86119A_Stephens, Richard B_20211026

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O(—U XCAMA ❑ DREDGE & FILL (� N9 86119 Cjn a C 0
G NERAL PERMIT "( DatePrevir ious per_
Date previous permit Issued
®New ❑Modification ❑ Complete Reissue []Partial Reissue
As authorized by the Sate of North Carolina, Department of Environmental Quality end the Coastal Resources Commission in an area of environmental concem pursuant to
15A NCAC -- i Ht• I I��` Q .p 41 - t Rules attxhed. ® camas Permit Rules available at the following link: j
ApplicantN4M �s['_Ytp„r[Y Ii. uTeA� 2irtS AuthoAxedAgentFMYMki:, %MwY% --
Add. _2gt'( P Yt rh i� h�'fs. �('. �1 arrt Project Location (County):
City _�ys • 6&bR—.J L` *ate W _ _ ZIP _�py�'�. _ Street AddrenfSftate RoadA_ot
3/t -i* f `_ai�S L.n.
Emau _ rS�glaO R 5's ee_rc CAM soon
City --,----ZIP 2'79/A1
Affected CW EW PTA �`� ES PTS
Adj. Wtr Body—..Y_t'+t' fw IV11f1 et 5 1ZIVe' ..k)
AEC(* �OEA ❑INA ❑VW L:]SPIMA OPW5 CxxeteMej.wn:e«y fi � stoma-� .3A(inJ
ORW: yes ro� PNA: yesAiD
(or J(gOl pier^ aeJ t-tD0.ac ex4thj
ack3 (Scale: r =
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Beach Bulldozing _._ ti t•- r-r._..,_._...,_,-_._(...,4 _ t Hr.,.,-,,,, 1 i {-.I, i
Other
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SAVabsermd: Ye,...
Moratorium- a yes no •. .e i f. I .'..._{ r I ,�..r i ttt,_,.,,,,�•� 4 .�_._,..� �., ...Iq r I
Site Photos: no ,Fr-"d- ¢ - .T,_.,,•...,�,_--t}-+ }i
Riparian Waiver Attached: ye m, _ 1 ! �...±�..�._.:__
A building permh/zoning permit may be required try: to ins .a'Lx Gy n, f— MI
TAg/PANEUSE7BUFFER(ekde one)
Permit Conditions
See note on back regarding River Basin rules
� - See ae4tional notes/condldons on back
1 AM AWARE OF STATUTES CRC RULES AND CONWIM THAT APPLY TO THIS AND REVIEWED COMPEL STATEMENT: (Please initial) _
Age pp PRIWIDName permit �s i Name
- ' `�. %
_11nats6 •• revcompliance statement on back of permtt•• sign tore
a-11 70/2(0/7-1 Z/Lb l
Appllatfon Fee(s) Check N/MgNy Order Issuing Date Expiration Date - --
lype of Projeet/ ActlAy . C r,yls4ln.
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IS!
A CQp e, vu� wake_
Shoreline Length /- 159'
Access Length
Pler (dock) length b� Xy0/
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r
Fixed Platform(s)
4 4 C
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Floating Platforms)
Fingerpler(s)
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Total Plaftorm area •-^
I,,,,r_,_„)_���,.,,,,r..
Groin length/ff ^•
r I I I
4
1
Bulkhead/Ripmplength -.
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Avg distance offshore
Breakwater/Slll
Max dkUnce/length
Bassin, channel
Crblcyards
Beat ramp
I
Boathouse/ Boatlift

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit:
Mailing address: ZIP 17 � x.��
Telephone Number: ZS Z
I certify that (have authorized EWW1A9&--- (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of
L
at my property located at
This certification is valid through
(Property Owner Information)
Print or Type
Title, co. owner or trustee for property
Date
Telephone Number
Email Address
(date).

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: �{' IJ �-tle IL1115
Address of Property:
Mailing Address of Owner: LINT (JU-Vt fI L[LJM I I ►IUIC I1/IW (J TU I VL L033 L
Owner's email: f��J���� QC rr C Owner's Phone#: l f 2) Le
Agent's Name: &" ko a"A Agent Phone#i ?,9-/` ZL9-3US-S-
Agent's Email:
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
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.)
1 DO wish to waive some/all of the 15' setback A., : \ \
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property
Typed/Printed name of ARPO: 22� V to T
Mailing Address of ARPO: 3 8, J L 14RG kJ O0-1 7�_ ✓ 1� V a3 7
ARPO's email:-Df?k L:'1P P &DLC-DQPO's Phone#: [phone] zlt)
Date: / i ao `Z *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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:
Address of Property:
Mailing Address of Owne
Owner's email: VSfAv.05 150 et-tv, (011 Owner's Phone#:
Agent's Name: Agent Phone#: (Z52' q2_Q- WST
Agent's Email Adh f • h/G-llv1CQC?(.tf&,0k • 06"
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
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.)
17
1 DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property OWhbr'
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: JtJL4,a2'ati
Typed/Printed name of ARPO: rrtir x s / > /.: G' i; !` J� ri U `
Mailing Address of ARPO:
ARPO's email:
ARPO's Phone#: ) 7 ,t '7 / q 6 o 5�0
Date: ;' , ' / i` I *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

3,21 yea.` S L h gerTAaw
Perquimans GIS
10/18/2021, 9:20:32 AM
Address Points perquimans___nc__lot perquimans_nc_acres
Centerlines perquimans_nc_easement Imagery 2020
perquimans_nc_misc perquimans_nc_dims Red: Red
lK
Al by
eltiec�ot cti,-1 , uc zx�s 1
1:564
0 0 0.01 0.01 mi
Green: Green
0 0.01 0.01 0.02 km
State of North Carolina DOT, State of North Carolina DOT, Esn, HERE. Garmin,
Blue: Blue INCREMENT P,USGS,EPA
® Imagery2016
Perqumans GIS
For tax purposes only Not a WWI document or survey Perqulmans nor State of NC assume any h*Aty resulting from use of this map

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