ave,, Morcheed City, NC 28557 . DCM reprcsentalives can also be contacled
at (252) 80&2808. A/o response is co nsidered the same as no objec on if you have been notified by
Certifled ,lail.
WAIVER SECTION
lunderstand that any proposed 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
(this does not apply to bulkheads or riprap revetments). (lf you wish to waive the setback, you !!!.gg_g!g!!
the appropriate blank below.)
I DO wish to waive someiall ofthe 15'setback :-t n I(-ln't qtrt - t*c"tr-l
X Signature of Adiacenf Riparian aropetv Owner k'-oR-
nature of Adjacent Riparian Property Owner:Q-rnn ]*-)I
Typed/Printod name of AR
Malllng Addreas of ARPO:
ARPO'5 email:
PO:A)
o )6 e o9
ARPO's Phone#: 2 {7_-Lt} -eLfl
p to one year from ARPO'S Signature*Date:o 71 'waiver is valid for u
Revised May 2021
Name of Property Owner:
Address of Property:
I do not wish to waive the '15' setback requirement (initial the blank) _
')
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERW OWNER NOTIFICATION^^,AIVER FORM
CERT IFIED MAIL RETURN RECEIPT REOUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
( .u4ilil) BRlAtt/Name of Property Owner
Address of Property:lLo BLAD€S Ro,1o,H,AU4flr Ut3L
Mailing Address of Owner:
Owneis email:
Agent's Name:
Agent's Email:
Owner's Phone#:
Agent Phone#
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15'ftom my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (lf you wish to waive the setback, you logglllig!
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
R an Propedy Owner
-oR-
Signature of Adjacent Riparian Property Owner
Typed/Printed name of ARPO:
Mailing Address of ARPO:.=n Fh).. 7/ /1,,-.t //c :29<?),
ARPO'S email: ,turu l,nL /A t/b::, ',;,u ARPO'S Phone#:,/s a 73f l'565
'waiyor is yalid for up to one ysar from ARPO'S Signaturor
Revised May 2021
Date:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be co )
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, ths development they are proposing. A
descriotion or drawino. with dimensions. must be provided with this letter.
t/ I OO NOT have objections to this proposal. _ I DO have objections to lhis proposal.
Management (DCM) in w tlng within 10 days of recalpt of thls notlce. Correspondenc. should be
mailed to 1(N Commerce Aye., Morehead Ctty, NC 28557. DCM reprasentaliyes can also be contacted
at (252) 808-2E08. rvo rBsponse ,s co nsldered the same as no obiectlon if you have been notifled by
Certlfled lltail.
I do not wish to waive the 15' setback requirement (initial the blank)_