86115A_Mitchell, David & Shelia_20211018

JKCAMA ❑ DREDGE & FILL N9 86115
a C D
PreA�iuGENERAL PERMIT Dotperrnitissued 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 emironmentai concern pursuant to:
t
I SA NCAC -,i , 1200 !! Rules attadied. ® C--1 Permit Rules avallable at the fdiovrYtg link: www deo.nc.QoW9.6 SAryg*
Applicant Name _v.d S �. t t 01_ + i- ckell Authorized Agent
Address }flor, ' Project location (County):, {f IMp yt 4
City - _� __� State Mzip 2-7q(N Street Address/State RoadA.ot #(s) {�1
Phone # ( +a t) G( ri - 1�� 1 U Chas [,h _br
Ernal 65_4MC @ '4 (n1il Ciill'1 Subdivision Afrac
City —� __SIP _ 211?
Affected ❑ IEW ® EW X PTA n ES Pt5GL t� l 14 t Yef r m�/unk)
AEC(s): OEA IHA UW SPIMA PWS Closest Mai. Wtr. Body 6-ern ar-tc
ORW: yes/rit} PNA: yes/%
Type of Project/ Activity
Shoreline length
Access length
Pier (dock) lengthy
Fixed Platform(s) �—
Floating Platform(s)
Finger pier(s)
r--
Total Platform area 0 S 4
'V
Groin length/#
Bulkhead/ Riprap lengthi---
r
Avg distance offshore
Breakwater/Sill
;--;-
Max distance/ length
Basin, channel '^
i.._ .
{
Cubic yards
Boat ramp
_�..
Boathou oatli to
Beach Bulldozing
t,
Other
SAV observed: yes
Moratorium: n/a es no
Site Photos-. +�y s no ',----�--�
Riparian Waiver Attached: yes n�
A building permit/zoning permit may be required by;
Permit Conditions
t 0 r k 12'
(scale:
TAR/PAhyNEUSEBUFF9!J" one)
F] See note on back regarding River Basin rules
See additional notes/conditions on back
TO THIS PROJECT AND REVIVIft COMPUAtG�STATE ENT (Please Initial)
3JAV i� A-S Jt �J � !� )) l +F=
or ppfcarK Jyame
SWnatr�urre**Pllease read compliance statement on back of permit's
Application Feels) Check #/Money Order
Signature r
(0/ir /zf zl/ - �'/zz
Issuing Date Exniratinn nano

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion tobecompleted by owner or their agent)
Name of Property Owner: L) cw ►
Address of Property: L4 o Lo ('1G >ac—A D 1- 10 t le r 4-f—vrd r " C'
Mailing Address of Owner:
Owner's email: 1 o54-j
Agent's Name:
Agent's Email:
td I\/6
owner's Phone#: (S �O1-7 �
Agent Phone#:
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 ordrawina. 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
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
10iye
Signature of Adjacent Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:C,
Typed/Printed name of ARPO: 4,// G . )/0 V,-(y
Mailing Address of ARPO: 1 31?-
RECEIVED
0 C T 0 6 2021
DCM-EC
+-Q�,rd NG
ARPO's email: / C) A/ j�� ARPO's Phone#: .Z L 7 '-3 $3 �1
Date: / V - 3 ` J-A Z ! *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

Address of Property:
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top ((portion to beeccom�plet_ed, by owner or their agent)
Name of Property Owner: pwi, 6 r , `f `�(�'I
t g 6 1 nrNS ?-, ca-cK nau_e 4u-J�e' yd kx
Mailing Address of Owner: I
rd A C
Owner's email: l 0,5�90X Q)Q Y�Q'l ( "Owner's Phone#: S� tr c�r�s 7 ,
Agent's Name:
Agent's Email:
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
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.
�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
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, yoKmf` ,�D
the appropriate blank below.) V
I DO wish to waive some/all of the 15' setback 0 C T Q 6 2021
Signature of Adjacent Riparian Property Owner
-OR- DCM-EC
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: _► 1EIT) t =L P*12en1 sk-t,
Mailing Address of ARPO: / C/ l Lon ec_cJ-, D r 1 v'-e_ ! r_W.CJ r0(
ARPO's email: 1%hc 1r-P_c-, Q C40I•coy4RPO's Phone#: 310 S- %( 0
Date: 10131 ;2 I *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

3 � P; e
r N
RECEIVED
0 C T 0 6 1011
ACM -EC

I L i O l beelizz)h vr-
Perquimans GIS .
10/11 /2021, 11:03:35 AM
Address Points perquimans nc lot perquimans nc acres
Centerlines perquimans—nc—easement Imagery 2020
perquimans__nc. misc perquimans nc dims Red: Red
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lV E if "JC 1`701c,
1:564
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Green: Green
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State of North Carolina DOT, State of North Carolina DOT, Esrl, HERE, Gamin,
Blue: Blue INCREMENT P,USGS,EPA
Imagery2016
Perqwrnans CIS
I or lax pugxises only Not a Iogal rimtiment (x survey Pefgwmans mw State of NC assume any liability resulting frorn use of this map