79348A_Midgette, Jody_20210726

V, CAMA / � - DREDGE % FILL £ ; �e'") B C p
GENERAL PERMIT Previous permit# �:/
New 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 I SA NCAC M " T1
ales attached.
Applicant Name._ Mir--- _ w _ Project Location: County_.i_u4GCA._.__ ___
Address . � (J a � e. - _ . (, Qlaake -_ _ .. NG t - ---- Street Address/ State Road/ Lot #(s) [�
City___ J�r_�'� r ---- state_ zlP v Lo "_, .__.._
Phone # {_ ? _ _ E-mail Subdivision �/
Authorized Agent_ __l .. + .(t.:k..................�__ _ ___ CitY __p4�.� __J!Jp,l ._. Z!P i_. y___.
�i - pp
Affected 44
� '� APTA -:"USA u WA Phone # () __..__...__ River Basin Pa
OEA _i HHF �i_ - �•_
AEC (s): Adj. Wtr. Body_ jf. K%.r • .__.. ;1.+. s .._........___ Lman fupkn)
PWs.
ORW: yes / no) PNA yes IQ Closest Mai. Wtr. Body _(✓tall.%.41t-ch,._ E .......... .....__._ _
Type of Project/ Activity ' C}ta'N. R NJeL)
(Scale:
Pier (dock) Wrgt+_._._
Fbwd Pbaforns(s)
Fftw piers)
Gram katgeh ... �...._ -+
number
b
max ice offshore ..
BasU+, dnt+nal _ _.........
cubic yards t
Boat'xrW
Boathouse/ Bovdk
A
y,.
Beath Bulldozing o
Other
is
Shoreline Length �7�__ _ 'j Co- 1y�C�`CttiL ��it
SAY not sure yes cart �'t; N
Moratorium: Nay s no
-j -�
Photos: ye�y
Waiver Attached: yes _QQ1;
A building permit may be required by: C.6n, r G See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions � i-—.�ws'j &acrtJ•d i� MGs + M 4I,> A)Wt. a' �n4bg Silo It
Lls'� C'?cCCe4j l� �Ma� A)LA-
_A1C, __
Agen r Applicant Printed Name
5ignatu "" Please read compliance sta e t on back of permit600
.(2)0. _ _ ... I w .
Application Fee(s) Check #
Permit Officer' Printed Name —
Signature r�
Issuing Date Expiration Date

N.C. DIVIS1014 OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date n U --\`t
a
of Property Owner Applying o ermit:
e'
Mailing Address: & jj
I certify that I have authorized (agent) .F- 1G-rt V),-(L to act on my
behalf, for the purpose of applying for and obtaining all CAMA
install or construct (activity)
at (my property located at)
This certification is valid thru (date)
necessary to
,�

SOSD
DIVISION OF COASTAL. MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner
Address of Property. s
(Lot or Street #, Street or Road, City &
n�- rbcar
Agent's Name # ( M _— Mailing Address: P-0 �+ .. q'0-)—
Agent's phone *9 (;� ' (J t(A-
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
hey ar$ prpgosing� A c • 'on or d awin ' h dimensions must a Quid this fetter.
_�___ I have n bjections to this proposal. __ __ I have objections to thi proposal.
1f you have objections !o what is beir, y proposed, yotr .must notify the Division of Coastal Management � ti/$r"
CM) 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 (252) 264-
3901. No response is considered the same as no objection if you have been noti fed 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 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
1EXAQ Sitc��
Print or'Ty-pb Name
off: C'ct
Mailing Address
&A-P�txmec, ,
City/StatelZip
Te�l{e'phone Number / Email Address
Date T
"Valid for one calendar year after signature'
(Adjacent Proper"wrier Information)
Signature
J)0 v IdJ
Print or Type Name
Mailing Address
wcsf ,P6tV\
Ci4oState/Zrp
Telephone Number/ Email Address
Dare
Revised Jan_ 2017

■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the malipiece.
or on the front If space permits _
1. Article Addressed to:
A Sure
0 A®errt
X ❑ Addres
Recely (Printed Name) C Date of Dek
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D. Is delivery addleee dtff nrTt from Item 1
If YES, enter diii address below: ETNO
QL }BOA
03 V) (--t-"er Gf
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3. Service Type ❑ Priority Mail Wre"
❑ Mail-
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Restricted Delivery
on ellls�d Mal Restricted
Rc:e tiff. Mail®
❑ cortriied Mail Restricted Delivery
❑ Signature Conhmaticn'
9590 9402 6345 0296 2434 71
❑ collect on Delivery
❑ Signature oomtrmauon
Article NuMber (TMISW "M service 18W
❑O Ckuured Ma ivory ResMded Delivery
Restricted Delivery
_2.
Mail Restricted oely
7020 3160 0001 2522
1279
PS Form 38 , JU -M
---
Domestic Retum Receipt i
■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailplece,
or on the front if space permits.
�p �q V �v
ncai
l.' 0❑ Agent
Adore
B. Received by (Printed Nerve) C. Oa 1
D. Is delivery L-1 YW
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No
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3. Service Type
Priority Mail Express®
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[ Adult SignatureRestricted Delivery
[3 Registered Mail-
❑ Registered PAelI Restricted
9590 9402 6345 0296 2434 88
ja ed Mall®
❑ (,et Mall Restricted Delivery
Delivery
o❑ Signature re ccoorntfim ation�
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❑ Coiled on Delivery
ectd
a n,.,,_y on Delivery Restricted Delivery
Restricted Delivery
2. Artice (�umbPr tlYarssfierirnrn �
2522 1286
Mai
Delivery
?020 3160 0001
Mail Restricted
--t---
$500,
_
PS Form 3811, JUI toy 2 0 PSN 7330-02-000-9053
Domestic Return Receipt

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VII