Griffin, Jeff 80033C

LAMA / ❑ DREDGE & FILL N9 80033 A B C / D
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 ^7 /�
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC o / 7 / , rn
A�jRules attachgd.
Applicant Name �) d—\- cA -` ! Y) Project Location: County (D ` F' !V�I{
Address ' l �n & )bO 1/ 1 7 / r, V F Street Address/ State Road/ Lot #(s)
City--� 1 ,A ( n r.I ( tate r / c ZIP
Phone # 0-a) r � o' � ` E-Mail
1 I Subdivision ZZ
Authorized Agent )q JS f 1 �J C h City ZIP
❑CW -NIEW PTA El ES ❑PTS Phone# ( ) River Basin I
Affected AEC(s): El OEA ❑ HHF ❑ IH ❑ USA ❑ Adj. Wtr. Body
N/A nat "an unkn
❑ PWS: _
ORW: yes / no PNA yes / 'no �\ Closest Maj. Wt.. B_d, �SoC� Lf So fl �
Type of Project/ Activity
(Scale: I/ )
Pier (dock) length
Fixed Platform(s) � i
i
Floating Platform(s)
—
Finger piers) /
i
I
Groin length
number
l
Bulkhead/ Nprap lengthT
l I
avg distance offshore i
max distance offshore/
-
Basin, channel
t I Jr
cubic yards
I
\� -�� 1 o-
Boat ramp
Boathous@/ Boatllfj/ !'
/i
— 1 1 ! I
i I
Beach Bulldozing
i I I
—
Other i"$Y ✓ j FF
�.
Shoreline Length
SAV: not sure yes zn-o�
Moratorium: n/a yes�—
Photos: yes no'
_
Waiver Attached: eyes no)
l
A building permit may be required by:
% �? ❑ See note on back regarding River Basi rules.
( Note Local Planning furisdictio�u�l
/1/
4"'-./-
0�1 L' )'A"'-, %i/%'�4�
Notes/ Special Conditions
VNV
lIN
Signature •* Please read compliance statement on back of permit"
Application Feels) Check #
Signature
Issuing Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project 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 adjacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑Tar- Pamlico River Basin Buffer Rules ❑ Other:
❑ Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management 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 Office (252-946-6481) or the
Wilmington Regional Office (910-796-7215) for more information on howto complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pander Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/ 17

®CAMA / ❑ DREDGE & FILL N9 80033 A B C ) D
GENERAL PERMIT Previous permit#
ONew ❑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 ! /� (.
I 0 Rules attached,
Applicant Name \~( —l�_ ' / Project Location: County
Address_ ' l �r �\ t `^ S I I _ _ Street Address/ State Road/ Lot #(s)
City State ZIP
Phone # O E-Mail
Authorized Agent
Ei cW _LEw
D
Affected
Afecte OEA ❑HHF
❑ PWs:
6� PTA
❑ IH
❑ES ❑PTS
❑UBA ❑N/A
ORW: yes / no PNA yes / no
Type of Project/ Activity
Pier (dock)length-
Fixed Platform(s)
Floating Platform(s) . ,a
Finger pler(s)
Groin length
number /
Bulkhead/ Riprap length_
avg distance offshore_
max distance offshore
Basin, channel
i
Boat ramp ,
Boathouse/Boatlift
Subdivision
City / ZIP
d 77
Phone # O _ River Basin t ��I / ' 'i
Adj. Wtr. Body (nat /7 %unkn)
Closest Maj. Wtr. Body '
Beach Bu Idozing���
Other
I I
Shoreline Length <';!
SAY: not sure yes no
i I
i
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no i.
A building permit maybe required by: f r I
(Note Local Planning jurisdiction)
Notes/ Special Conditions i 1
Agent or Applicant Printed Name
Signature ** Pleaseread compliance statement on backof permit'**
/%>%
Application Feels) Check #
(Scale:
❑ See note on back regarding River
l
rules.
PermitOfficer'�'Printed ` e
Sign Cure
f IssLing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
nul I and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that 1) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project 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 adjacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar -Pamlico River Basin Buffer Rules ❑ Other:
❑ Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management 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 Office (252-946-6481) or the
Wilmington Regional Office (910-796-7215) for more information on how to com ply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/1-888-41RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New River Inlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pander Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Z1�'Pev'S,A &r, 9 v,
Mailing Address: ��6 QJy f•t �✓
Phone Number: 211 6 A G2 33
Email Address: � ji -N , o ff G eA4 �M
1 certify that I have authorized nVDr?F L✓E,SB
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: ��� -ZY yrrFJ 7)ocK
�Y Zvi fG001;1v6 'POCK ��i�o GonGl�Ay J3ca�/6 �bqT &,C
at my property located at Ji 6 ,OZXbQy//Pl DRi�f �b kibct SUb�Fs
in Cig2T�4el County.
/ furthermore certify that l 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 Own nformabon:
natur
e
J tlovsM �J.�f i�
Print or Type Name
V AJv '
Title
1,7- 1 V661 Z1
Date
This certification is valid through ;7�� 1 41'6 t Zea---

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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. �V-W 0
Address of Property: 116
Mailing Address of Owner.
Owner's email: 1Q, I'l-IU�me IM9i� L—OOwneesPhone# 711 611 C'nl
Agent's Name: HNrJjLEC3/S Agent Plane# Z$Z
Agent's Email: AWhebbdd/r/vc G01411• 6014,
V
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property Owner)
I hereby certify that I oven 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 propose4 you must notify the N.C. Division of Coastal
Management (DClln in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection ff 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 J _ ,
I DO wish to waive some/all of the 15' setback `¢' UA � Q--cDf Ji
SignaturV of Adjacent R/ n merry caner
rmo
i do not wish to waive the 15' setback requirement (nitishthe blank)
Signature of Adjacent Riparian Property Owner.
Typed/Printed name of ARPO: ��10�LM 45 y!� 1 O v° l br
Mailing Address ofARPO: �It1 g A-r-b6ryt17ae-- K �
ARPO's email: jQe-/l2C_ f' III urilf 40r ARPO's PhoneN:,I � � "_—%
Date: �Z ?A Z j •waiver is valid for up to one year from ARPO's Signature,
Revised May 2021

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N.C. DIVISION OF COASTAL_ MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONfWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be Completed by owner or their agent)
Name of Property Owner
Address of Property:
Mailing Address of Owner. Soi,�.r 61 'g L r-h
Owners email: g Olb s» >vm Owners Phone# k�
Agent's Name:ANfTRE Alow AgentPhone#,
Agent's Email: AWb6ad//!e 0 a '1. 6014
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
Bottom portion to be completed -by the Adiacen2 Property Owner)
I hereby certify that I own property adjacentto 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
descriDtion or drawino. with dimensionsmust be provided with this letter.
1 DO NOT have objections to this proposal. 100 have objections to this proposal.
ff you have objections to what is bring proposeu, you must noary me n.�. urv�rwr w
Afanagement (DChq in writing wfthin 10 days of receipt of this notice. correspondence shouid be
mailed to 400 CommerceAve., Aforehead City, NC 20557. DCAt representatives can also be contacted
at [phone]. No resporuse is considered the same as no objection it you have been nnvfred by
Cerdffed Afaii.
WAIVER sEc noN
1 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
phis 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 t 5' setback
Signature of Adjacent Riparian Property Owner
-OR n A
i do not wish to waive the t 5' setback requirement (Initial the blank)
Signature of Adjacent Riparian Property Owner.
Typed/Printed name of ARPO: U!f I LT)r1 �5�j Jf� LJ/
Mailing Address of ARPO: 3f� Mar Iyu C`//1 ��%� L cmw �I
S ARPO's email:
G ' ARPO's Ptfone#:
Date: i *waiver is valid for up to one year from ARPO's Signature'
Cf r! %55 Revised May 2021
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ACV DMIIN6 DE516N S CON51.
ANVa MM
3413aVAWMROAD
NEW 6CilI, NC 28662
25,2-665,-4398
JEFFERSON GRIFFIN
116 ARBORVITAE DRIVE, PINE KNOLL SHORES
. reM/202i
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PROPOSED SITE PLAN
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