79369A_Day, Michael_20210802

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i - C hik / GE & FILL N9 -179369 CA) B C D
G E PERMIT Previous permit #
ew Modification I 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 T H. I
,KRules attached.
Applicant Name MAA Project Location: County_ - - _d_ _ .. ....... ..
Addressor,
- Street Address/ State Road/ Lot #(s) k_ N,
A"riLk -
City "P -VVW StateNC ZIP qfo4p _
Phone # (4 ... 2)102.-­2515 E-Mail .",&Q ev,04*( L4. rVt- Subdivision 15 h -5,0w.,A6_i A -A
Authorized Agent AC6
.y a) A -If,
zip 14-11
CW gW % PTA /-Jo YPTS Phone# River Basin P43"fllv�
Affected OEA HHF 1H USA N,,A
AEC(i): Adj. Wtr. Body Ca*, t -6) 5 _A,_ _ 0k&1A
Pws: PNA yes Closest Maj. Wtr. Body CtAYY_1 +U-CY—
ORW: yes /0 10
Type of Project/ Activity Coyt!5"C.AOlen, of t 10t'1 fl: 'or yu-,4A IOV14�*e _a1q__
0 � ", 2- { }- WYIA. waa6A (2 W L - (Scale:
A
Pierlength
Fixed Platform(s) ............... ... .. . . ....
Floating Platform(s) ........... .. .... ..
Finger pier(s)
Groin length
number
Bulkhead( Riprap length
avg distance offshore T-21
max distance offshore
Basin. channel
cubic yards
Boat ramp
Boathouse/ Boatlift
DAAA
Beach Bulldozing.
Other
....... ....
Shoreline Length SwL_
SAV: not sure yes no
Moratorium: 10117 yes no
Photos; (9 no
Waiver Attached: yes
A building permit may be required by: ""llf ")A t I
Note Local Planning jurisdiction)
Notes/ Special Conditions
William Eger
(Ag.n rApplicant Printed Name
Sig I nature "-pleaslad �compliance statement on back of permit
r5v4l�i
Application Fee(s) Check #
See note on back regarding River Basin rules.
Z
Permit Officer's Printed Name
Signature
1Z 41-
Issuing Date ExpitqD`alte ,

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Michael Day
Mailing Address: 132 Freedom Ave
Powells Point, NC 27966
Phone Number: 252-202-2595
Email Address: [e-mail]
I certify that I have authorized Affordable Bill's/William Eger
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
with 2-8' returns. No fill
at my property located at 256 N D
in Dare
County.
Install 107.5' +/- of vinyl bulkhead
wood Trail, Southern Shores, 27949
I furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
r ..-
Si u
Michael Day
Print or Type Name
Owner
Title
�l l
Date
This certification is valid through I l
RZEC IVE®
1 U L 16 2021
DCM-EC

,C,
, i,

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: Michael Day
Address of Property: 256 N Dogwood Trail, Southern Shores, 27949
Mailing Address of Owner: 132 Freedom Ave, Powells Point, NC 27966
Owner's email: [e-mail] Owner's Phone#: [phone]
Agent's Name: Affordable Bill'sNVilliam Eger
Agent's Email: [e-mail]
Agent Phone#: [phone]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
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 DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. 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 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). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Robert or Susan Baculik
Mailing Address of ARPO: 258 N Dogwood Trail, Southern Shores, NC 29749
ARPO's email: [e-mail] ARPO's Phone#: [phone]
Date:
"waiver is valid for up to one year from ARPO's Signature*
UtIvu--
JUL 1 6 2021
Revised May 2021

(' 3 C"
0
r
7t

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: Michael Day
Address of Property:
256 N Dogwood Trail, Southern Shores, 27949
Mailing Address of Owner: 132 Freedom Ave, Powells Point, NC 27966
Owner's email: [e-mail]
Agent's Name: Affordable Bill's/William Eger
Agent's Email:
[e-mail]
,u` I % 10
Owner's Phone#: [phone]
�
Agent Phone#: [phone]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
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 DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. 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 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). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property Owner
CIS G1
I do not wish to waive the 15' setback requirement (initiaLihe blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: James Ste
Mailing Address of ARPO: 254 N Dogwood Trail, Southern Shores, NC 29749
ARPO's email:
Date:
ARPO's Phone#: [phone]
*waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

Affordable Bill's
300 W Albemarle Drive
Nags Head, NC 27959
252-489-9555
July 15, 2021
We will be installing 107.5 feet of vinyl bulkhead with 2-8' returns at your neighbors lot
at 256 N. Dogwood Trail, Southern Shores.
Regards,
William Eger
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)fit 16 2021

NOTES g
SITE I. AREABYCOORDM ECO1iNrAT)ON.1.12UQF 03U..0 V
I PHYSICAL ADORES& 25I NORTH DOGWOOD TRAIL J j�
i I PARCEL D OM3I100a PAN I99IB13137215
d A FLOOD ZONE AS SHOW PANEL R372009993M
HFLRM. ZONE SUBJECT TO CHANGE BY F.EMA) 41
a RECORDED REFERENCES: M.a Z PR M O.a IM4, PO. 367 Vj Z
a rF 13 THE SOLE RESPONSWI.RYOF THE PERWTTNM MIMICPAWY TO VERIFY p �
` SITE COAFLUNCE H.9TTHALL ORDNANCE& ZONING. I SETBAC43 _
i REW 0aadENTS PRIOR TO THE ISSUANCE OF PERYTS StRVEYOR a
AAAIES NO CERTWCATION AS TO C060NIANCE3 ETHER SHOWN OR NAMED
r. THIS SIANVEY a StALECT TO ANY FACTS TNATAMYBE DISCLOSED BYA FULL N
i AND ACCURATE TITLE SEARCH O S U
fl �® DARYFROM RECORDED LISTEDAND PHYSJCAL EVIDENCE LV 22
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This map is prepared
from data used for the 256 N Dogwood T Owners: Day, Michael B -Primary Tax District: Southern Shores
.:.�1' Of inventory of the real Southern Shores Owner Subdivision: So/sh Soundside Blk 109
property for tax
Parcel: 0 0�1 Lot BLK-Sec: Lot: 17 Blk: 109 Sec:
'•tf,, purposes. Primary �,
° information sources such Pin: 9 7216 r��p Building Value: $0 Property Use: Vacant Land (Private)
as recorded deeds, plats, ,��- G�Land Value: $173,300 Building Type:
wills, and other primary V Misc Value: $0 Year Built:
( +lu f public records should be
4 �•� ~ consulted for verification �^_ Total Value: $173,300
of the information
contained in this map.

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This map is prepared
from data used for the
Ot
inventory of the real
�J
property for tax
purposes. Primary
•
information sources such
as recorded deeds, plats,
wills, and other primary
public records should be
r�!
consulted for verification
of the information
256 N Dogwood TRL Owners: Day, Michael B -Primary Tax District: Southern Shores
Southern Shores NC, 27949 Owner Subdivision: So/sh Soundside Blk 109
Parcel: 021391000 Lot BLK-Sec: Lot: 17 Blk: 109 Sec:
Pin: 986813137216 Building Value: $0 Property Use: Vacant Land (Private)
Land Value: $173,300 Building Type:
Misc Value: $0 Year Built:
Total Value: $173,300

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