78119A_Harshey, Anne_20210524

VCAMA / ✓DREDGE & FILL V g C D
GENERAL PERMIT Previous permit #----- ----- _____--
New Modification Complete Reissue Partial Reissue Date previous permit issued_
As audionzed by the State of North Carolina, Department of Environmental Quality �� ! J
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC r Vc
Rules attached.
Applicant Name All,, F{ ';Le Y Project Location: County CC4 r { t C 'I CA
Address $$ ()t _ S� ? Street Address/ State Road/ Lot #(s)
City Ui L'N,,— State >J,4, ZIPa.a1wG La
Phone # 071 ) 134 - (80C E-Mail lC>c' Pi i? I �gubdivision (e24-c t - 13?,CC
Authorized Agent ,xac klkcCcis City Coro( la Zip
Affected Cw 4W ✓PTA ✓€5 PTS Phone # ( j River Basin �:±SgGto{or�k
OEA HHF IH URA N/A '7 1 fd K---f V-�nat / an unkn
AEC(s): Adj. Wtr. Body ova S S )
PWS:
ORW: yes / J,,) PNA yes ! no Closest Maj. Wtr. Body
Type of Project/ Activity `V6&.� G—(k-kee-i
(Scale: /U TS
Pier(dock)length
Fixed Platform(s)
Floating Platform(s)
Finger piers)
Groin length
umber
Bulkhead/ Riprap length
distance offshore S
max distance offshore 2
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach B Ildon in
u g
Other YO
�IV
Shoreline Length ..-�
SAV: not sure yes no
Moratorium: yes On/ rt rice
Photos: 0 es no j
Waiver Attached: yes no ..d /
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
4
See note on back regarding River Basin rules.
-rat
Agent iic, t Pnntet lieAphance
Permit Officer's m
,'s Printed Nae
Signature - P ase read cotatementon back of permit "' Signature
i .i G 5-- %I-�k `N-
Application Fee(si Check # Issuing Date Expiration Date
G e Aidi A4- Tl 110 R

AMTAUTiHgAWION FORAW,EIRW,6PPLICATION
Phone Number: ;; . f4 *-
��� 1�11 Y t
�00
*#W1 ttavia,atlthcnlzed
' 1 11 IIR YIw�r O • � I
Agent [ Contractor
to aiGt Oft my behalf, `for the purpoa %i `and obtaining all CAMA pOMit
M f rtho blowing prop d de opMetll! ..r ti l
property located at
I fU/*$1#VM certify that l am authodzedi to :grant, and db in fact grant permission to
Division ai`l�oasfr . Management staff, the Local Permit Ofter and their agents to enter
on the aforemendonod lands in connecOon with evaluating inforntadw dated hp this
Permit applicat,
IS certification is valid through,, ,,t.,.►� 7

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I hereby certify that I own property adjacent to
I
(Narne.of Property Owner)
property located at 46
G '/ (Address, Lot, Bloc , Road, etc.)
on 4—ot0 CIS �4�c� �� a� in N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loca
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
rto
4z�
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 Information)
, - lz� (44—e4
Sttatyre C 6Lklk
Print or T e Name
t 0 c. �1�P Qe ��-
M fling Address
C�ty/S ate ip
Telephone Number/email address
3/fYlZaz1
Date
5 e z eL. rF t -errc If =-�I •�ec� r . E au.�
Y
(AdjpcerL Pr erty Owner Information)
Print or rtype Name -
Z537_.,• nn.i
Mailing Address
Ilias;
City/Si te/Zip
?52 epr-5-<f3S-7
Telephone Number / email address
4/ / / 9 % 70-7- 1
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to f- d A r--,/�4r,sh rev 's
/T 'Name o�fProperty Owner)
property located at yy 1�q
(Address, Lot, Block Road, etc.)
on , ins fo 1(4 N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
k--� I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below/ or attach a site drawing)
N
...,.ti emu- gle-
WAIVER SECTION (`:;S.
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 Information) (Adjacent Property Owner Information)
or TVoe Name
1.s 2- - Zd'z - & -1
Telephone Number/email address
-43/ f>-l&iSM
,�" � (�'t,ec � ��� ( `mil
— v
Signature
Print or Type Na
a G
Mailing Ad ss
r 14 rya OAV .
City/S(ate/Zip
Telephone Number/email ad ress_)
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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Complete items 1, 2, and 3.
Print your name and address on the reverse
so that we can return the card to you.
Attach this card to the back of the mailpiece,
or on the front if space permits.
Article Addressed to:
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IIIIIIIII (III IIIIII IIIII III II I IIIIII II I II III
9590 9402 3209 7166 6721 79
Article Number (Transfer from .can,tr n /-Mott
7020 2450 0002 3104 0675
Form 3811, July 2015 PSN 7530-02-000-9053
Complete items 1; 2, and 3.
Print your name and address on the reverse
so that we can return the card to you.
Attach this card to the back of the mailpiece,
or on the front if space permits.
Article Addressed to:
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A. Signature ■ Complete items 1, 2, and 3.
X ❑ Agent N Print your name and address on the reverse
❑ Addressee so that we can return the card to you.
B. Received (Prince ame) C. Date of Delivery 0 Attach this card to the back of the mailpiece,
or on the front if space permits.
D. Is delivery address different from item 17 s 1. Article Addressed to:
If YES, enter delivery address below: o
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❑ Priority Mail Express®
❑ Adult Signature
❑ Registered MallT1
❑ Adult Signature Restricted Delivery
❑ Registered Mail Restricted
Certified Mail®
Delivery
Pert ified Mail Restricted Delivery
❑ Return Receipt for I
❑ Collect on Delivery
Merchandise
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❑ Signature Confirmation I7f
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Restricted Delivery
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D. Is delivery address different from Item 17 ❑ Yes
ff YES, enter delivery address below: ❑ No
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❑ Collect on Delivery Restricted Delivery
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Article Number ransfer from service label
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7 015 3430 0000 2890
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Form 3811, July 2015 PSN 7530-02-000-9053
A. Signature
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B. Received by (Printed Name) I C. Date of Delivery
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II I'lll'I III I') I II III I I I i I II I it I'I I III III 3, Service Type ❑ Priority Mail Express®
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2. Article Number (Transfer from service label) ❑ Collect on Delivery Restricted Delivery ❑ Signature ConfirmationTM
fall ❑ Signature Confirmation
7 015 3430 0000 2890 5 911 pail Restricted Delivery Restricted Delivery
PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt
■ Complete Items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to: wl
JAMB- ✓ 664GI,- rlt C� �•e%
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9590 9402 3209 7166 6711 89
2. Article Number (Transfer from service label)
7015 3430 0000 2890
Domestic Return Receipt I PS Form 3811, July 2015 PSN 7530-02-000-905
❑ Agent
B. fleceived by (Printed Name),• I C.
D. Is address di!jewbrit from item 1 T EP Yes
If YES, enieraervery iaddress below: No
3. Service Type
❑ Priority Mail Express®
❑ Adult Signature
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❑ Adult Signature Restricted Delivery
ertified Mall®
❑ Reglstered Mail Restricted
Delivery
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❑ Return Receipt for
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Merchandise
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❑ Signature Confirmation—
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urrituck County GIS Data Viewer
Currituck County GIS
Phone: [phone]
E-mail: [e-mail]
1710
Addresses
Communities
Aydkitt
Barco
CohJock
Corolla
currhuck
Gibbs Woods
Grandy
Harbirmw
Jarvbburq
Knotts Island
Maple
Moyock
Point Harbor
Poplar Branch
Poveas Point
Shawboro
+, };
Sligo
_ Wateridy
County Boundary
—^ state
County
Streets
Major Streets
—Arterial Principal
Maror
—collector Major
Parcel Land Hooks
{ k, ; nAJ w t a,
ry
0.
1 Parcels
Currituck County
Aerial Photography (201 1
■Red: Band_i
100 ft
', - �' N4reen: Band_2
A;110. .. .. 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.

Currituck County GIS Data Viewer
V
Currituck County GIS
Phone: [phone]
E-mail: [e-mail]
Addresses
Communities
Aydlett
Barco
Codnjock
Coroft
Currituck
Gibbs woods
Grandy
MartWger
JaMs"
Knotla Island
- tvtapla
Moyock
Pant Marba
Poplar Branch
Powelle Pant
00 shawboro
SAGO
't waterwy
ry't« County Boundary
-- state
',-' county
Al
Streets
r
Major Streets
—Arterlal Princioal
Arlarlai Mapr
y Colector_Mapr
Parcel Land Hooks
407 Parcels
4110611. * Currituck County
309
�� .
Aerial Photography (2011
ORec: 5and_1
a _.._. EGreen: Band_2
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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