86112A_Arn, Sandra & Timothy_20211012

0UMST4, JCAMA ElDREDGE & FILL 41? 86112 B C D
li L GENERAL PERMIT Previous permit
Date previous permit issued
❑ New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
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. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # (_ )
Email
Authorized Agent
Project Location (County): ` -7
State ZIP Street Address/State Road/Lot #(s) _
Affected ❑ CW ❑ EW ❑ PTA
AEC(s): ❑ OEA ❑ IHA ❑ UW
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length Jti
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes • no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
Permit Conditions
❑ ES ❑ PTS
❑ SPIMA ❑ PWS
Subdivision
City ZIP
Adj. Wtr. Body (nat/man/unk)
Closest Maj. Wtr. Body
(Scale: )
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT.
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit" Signature
Application Feels) Check #/Money Order Issuing Date
(Please Initial)
Expiration Date

Statement of Compliance and Cons !ncy
This permit is subject to compliance
th this application and permit conditions. Any violation of these terms may
subject the permittee to a fine or cri
ial or civil action; and may cause the permit to become null and void.
This permit must be on the project s
and accessible to the permit officer when the project is inspected for
compliance. The applicant certifies [
igning this permit that: 1) prior to undertaking any activities authorized by this
permit, the applicant will confer wits
)propriate local authorities to confirm that this project is consistent with the
local land use plan and all local ordii
ces, and 2) a written statement from the adjacent riparian property owner(s)
has been obtained, or proof of deliv
of certified mail notification of the adjacent riparian property owner(s).
The State of North Carolina and the ision of Coastal Management, in issuing this permit under the best available
information and belief, certify that t project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To You oject:
1-1 Tar - Pamlico River Basin Bc - Rules 1-1 Neuse River Basin Buffer Rules
If indicated on front of permit, your )ject is subject to the Environmental Management Commission's Buffer Rules
for the River Basin checked above d to its location within that River Basin. These buffer rules are enforced by the
NC Division of Water Resources. If y have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-9z 481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Condition
Please ensure all debris associated with the loval or construction of the permitted development is contained within the authorized
project area and disposed of in an appropri ipland location.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave Morehead City, NC 2855
252-808-2808/ 1-888-4RCOAST Fax: [phone]
(Serves: Carteret, Craven — south of the Neu ver, Onslow
Counties)
Elizabeth City District
401 S. Griffin St. Ste. 300
Elizabeth City, NC 27909
252-264-3901
(Serves: Bertie, Camden, Chowan, Currituck, e, Gates, Hertford,
Pasquotank and Perquimans Counties)
Washington District
943 Washington Square Mall Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Craven — north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover and Fender Counties)
http://portal.ncdenr.org/web/cm/dc iome Revised6/01/2021

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DE
IWLVERED
I hereby certify that i own property adjacent to
(Name of Property Owner)
property located at
(Project Site: Address, Lot, Block, Road, etc.)
on C �,�1Lr �, in C-A%1PW N.C.
(Waterbody) (City/Town and/or County) ;2 � 3 Z
Agent's Name #:
Agent's phone #:
Mailing Address:
Emai
He/She has described to me as shown below the development he/she is proposing at that
location, and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must flit in description bow or attach a site drawinf
��41f ,
%, r +,� lev,
If you have objections to what is being proposed, you must notify the Division of Coas%al
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence shouid be
mailed to 401 S. Gruen 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 beer,
notified by Certified Mail.
(Prope Owner Information)
Signature '
711�m
Print or Type Nam.
3/ r : ,
Mailing Address
CState/Zip 2 �L-�Z
2 s2 - 3 3
Telephone Number/Email Address
Date ,�
*Valid hr o eC606®ry:�ear a n ur'��7^
Print or Type Name '
Mailing Adiress U
City/State/Zip v �r I dL(,
�1- S I I �, 0 6
Telephone Numb r/Email Address
l �- Ix
Date*
Revised Jan. 2017
M

110,

10/6/21, 9:19 AM
Yahoo Mail - Re: Riparian Property Owner Notification
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FQRM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERED
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at ��_ j`� . pzu4wc
n (Project Site: Address, ,Lott,, Block, Road, etc.)
on in N C.
(Waterbody) (City/Town and/or County) 2 3932-
Agent's Name #:
Mailing Address
Agent's phone #. Email
He/She has described to me as shown below the development he/she is proposing at that
location. and I have no objections to the proposal
---------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below o? ahtdr a site drawing)
If you have objections 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. Griffin St., Ste 300, Elizabeth City, NC, 27909. DCM represer0tives can also be
contacted at (252) 2"3901. No response is considered the same as no objection N you have been
nol led by Certified Mail.
(Property Owner Inform'Jation) (Adjacent PropertynnOw,�Information)ner /nffo��rmation)
Signature ' Signature'
� E1(0a-T. TZeyel(>✓
Print or Type a ' Print or Type Name
Marling Address Mailing Address
City/slate/zip City/stale/ZIP
33 �asd - 391v-33 t lv el ��la.revcll cC
Telephone Number / Emed Addross Telephone Number / L mad Address (a mail , W VY)
60 -aoa
Date ? '%�^— Date'
Valid for one calendar year after signature' Revised Jan 9017
2/3