79309A Woodhous Drive; Grandy, 27939_Flatness, Collin & Debra_20210628

✓CAMA / �PREDGE & FILL
-� GEwNERAL PERMIT Previous permit # � B C D
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
attached.
Applicant Name Co[ I %tom-- A, (? 6G► Fla+)%eSS Project Location: County 616- f r t,4ce k,
Address 119 („JOVJ�Ou5,e [>; vG Street Address/ State Road/ Lot #(s) 113 1 ,1elt L4,e,
City 6PO4,/ State/VC zlp �)?t13 9 Lo4- 4-
Phone # E-Mail i,- fj&t Zsj @kACly' • CoM Subdivision (Jlp, t,&* :Prb d �S�'o t•3 . __
Authorized Agent City C- c"A y Zip a, ?13q
Affected CW ✓EW PTA ✓1=S PTs Phone # (232) 425 `K82- River Basin PO'Sp r4a,11,
AEC(s). OEA HHF IH UBA N/A Adj. Wtr. Body r„�o,na [ -10 t bui r
PWS. i y y Y (nat 65D
ORW: yes / Q PNA yes no Closest Maj. Wtr. Body � t t A%c K —6.
Type of Project/ Activity 6AC,ct n-44- 3i k 4Iea 'A
(Scale: J S
Pier (dock) length /" �
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
�C3
Bul prop length
avg distance offshore
max distance offshore �, t
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boadift
Beach Bulldozing
Other
Shoreline Length:
e
V
1 1.
O out.
SAV: not sure yes no Q
o� F (r 5Moratorium: � yes no �
Photos: ye no
Waiver Attached: yes
A building permit maybe required by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
- Qs b r,_ T1 +,05-S
Agent or Applicant P ' A}ame
Signature "Please read compliance staterr � t back of permit'"
VC,0.0d 3acfl
Application Fee(s) Check #
See note on back regarding River Basin rules.
P it�ted Name _
Signature
Issuing Date
[o--;a-
Expiration Date

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
L
Name of Property Owner: r O U j (r)
Address of Property: I I
Agent's Name #:
Agent's phone #:
(Lot or Street #, Street or Road, City & County)
Mailing Address:
a-793
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.
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
(L)CM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 401 S.
Griffin St., Ste 306, 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 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.)
°y— I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
0', W40F WAR
FIF - .1.4, W011 1wimmo
Print or Type Name
) 19 1K6j
Mailing Address
(2rrarIAV ,
City/stateop
(Ad'acent Prop e Owner Information)
Signature-0A
C f
Print or Type Wame
l a d' 41,4 k�rG c 7-
Mailing Address
4�27
6,r
City/S atf ep
-° 5-5 3 17, �S�A3 - E 3)6- z 5 z- Y53 -`?,? fZ
Telephone Number / Email A dress Telephone Number / Email Address
( p- G- --� t
Date
Date,

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner:
Address of Property:
Agent's Name #:
Agent's phone #:
+eb r
1 3 -In le+ La-n
(Lot or Street #, Street or Road, dity S County)
Mailing Address:
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.
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.
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 oblection If you have been notified by Certiffed 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 In rmation) (Adjagent P perty Owner Information)
Signature Signature*
i
Print or Type Name Print or Typ Name
Mailing Address Mailing Address
rare / . ► �t • °�� M7
City/statwzip City/statelzip
Telephone Number/ Email Address Telephone Number Email Address
Date
G-16-Q
1M ./ ,�P_ Z/
Date*
'Valid for one calendar year after signature`
Revised Jan. 2017

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