83904A_Boring, Connley & Nancy_20210831

!CAMA / ❑ DREDGE & FILL lr9 83904 A B C D
r. CAE ICI E RAL PERMIT Previous permit #
WNewModification _._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
❑ Rules attached.
Applicant Name
Address—,
City State ZIP
Phone # ( ) ; >. i E-Mail_e, �.
Authorized Agent ((jr— t
Affected ❑ Cw R(EW PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
cubic yards
Boat ramp
Boathouse/ Boatlift ) 1 ikl '
1, ,; C
Beach Bulldozing
Other
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City r14, t:a ff ZIP
Phone # (='<:' ) .:: 2 ;CCS River Basin
Adj. Wtr. Body - - k (nat /man /unkn)
Closest Maj. Wtr. Body" : t
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■■■��■■■■■■■�
M111111111111MMMINEE 102P10111■■■NE SOMEH M
MINI INN PAW
IME M —
nwwwENN
Shoreline LengthK i
SAV: not sure yes no `t rt -
- — . --t }
Moratorium: 1
n/a yes no << . i
-- -
Photos: yes no
Waiver Attached: yes no.,,
A building permit may be required by: . .� t t G. ! it Cd` i ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions -) k.)o Dn, _' p i% F�tX Fw; �. �c�l' f �.. �!� I L n PS c�goa
Agent or Applicant Printed Name
r /
Signature Please reacGmpliance statement on back of permit'`*
Application Fee(s) Check #
Permit Officer's Printed Name
Signature
i #-Z s
Issuing 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
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 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:
71 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 Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ 1-888ARCOAST 252-946-6481
Fax: [phone] 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)
(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 Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: C��?✓1 /�inviC (50'r'1 ✓5
Mailing Address: C+
t4 v l ----H- , ✓Q c_ Z- 7 f G
Phone Number: ZS Q 6y6"Y3V zS-Z - Z 36.6_S7-
Email Address: � r (. C 0 � 0
I certify that I have authorized ��l`+ -r1 jeAkts ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: i-Dei r C4 6L, oq f7au<
at my property located at /01 f4"A_1 -cl we-\
in L' ! f (-1 <1 C''C County.
2—
1 furthermore certify that / 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:
—Sigqa ure
V1v7 /L /—CJ/,�C
fi6rint or Type Na/ne
Title
Date
This certification is valid through __ i__/ 17 1

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:
Address of Property:
Mailing Address of Ownei
Owner's email: U Q{o' /EOM 1, Owner's Phone#: 02 5 0�1� �la6J'
Agent's Name: Agent Phone#; a52,-
Agent's Email: Gi�'t/C"t ('o-As'f irnr-f if (G) (/laA,, �, . C - --
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.
X 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
MR
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: �GuioG
Typed/Printed name ofARPO: SUNIL NAIK
Mailing Address of ARPO: 616 Foothill Drive, West Chester, PA - 19382.
ARPO's email: [e-mail]-Rpo's Phone#: [phone]
Date: August 20, 2021 *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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 ownelr or their agent)
Name of Property Owner:
Address of Property:
Mailing Address of Owner
owner's email: I-RHONUMMIL091,44WI, Owner's Phone#:
Agent's Email:
C,,CC.�►�
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
I DO NOT have objections to this proposal
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'
of
ma
I do not wish to waive the 15' setback "uirement (loKal the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: /
Mailing Address of ARPO: ///
Property Owner
ARPO's email: bJhol5 74 /2 A/hAJ / ZAAPO's Phone#:
Date: r�� `waiver is valid for up to one year from ARPO's Signature*
- ,�279V6
Revised July 2021

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Currituck County GIS Data Viewer
Currituck County GIS
Phone: [phone]
E-mail: [e-mail]
Addresses
Communities
Aydlen
Barco
Coinpck
Corolla
Currituck
Gibbs Woods
Grandy
Harbinger
Jarvisburg
Knotts Island
Maple
Moyock
Porch Harbor
Poplar Branch
Po yells Point
Shawboro
Sligo
WaterMy
County Boundary
— state
— County
Streets
Wright Memorial Bridge
Major Streets
— Arterial_Prmcipal
— Arterial Major
—Colbetor_Mapr
Parcel Land Hooks
Parcels
Currituck County
Aerial Photography (202i
NRed: BarM_1
Green: Band-2
Blue: Band-3
This map should be used for general reference purposes only. Currituck County assumes no legal liability for the information
shown on this map.

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