80340D - Hughes

OF❑CAMA / 11 DREDGE & FILL Na 80340
GENERAL PERMIT Previous permit# A B C
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality 01 LI 1 Z o 6
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC
❑Rules attached.
Applicant Name J?i P. On kt S (c,,.,,i( L.; 1.) (/0 (V\c,,,,,,.,} Project Location: County 1(�J r • ^S--, i C. r(--
Address 12 I j 1j�.��1n',14- g c ��1� M e., Street Address/State Road/Lot#(s) I�IM3 Cc e c
City r'\ cL4 v,k1 c.- State N C. ZIP 2 ?;/O3 L �` �, �.�
i
Phone#[phone] jl C) E-Mail Subdivision
Authorized Agent ,.v, (), ; C.4.- City ZIP L`64-kl0 E
Affected ❑CW Dew RI PTA ❑ES ❑PTS Phone# ( ) ' River Basin ( ,,,,A0...&_
AEC(s): ❑OEA ❑HHF IH ID UBA ❑N/A Adj.Wtr. Body 4\w W` (nat )man /unkn)
❑ PWS: �—
ORW: yes / no PNA yes / Closest Maj.Wtr. Body 1�W
Type of Project/Activity V. A r, o i i SI n� \‘)o \\4\ c,— (lM (o e 1- o' -r ,Si.'S. ` J
^� (Scale:NI \ S )
Pier(dock)length
I
Fixed Platform(s) l • M■—
Floating Platform(s) i
I I —Finger piers) 4 —P'. } • . .
Groin length —
number -- iii h--
1 •Bulkhead/Riprap length_ _.__;._. — �� ._ �e (I u��S � 1.._
-r • �- 6
avg distance offshore t .�, •,., k,
max distance offshore I i1A'(.1i. j \ I Cpr_ L j it1t. j ti,
-f
Basin,channel I ,n a`ti' tit)^„6v
• CO T'^ •
,j n
cubic yards ( 1 1
T
Boat ramp j 1
Boathouse/Boatlift '\� - —. rt ..... ..... ._........... .. ...._........_.__ _
i 1. I. , '-'
Beach Bulldozing t,^L j : ! : 111141 1 1
,h. ""'
Other P,1,,..1S �oi
1
1 fiiii {
V % : A. k
Shoreline Length (.P 0 I 1
h L I 1 f1/Las `� Pit:
SAV: not sure yes no ;--_ 1 --
L � i i
Moratorium: n/a yes ujrh c i t 1
Photos: yes no 1�1 1 cv, �1\'tS . _.r.:(.-- ‘�1......�.-,.- . "�
f( JAi., I \ - - 21,
Waiver Attached: yes') ,no ; (4 �, �" � i 'U J i "�' ,'�� - � 0 f � Emil
A building permit may be required by: Q'-)l "' '' f\i` r,, lr`'1 . See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions Le.,..a k,...e
.--.--)01.01.' (----rr,- ' 4 ' jt e , ,-,., f\--S r‘tc„,\i•-
Agent or Applicant Printed Name PermitOffJ's Printed Na
Signature * Please read compliance statement on back of permit�`*' Signature
A/7.0b,otit r -I (o i ‘y �- ; -z�Z, - I? 202j
Application (s) 00 C'e�,{ 0,;u4 Check# Issuing Date Expiration Date
G (421-g9C4

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 how to comply with 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/ I-888-4RCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves:Carteret,Craven,Onslow- (Serves: Beaufort, Bertie,Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

N.G. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date '2 y ' 2/
Name of Property Owner Applying for Permit:
Mailing Address: // � �
/997 [�t�LYGL 2.aAO'lir/J l?L1
sPp/y
I certify that I have authorized (agent)
0041i to act on my
behalf,for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct(activity) 8,0 /
at(my property located at) /fr7 c'e4 � ij y/27 •
This certification is valid thru (date) ,� ' 3/ 2/ —
—21
Date
roperty caner Signature

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complete PS Form 3811,Domestic Return
Receipt;attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records.
3 Form 3800.April 2016(Reverse)PSN 7630-02-000.9047

ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVEK FUKM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: fileal aLe,i 4-4�'// S
Address of Property: / 5/7 CC al✓a 2 /G,10✓iaq RP/ S11,4 /U C.
Mailing Address of Owner: .s6,,m Y I
Owner's email: Owner's Phone#: /'e G `207—E,3a
Agent's Name: Oc t.6 / .erct- Agent Phone#: ?I a 9,, S,9s
Agent's Email: Do✓ 7 Qr'o c C• Lc''.#A & G,•yradI. &a 1
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
des Itio or drawing, with dimensions, must be provided with this letter.
t" I DO NOT have objections to this proposal. I DO have objections to this proposal.
' I 1 P P
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 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 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 siqn
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
4r rli ' (/)q-/ /
a ure of Adjacent Riparian Property 9er
-OR-
cifi I do not wish to waive the 15' setback requirement(initial the blank)
idl CH-4 Signature of Adjacent Riparian Property Owner:iAlI.LI_ I u.,i''I"^'l
Typed/Printed name of ARPO: <-1i2)E T tali het J�
Mailing Address of ARPO: / / :, tp`f"h e a/ d le a n 614 VA �! 114
ARPO's email: ARPO's Phone#: gip7/Q---004/1-
Date: �I -. —LI *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

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I A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail
I A unique identifier for your mailpiece. associate for assistance.To receive a duplicate
I Electronic verification of delivery or attempted return receipt for no additional fee,present this
delivery. LISPS®-postmarked Certified Mail receipt to thi
I A record of delivery(including the recipient's retail associate.
signature)that is retained by the Postal Service'" -Restricted delivery service,which provides
for a specified period. delivery to the addressee specified by name,or
to the addressee's authorized agent.
mportant Reminders: -Adult signature service,which requires the
I You may purchase Certified Mail service with signee to be at least 21 years of age(not
First-Class Mail®,Frst-Class Package Service®, available at retail).
or Priority Mail®service. -Adult signature restricted delivery service,whicl
I Certified Mail service is not available for requires the signee to be at least 21 years of ag
International mail. and provides delivery to the addressee specifier
i Insurance coverage is not available for purchase by name,or to the addressee's authorized ages'
with Certified Mail service.However,the purchase (not available at retail).
of Certified Mail service does not change the •To ensure that your Certified Mail receipt is
insurance coverage automatically included with accepted as legal proof of mailing,it should bear t
certain Priority Mail items. LISPS postmark.If you would like a postmark on
i For an additional fee,and with a proper this Certified Mail receipt,please present your
endorsement on the mailpiece,you may request Certified Mail item at a Post Office'"for
the following services: postmarking.If you don't need a postmark on this
-Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion
of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply
You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.
electronic version.For a hardcopy return receipt,
complete PS Form 3811,Domestic Return
Receipt,'attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records.
S Form 3800.April 2015!Reverse)PSN 7530-02-500.0047

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I Check e
Date Received Data Deposited Check From(Hemel Name of Perm.Holder Vendor Check number_ amount Permit Number/Comments Receipt or Retund/Reallocated
Cdumnl Column2 Column] Column) Columns Column) Column? Column. Column.
9/16/2021 RG Marine Jim Schindlon Bank of America 993 $ 200.00 iOP#80370D BH rct.15630
9/16/2021 Justin Noll ,Justin and Kimberly Noll Merck Employees FCU 1040 $ 200 00 GP#80282D BB rct.15621
9/16/2021 Davey Resource Group,Inc. Joe Michalek United Bank 2318'$ 200.00 GP#80353D KE rct.15745
9/16/2021 Burl Sniff Money Order Leon Brown Wells Fargo Bank 5.9187E+10 $ 200.00 GP#80347D KE rct.15744
9/16/2021 David Morrison same First Citizens Bank 220 $ 200.00 GP#80341 D BB rct.15533
9/16/2021 David Grice($200 credit from 5/18/21) IS&A Hughes Family LTD Credit ON ACCOUNT(5/18/20) 17-7680537E Credit GP#80340D none