86117A_Dailey, Alonzo & Shelia_20211025

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� +r MCAMA ❑ DREDGE & FILL N° 86117 A. B c D
GENERAL PERMIT Previous permit
Date previous permit issued
0 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.dgg.nc.Yov/CAMArules
Applicant Name
Address
City
Phone # (_ )
Email
Affected ❑ CW
AEC(s): ❑ OEA
ORW: yes/no
State ZIP
DEW ❑PTA
❑ IHA ❑ UW
PNA: yes/no
Type of Project/ Activity
Shoreline Length
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•
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City ZIP
❑ ES ❑ PTS Adj. Wtc Body (nat/man/unk)
❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
(Scale: )
Permit Conditions ❑ 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. (Please Initial)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit" Signature
Application Fee(s) Check #/Money Order Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CANA PERMIT APPLICATION
Name of Property Owner Requesting Permit:41onzo bcA" I C
Mailing Address: POO S r-\,Ct / ( b r s -- f-
n
c- �) r� 50
Phone Number. 7 5 Z - 3.53
Email Address: Qc 59/;Z� I i Ue" Ga n
I cer ify that I have authorized LuNA%Ae., r.-? C.
Agent 1 Caftedor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for ffm following proposed developmenr
at my Property located at bloo
in � 1 county. -
I furthem mm rei ft 6W I am authorized to grant and do in fact grant pennissbn to
Divsion of Coastal Afanagement staff; the Local Permit Officer and their agents to enter
on the aforementioned lands in connedion with evatuahng information mated to this
permit application.
062216
SignaW
Print or Type Nance
OLJI.er`
7-die
This certification is valid through /;�- / ( a- , a /

AD.lACENT RiPARuw PROPERTY -OWNER STATEI�NT
I heir certify that i own properly adjacent th 4-1cin-ZI) 's
lie) _ _ (Ns of PrcmmW Ch mad
.. _
t
(Ad*m% Lak RaaO. )
(Waftrbodtr) (CftffOWWWWmrCMINfti
The appficant has desa bed to me., as shown bebw, the development proposed at the above
ln_
✓ I have no objection to this proposal.
ke
I `34 eta f
f-",60�� soles
WAIVER SECTION
I understand that a per. dock, mooring pigs. boat ramp. brealmater, boa thotrsej- lilt, or groin
rust be set bade a mmimnm distance of 15' from my 0 of ripamn acces urdess waived by
me: (if you wish to waive the setbadk. you mast hu- tad the appropriate blartc below_)
I do wish t D waive the 1 S seffiadc requirement n
I do not wish to waive the i s setback req kr Ir rd:
r � � 1 •- ff 1"M
n I p f S `e-'1'Qi -LL,Ie�
�lrint OT Titpe Names _
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to n 2 , 1 e° 's
property located at
� Nefne of Pr+oPerly
h t (Address, Lot, BM
Road, )
on fl$Ci (404qll in_ 2- - 0
(Waterbody) (Cityfrown"or County)
The applicant has described to me, as shown below, the development proposed at the above
location_
l have no objection to this proposal.
I have objections to this proposal.
DESCRIP 1 ANDF OR DRAYIIMI6 OF PROPOSED DEVELOPINSIT
jbpropossig dery lbjii iiii must al�da beslbw or a#taci a sif+e drawing)
x9o, "C
P
1, w
boa
P
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 16 from my area of riparian access unless waived by
me. (If you wish to waive the setbadc, 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.
(Propecty Owner Information) (Adion e - Propwty Owner information)
170
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O 0 or T �� 1 Pnnt or r Name
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IS S '� ate- }-als9
T, INumber/emaH address T� Number/email aadrm
g� 1
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Pasquotank County NC uO S n1 am Dr.
September 27, 2021
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