79401A_Beazley, Justin_20210823

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A(CAMA / DREDGE & FILL �V B C D ENERAL PERMIT Previous permit # CJ
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
Rules attached.
Applicant Namegt�,� i2_��1!____ _ _ Project Location: County
�-1 L Street Address/ State Road/ Lot #(s) I03 _
Address Street !� -' _� v%
City-� lcLc ��L_— State ZIP -a. `�J _� e r -Lo� --�Q_ j — - —---------
r
Phone # 533a-_ E-MailN6� Subdivision 1A$-__r��-
Authorized Agent - -- citys cif _t }ScL _ - - -- -- ZIP �� .X
- -- —//--
Jew yfEW PTA ES L7PTS Phone# ( _)_ _-______ River Basin
Affected OEA _;HHP IH USA N/A
AEC(s): Adj. Wtr. BodyCQ.��S,_- ---__ nat _an�nkn)
Pws: - � —
ORW: yes / no PNA yes / Q Closest Maj. Wtr. Body
Type of Project/ Activity A"--;,J
5'(
,11)
(Scale: `�S
,v
Pier (dock) length St( X
Fixed Platform(s) JG "� -
KO
nfO�
Floating Platform(s) -
Finger piers)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore _
r�
max distance offshore
Basin, channel
cubic yards - --- - -
l6
ZZ
Boat ramp-
- --
gip,
Boathouse/ Boatlift
--- - - -
k44,ti'zed
sYt'X C, ,,ot
�
rr
Beach Bulldozing__
Other
`
-- _
-- NG DOT --�
Shoreline Length _--_ �CQ__ _—
i� Q; Gk-,
�J
r f
SAV: notsure yes
Moratorium: [ n/ es no
V
JxJL-
Photos: ye
Waiver Attached: yes no
A building permit maybe required
by: / (C , L.G
i�O! ��
_'
See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Llet 4- ClLbA
-
Agent or Ap Printed Name ermitOfficer's Printed Na
Signature Please read compliance statement on back of permit * Signature---
pplication Fee(s) @Meek# Issuing Date Expiration Date
A^) sF

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner �' u,4-, *J n t ..ir 2; f#ZiT- Y
Address of Property (ai eA66Y DkihS LAJ r- URP V CC Ai" 2-77ci 29'
(Lot or Street a Street or Road. City d CoLmty)
Agents Name #
Agent's phone #.
Mailing Address
'. nereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to rT,e as shown on the attachec: drawing the development
they are ping A dessx pbon or draw,no. with dimens►ons, must I provided with this letter.
I have no objections it) thi, proposal. I have objections to this pngxmal,
if you have objoctions 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.
Grifn St, Sto 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901. No response is considered the some as no objection if you have been notified by Certified Mail.
WAIVER SECTION
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 msh 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
(Proporry Owner information)
SrXrwture
VV-ST-,V-4 1;epLt-cY
Print or Type Name
Q 3 e:re-,g. r DA%f is (-nt
Malting Address
Cu4Qry-vcK AK, Z-7riz9
Otyltatel7ip
"157-016-5532 yt`XnLe 2eyr(iu^.t►c�-
'elelshone Number/Emad Address
'Va'+d for one m*nax year after Signature*
(Ad7nt Property r 1 tion)
S Ware
u /&) r
Tint or Type Name
Marking Address
OVIW 27',09
City Rte-op
Telephrrrre Number/Email Address
I
[parr"
Reosed Jan. 2017

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