Irmen, Jack 80610C

")CCAMA / - DREDGE & FILL N9 8(")610 A B @ D
GENERAL PERMIT Previous permit#
%New --Modification -Complete Reissue _Partial Reissue pate previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality 77
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ©'f H
`Rules attached.
11� J.. r
Applicant Name AC:V- VPIt-N - __ _ ._ Project Location: County
Address , (��� t�G. X-IU(L Street Address/ State Road/ Lot #(s) Cf•�&t)V iC L
City 51VIi _ t 4,2ti __ State lvt ZIP 2�quo SS __170 • - - - —
Phone # O ��_ G E-Mail Subdivision_ -
Authorized Agent _'_ f�fC�/1i��(1 (l^�SrUi_�/ia1� _ City/��'��' ZIP (�1
ILiy
Affected ,LCw EW PTA 'ACES L PTS
:- OEA L-HHF - IH UBA 7 N/A
ORW: yes / no PNA yes / rio
`
Phone # ( 1A ) CJL I_River Basin !'VI Ij f CJ t
Ad' Wtr. Bod man, [unkn)
Closest Maj. Wtr. Body 1
Type ofProject/ Activity
&PISi'O
160b'(CVUJU?b QL �i, f9ti121 f"IkG1)
bi aM),n A A0D Si.12 lCf Oft
(AW06 A-1 7'Hi; f P) CIA
VOW 1! ILI . �gcoCt) 13f 1 S' (5-AlW"r (Scale:
Pier (dock) length(t
Fixed Platform(s) It � k I
IJon
r 1,gf ,jMr,
c!�
FloatingPlatform(s)
Finger pier(s)
v
W r j
Groin length
number -- --- -
Bulkhead/ Riprap length
�
M , i��X �3 t
Y
1
avg distance offshore -
�i9�1
max distance offshore
Basin, channel
'43
yards /
'Y t (
1 to
NVcubic
Boat ramp
Boathouse/ 13-
Beach Bulldozin
Other
S��trtiw
U
�k
Shoreline Length(
SAV: not sure yes p?) (:VHo7
Moratorium: n/a yes JnoPhotos: yes)
Waiver Attached: yes Co
.'
A building permit may be required by: V,/�i5uxo 1 J See note on back regarding River Basin rules.
( Note Local Planning Jurisdic 'ckn)
Notes/ Special Conditions (�oUE -SAQ /}L'� u(LlZ e1J LIE) QL��u1 ( lJ [ jFii'-y l {���� Vt� LF1AS'It�� jtu'E(1JWt� �jiliu
6 be A'tck INAN UN sr{ tlL 13 ae,'yiTec--�) t &0 Si.1�STOATL I,-) RX11160 I )? CV-
!� 1 t tL /Y
A en orA licant PrIntSrgnat ''•` Please r•e statement on back of permit "
r
- _ 110(3
Application Fec(s) Check #
P (nitOfficer s P inte i Name
1 /
Signature
Issuing Date Expiration Date

2
�eCAMA / ❑ DREDGE & FILL N9 80610 A B 0 D
GENERAL PERMIT Previous permit#
XNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality EE
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC © H 1 2-bD
I-1 P'.1— attarharl
Applicant Name lick JyAeW
Address *171� COM10. W012,01 �W
City, sNirroS ��-afw State_AG _ zip MY&O
Phone # I,% ` ) Z E-Mail
Authorized Agent Q iVaMlkt) A CmNS tVV(1M)
Affected ,J� CW 'HEW 19PTA %ES [IPTS
ElOEA ❑ HHF [IIH ❑ UBA ElN/A
AEC(s):
❑ PWS:
ORW: yes /(no) PNA yes /
Project Location: County o4jaow
Street Address/ State Road/ Lot #(s)��
Subdivision
City n3A i % LLRf�CV iO zip 7E &0
Phone # ( ) 78 Z River Basin wjil -aw-
Adj. Wtr. Body ��.I ALD 1:1�A l nat /man /unkn)
Closest Maj. Wtr. Body' ( g
Type of Project/ Activity %Ojeb QU,vhTC DWYAVi F/fOL1 �y J&IYA WfI3t eoW.� RA-1W.M. to') ►=iyiil)
PIr1r1)1M, MD t3'(/2 KA& tALVLA Al 7h(� tAM CFA &k6 M-1, Pe5b 13,t13l 4.-*t(F(' (Scale: k(S )
Pier (dock) length ' ( -=
i
Fixed Platform(s) j i� Y
Floating Platform(s) /
Finger pier(s) /
Groin length /
number /
Bulkhead/ Riprap length
avg distance offshore
max distance offshore i
Basin, channel
cubic yards
Boat ramp
Boathouse/ oatlif�_
Beach Bulldozing /
Other IP X 241 A('[Rall
Ind -Atz
Shoreline Length
SAV: not sure yes C no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes �o ,
A building permit maybe required by: V�7�W L Q lJ i1i� I "� ❑ See note on back regarding River Basin rules.
( Note Local Planning Jurisdic ' n) �7,
Notes/ Special Conditions (')OJJ y,W hy-iHo l z to By lm:i Wi O � IY5 (_b%JfV6 WASAU11tYl ifl COI jl L
No. A10 MC46 6041J 6' IN kitofl{ Y SOLL 56 MEVA-lm 30 &AA SLV,6TilRT(_ 7) RgLM E_lF bt-CK
Alert or Applicant Printed Name
6A,5
PetinitOfficer's Printed Name
SignatuLe AtPlease read compliance statement on back of permit Signature v l
Applicati n Fee(s) Check# 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:
❑ 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 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
Revised 7/06/ 17

AGENT AUTHORIZATION FOR CMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ( C k
Mailing Address: J�irl t_t k )C Dr-1i
Phone number:
Email Address: I ,. i) c i 'ITT, �j i v �� ; I'))(-; f
I certify that l have authorizedtM !i t i f l c ; .i
Agent/ Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: � ` X II � � � � ; �i �` / (� `,� i
at my property located at '7'1 `�l?�t�1 c.�� /;' >%1�; F , D1`r'' ,
in (. i j :-i C �' County.
t furthermore certify that 1 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:
Signature
Print or Type !Name
Title
02 1 cy
Date
This certification is valid through 1 1

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
(Name of property Owner)
property located at
(�" (Address, Lot, Block' , Road, etc.)
on -d-� i� ,in 111�<<( r&:
(Waterbody) , N.C.
(City/Towrt andla County)
T pplicant has described to me, as shown below, the development proposed at the above
ldcation.
1 have no objection to this proposal.
! have objections to this proposal.
ur-ZK K1F' 11UN AND/OR DRAWING OF PROPOSED DEVELOPMENT
(lndividuaf proposing development must fill in description below or attach a site drawing)
i
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.
;(Pr04P1G)Owner Information) ( cent Property Owner Inf rmation)
:aure Si tur
Pnnt or Type Name . a
1 / Y �;Pnt or yp am -} c
It , t
P
lVlating Address _ Mai ing Address
ccw'`Y i z: i C, : _;. City/State/Zip t cxy/statelzp�
Te%phone Number/email address Telephone Number I email address
Date Date*
'Valid for one calendar year after signature' (Revised Aug. 2014)

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT RE VESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner:
Address of Property: "I' i h oct u) L- L r r %� r'�.�j �"
Mailing Address of Owner: i'16, ?1 L V, i r,r- !
( ) c t7�
Owner's email: ll ell t�t1, � � ��,I �• wner's Phone#: �l�q - 5
Agent's Name: t: n LAe � t.- t t J J) �, ent Phone#: i}
Agent's Email: 01liC i ! ()1'i I tl f C_< i� i t 1,- +i 1, ►1
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom nortion to be cgM2lgkg.§y the Ad agent PropgM 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
f{ii f1 descrirrtion or drawing, with dimensioms, must be prgvided with this letter.
I DO NOT have objections to this proposal. __ I DO have objections to this proposal.
#, you have objections to what is being proposed, you must notify N the .C. Division of Coastal
Management (DCM) in writing within 90 days of receipt of thus 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 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 bank a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetrnents). (If you wish to waive the setback, you ntut ,Sim
the appropriate blank below.)
i DO wish to waive some/all of the 15' setback
Si._gnafrrre o djdjac€?nt Ripa,•iao Property O,,vner
I do not wish to waive the IS' setback requirement (initial the blank)
1 � Signature of Adjacent Riparian Property Owner: _
Typed/Printed name of ARPO: MI?I c,VA,fZO r/p7-7-
1Itb Mailing Address of AIRPo: Id-6 des-$- /
ARPO's email: c �01`t @ �+a 1. ARPO's Phonei6: S-Y,9 - L$ $ -/a 96—
Date, 479 � `ir aO a a *waiver is valid for up to one year from ARPO's Signature'
Revised May 2021