78104A_Salty Souls, Inc_20210409

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KCAMA / DREDGE & FILL No '78 1 04 B C D
ENERAL PERMIT Previous permit #
VUBW CModification ❑Complete Reissue _Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality r7
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC / / b-z>
� � es attached.
Applicant Name -� w (-f+f _S." S-' j �K�S e.tx Project Location: County � o��
Address PIle , �a y� (o q Street Address/ State Road/ Lot #(s)L, o T 12
State NL ZIP Z% q S9
Phone # if'a 54Y=J'(i a i1 E-Mail +'i*,i Subdivision D (d AJ
Authorized Agent ' S °�- i^ c . c.� r►.. City_ � f s q s ��� If
ZIP
Affected U CWA D ES ❑ PT'S Phone # ( r ) River Basin
AEC S : OEA ❑ HHF 0 IH O Uf3A O WA
() Adj. Wtr. Body t o. n 0. na<
L P'WS: -----
ORW: yes Kno— PNA yes /(l� Closest Maj. Wtr. Body-_ /C a ax
Typer of Project/ Activity < < X n � a�..1 p
d o c Y ( $ y l . n o a rk (Scale:
Pier (dock) le P i /� f100,
Fixed Platform(s)
Floating Piatform(s) a X /71, G
Finger pier(s) Groin length j
number
PraPlength-- - -
Bulkhead/ Ri �-�--r-+•- i.__
avg distance offshore
max distance offshore
Basin, channel -- - �..�� _�—s - - f•_ _.
wy
A ; t �
cubic yards
,
Boat ramp
+ -
Boathouse! Boatlift F
t : _
A14.)
Beach Bulldozing_
Other 3w - _it lLialti. - - -1
L
Shoreline Length - - — E T t B ! K Z..4
SAV: not sure y W— _ _ '�- r --
Moratorium n/a yes no
Photos: yes no
Waiver Attached: yes
A building permit may be required by: p .af AL, J cx- J____-----._--
❑ See note on back regarding River Basin rules.
to Local Planning Jurisdiction)
11 Special Conditions aia, e J N 13 '� a e �L1� -f-
w n jw�'4 r .
l tt yam` 3_.! L .l� /v
---oicant - ---
Agent or Applkant f'rirroed Name
Sleas ad compIiancestatementonbat* ofpormitO°'
Application F*s) CIN& #
--1--" O L;----
Pem*Cffsc is Prirrad Norris
S'
Issuing Date Expilration Date

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: Q Souls, Inc
Address of Property:
S Roanoke Way, Nags Head, NC 27959 (Dare County)
3 (Lot or Street #, Street or Road, City & County)
Agent's Name #: Tim Julian M a i I i n g Address:
Agent's phone #: [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. Adescrintlon or drawing. with dimensions. must be provided vi tt 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 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Grtlffn St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by CerdNed Mall.
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 sign the appropriate blank below.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement
(Property Owner Information)
Signature
Salty Souls, Inc (Tim Julian)
Print or Type Name
4707 S Roanoke Way
Mailing Address
Nags Head, NC 27959
City/State/Zip
252-564-5101
Telephone Number / Email Address
3/31 /21
Date
`Valid for one calarider,year after signature•
(Adjacent Prope ation)
Z�; <�
Signature *
John Tamaki
Print or Type Name
4705 S Roanoke Way
Mailing Address
Nags Head, NC 27959
City/State/Zip
757-778-1475
Telephone Number / Email Address
9 jz zI
Date*
Revised 2017

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner: Salty Souls, Inc
Address of Property: 4707 S Roanoke Way, Nags Head, NC 27959 (Dare County)
(Lot or Street #, Street or Road, City & County)
Agent's Name#: Tim Julian Mailing Address:
Agent's phone #: [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.
X 1 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
mailed to 401 S. Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. 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. (If you wish to waive the setback, you must sign the appropriate blank below.)
I do wish to waive the 15' setback requirement.
rC I do not wish to waive the 15' setback requirement.
formation) I
)
Salty Souls, Inc (Tim Julian
Print or Type Name
4707 S Roanoke Way
Mailing Address
Nags Head, NC 27959
City/StatelZip
252-564-5101
Telephone Number / Email Address
3/31 /21
Dale
(`A�djape/nt Property Owner Information)
�c�e �-Cam----
�i�nnitrt•e
Laura Jean Oelsner
Print or Type Name
29 Powder Horn Rd
Mailing Address
Cortlandt Manor, NY 10567
City/State/Zip
914-589-1866
Telephone Number Email Address
—� Date'
`Valid for one calendar year after signature` Revised 2017

LAMA / ❑ DREDGE & FILL _ NO. 72677 V
GENERAL PERMIT Previous permit # a B c D
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 / Z
les attached.
Applicant Name h Project Location: County
Address 16 % 7 Street Address/ State Road/ Lot #(s) Z-,—t y 2
!�Z7-7 s, X - - n o X" --�Q Y
Subdivision a/o/ N ZJ -V � \/@ 1, S¢ j
ctyN as zIP z S �`
-�� 9
Phone # ( ) River Basin
Adj. Wtr. Body C a n a nat m unkn
Closest Maj. Wtr. Body ��� �` moo+ S u ^ 14
City /J o /4 G State N--- ZIP Z79s t
Phone # (� 2) S5- y I E-Mail
Authorized Agent —
Affected ❑ CW
AEC(s): ❑ OEA
❑ PWS:
ORW: yes /
7EW "TA
❑ HHF ❑ IH
PNA yes / no
❑ ES ❑ PTS
❑ URA ❑ N/A
Type of Project/ Activity C =. /i s + r , /, x tp , p r cp x -'i 0 4-+-L (- - - 4
A 4- J(7t-. f (Scale: Zb / )
Pier KvcWen
Fixed
Finge
Groir
Bulkl-
Basin
Boat
Boatl
Bead
Othe
Shore
SAV:
Mori
Phot,
waiv
■■■■!■■■■■■■■■■■�1■■!■■■■■■■■■■■■■■HUME
■■■■■■■■■■■■ter.■■■■■■■■■■■■■■■■■■■■■■■■■■
r pier(s)
i length
■■■■■■■■■■■■■■■■■■■■!■■■■■■■■■■■■■■OMEN
number
avg distance offshore
—
max distance offshore■■■■■■■■■EE■■P1EAI!!■!!3!■■■N■■■■M■■■■■■■
MEN
■M■M■MM■M■■M■MNCME3i�:Fi��E1E��■■■■!■■■■■■■
,channel
■■■■■■■■■■■■■■E■sad■n�®■■■■■■■■�■■■■■■■E
cubic yards
■■■■!■■■■■■■■■I/■■■/I!■■■■■■■■■■■O■■■■■
amp
■■■■■■■■■EEO■■(►./■■<t►�■■■E■■■■■■ENE■■■!■E■
■■■■■■■■■■■■■E������H�i■■N'■■■■■■■■■NEE■
■■■■■N■■■■E■■E■!■■■���a■�E31�11Eltl�■■ti■!E■■
i Bulldozing
■■■■■■®it■■■!!�■�■!nr�■�n�■■=■■■■■■■■■■■!■
■MM■jTi■E■■!■■■■■■■■O■■■ENO■UOl�lME■■EEO
Jine Length
I1011ili!■■N■■■■■■■■■■■■■■N■■■■■■■■■!■■■!■■
not sure yes .■■■■■■■■■■■■■■ca■Ee■■■■a■■■■■■■■■■■■■■■
no
■■■■■lr:�a■■■■■E■■■■■■■■■■■■■■■■■■■■!■■
•■■■■■E■fi■■E!■■■■■■■■!■■■■■W■■■■■■■■■■■■
A building permit may be required by:
( Note Local Planning Jurisdiction)
o -L � ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions
Agent or Applicant
tt-P-rirnted Name
Signature ** Plea!e readc:-6mpliance statement on back of permit"
Application Fee(s) Check #
Officer's Printed Name
Signature
Issuing Date Expiration Date

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