86134A_Boyer, Robert & Deborah_20211022

VCAMA 9 DREDGE & FILL
3
a GENERAL PERMIT
n NY ti )1 54 (A-) B c, D
Previous permit Y
Date previous permit issued
[clew ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Co al Resources Commission in an area of environmental concern pursuant to:
15A NCAC 2 9 l
a I ` PC) ---- —
1-1 Rules attached. General Permit Rules available at the following link: wwwdeq_nc Qov/CAMArules
Applicant Name
Address 11 C ,ko &r,G D r-'✓e
city t State---A)C,-_______ ZIP _ 3
Phone # () 2(5'L[
Authorized Agent f- l lo�
Project Location (County):—'1'/cL—k'
Street Address/State Road/Lot #(s) l 16" _ - �✓
Email )30V(, t 1,0)3n l G rc, 1 . e- Subdivision Wa cl OKW S ple <'
City G—r_ zip-2-493)
Affected CW VEW 4PTA Lg�ES PTS Adj. Wtr. Body COr�a/�+ �O /- �wa�i n(nat/ unk)
AEC(s): OEA IHA ❑ UW SPIMA PWS Closest Maj. Wtr. Body (GJt. K�
ORW: yes, PNA: ye ri
hype of Project/ Activity ✓ r. GY'[ ®(� �..�� ttxa
(scale: /-7S )
Shoreline Length } 11(, r
Access Length
Pier (dock)length
Fixed Platform(s).
Floating Platform(s)
Finger pier(s)
Total Platform area
GLoin length/#
ulkhea Riprap length I 1 O'
Avg distance offshore
Breakwater/Sill _
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed:
yes
Moratorium: �n/�a
`9
es no
Site Photos:
e no
Riparian Waiver Attached:
yes no
6
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►s
V lc� .
A building permit/zoning permit may be required by: r(„ jr . -f l—C
Permit Conditions
TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
See additional notes/conditions on back
pu • ..
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) X
�_ f fir le!4-
tgent or pp' ant PRIN Name D it Officean)
ot
nature *—*Please read compliance statement on back of permit" Signature
>pplication Feels) Check #/Money Order Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
/`D L --t—Name of Property Owner Requesting Permit: `\Je�
�
Mailing Address: I & Irt/D©,D H6>0SE_ Die-
Gfzpf f Vp C 7 9
Phone Number: 7 41,p, q — 2- �S
Email Address: �° Y� C>So/ L �
I certify that I have authorized V tq/yS ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: lx.� ky x-j
at my property located at
in CUAiei'_r(dc�k County.
0
4 0od C)
I 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:
RECEIVED
Signa re
�d P r—F 13 Deigofo,h `(ems 0 C T 2 1 2021
Print or Type Namel
DCM-EC
Title
ao�i
Date
This certification is valid through

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner jiaLc:�t _ l `� Z CloniA 4J a -let —
Address of Property:/w L�✓odCl rl (J.SC-'�
Mailing Address of Owner: .S E
Owner's email: 80YEEZ d GmArL ,Com d D L C. Owner's Phone#.71 -7 — `o
Agent's Name: p L-141V Agent Phone#: -2-2 2-- `t5 7 ,5 7$ 7
Agent's Email: PE VAM9 CdytlS-rk (J(;7"' z)^10 lye�n , rn/71
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
description or drawing, with dimensions, must be provided with this letter.
CAI— I DO NOT have objections to this proposal. I DO have objections to this proposal.
/f 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 401 S. Griffin 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 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 sign
the appropriate blank below.)
DO wish to waive some/all of the 15' setback
Sign ture of Adjacent Ri�arlan P erty Owner ED
-OR-
I do not wish to waive the 15' setback requirement (initial the blank) (ICfi 2 1 2041
Sianature of Adiacent Riparian ProDerty Owner:
Typed/Printed name of ARI
Mailing Address of ARPO:
��m-EC
ARPO's email: lV -0 AA, `ARPO's Phone#: Fj�. - %2- -5b0y I
Date: Vl *waiver is valid for up to one year from ARPO's Signature*
C 2.77C-GCf
Revised July 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: Rab f- il— + De bo 'A Yl
Address of Property: 1 layl/ C C / ) O Ups = D" _ 6ey -/Ly �
Mailing Address of Owner: '17f - M t---
Owner's email:B©yti2 [3C, 1d 1 (p, s Owner's Phone#: ? 1- 663 —
Agent's Name: k)4^1 L�V14N� Agent Phone#: 2_5 Z— ki 5-'7-5 7:6 -7
Agent's Email /C} L�V/4I11,j Cy NS 7r/�c%G7-'/4/L/��%/=�dG. CGrY1
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
description or drawing, with dimensions, must be provided with this letter.
�� I DO NOT have objections to this proposal. I DO have objections to this proposal.
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 401 S. Griffin 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 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 sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature ofAdjacent Rya n 71e fty Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
cc, 21in,
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: 1 O l2Ac M�G`�
Mailing Address of ARPO: Cyr--)l� 1 b
ARPO's email: CVV\1KrA,(-U*XRPO's Phone#:
U
Date: _ *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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