86128A_Avery Family Trust_20211015

4`- XCAMA ❑ DREDGE & FILL
J(" GENERAL PERMIT
\`o B C D
Previous permit
Date previous permit issued
New Modification -Complete Reissue ❑ Partial Reissue
As authorized by the
JState
?ofnNorth Carolina. Department of Environmental Quality and the Coastal Resources Comrnission in an area of environmental concern pursuant to:
15A NCAC Rules attached. L J Genet -at Permit Rules available at the following link: www.deo.nc.gov/CAMAruies
Applicant Name Y i' ✓ `r _ ` ' ` Authorized Agent --16�-
Address _ fit- aProject Location (County): _ tt C/tit L_t�_,t LLn1/11-
City `C�(- m State T__ zip C?_- fit IP Street Address/State #(s) 4-
Phone # (2A R,4 - L-/B! 5! �2 9
Email 1?� "bi—ayi Zoe � ��7%i • C 15 Subdivision..(
city —.a�� /1 _ ZIP
Affected E]CW YEW �J PTA " 1:1ES EIPTS Adj. Wtr. Body B�LLn � na anlunk)
AEC(s): �OEA ❑ IHA F lJW CJSPIMA L_._l PWS Closest Maj. Wtr. Body ��VV��L� ----
ORW: yes no PNA yesC)
Type of Project/ Activity -6 X Le t i ✓ -e✓t�_ • n q i Vl (p t X t a�C O✓
(Scale:
Shoreline Length
Access Length
ier ock)length
'ixec Pla orm
Floating Platform(s)
Finger pier(s)
Groin length/N
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sitl
Max distance/ length _
Basin, channel
Cubic yards
boat ramp
Boathouse/ Boattift
Beach Bulldozing
Other
SAV observed:
tE7 f&4jqkg �dvlle- _,
Ojrcg r
yes. no
Moratorium: n a yes no
Site Photos: 4M no
Riparian Waiver Attached: yes (
A building permit/zoning permit may be required by:
Permit Conditions
--
P.XtS�ih�
ViP raf
*yam,. i...._
A u i �'tn.M.tit-
TARJPAMJNEUSE/BUFFER (circle one)
IDSee note on back regarziing River Basin rules
0 See additional notes/conditions on back
I ana IMAM: nc cTATIITes_ rat RMES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Signature
e""Please read compliance statement on back of permh"r�
i:'iicatO feels) Check ;UMo
Permit Officer's PRINTED N ne
Signature
`ts
Issuing Dave Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 6- C^ �- %
Name of Property Owner Applying for Permit: 4
:Mailing Address:
O li 4 C_C r H: /:Z-' D
F4pLf 1 J 3C r�
Q��
I certifv that I have authorized (agent) S / '= G'- s � to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) /01 c i- 5 Q G r c{ iv s
at (my property located at) / C 0 i3 V"E R X /D r
This certification is valid thru (date) (- `
Property Owner Signatufe Date

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
hereby certify that I own property adjacent to t- e�f�y� !?� `s
(Name of Property Owner)
property located at _ l car' Avg'-^ i ; S L 44
p (Project Site: Address, Lot, Block, Road, etc.)
on I C(j Lk0 ' 0 v1 k_ R iy`[ .'' in Q d Yv1J'' YN _, N-C_
(Waterbody)
Agent's Name #:
Agent's phone #: A s)�-. y S5 ) D A.-
(City/Town and/or County)
Mailing Address: i o Z Av ea A-
Z�97�I
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 ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing devefnpment must 0' in description below or attach a site drawing)
` n Ralk L ead t c,, U -a Ioc' 4L,7-w
i S�Y t�! E'►" �:.: lU� li�ic;►�9 i C��i14 �
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCA9) 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 contactedat (252) 264-
3901. No response Is considered the same as no objection if you have boon notified by Certified Mail.
(Property Owner Information)
Signature
rFs
Print or Type Name
Mailing Address
CitylStatelZip
%-C'3 $`Ir' $YS c/ l'J/e51`e��as C /Y2SN. co/ -
Telephone Number / Email Address
Date
"Valid for one calendar year after signature`
(Adjacent Property Owner Information)
Signature`
Print or Type Name
Mailing Address
CitylStatelZip
Telephone Number / Email Address U
Date'
Revised Jan. 2017

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
I hereby certify that I own property adjacent to I r i°5` �%' i -T b` k-- __ s
(Name of Property Owner)
property located at
r� (Project Site: Address, Lot, Block, Road, etc.)
on�I,S� t t ct it< K in �, �-� N.C.
V_
(Waterbody) (CitylTown and/or County)
Agent's Name #: {J`� �'#-�� d.,�1 i`-' Mailing Address:
Agent's phone #: `>J. �iS`� } C ..� `� 1. �� h `�7 �l 7`Y
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 6-velopment must fill in description below or attach a sire drawing)
a f1. r. t: " ' i it `i'�'rrl �'•tJl.i: �.i t'Y�'G� t� e _
1.
.
a , e, ,
.J f�f'ialcicx Litz s'�t� 1 !E'Y#1..n �G; �t7ti� �
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 representatives can also be contacted at (252) 264-
3901. No response is considered the same as no objection if you have been notified by Certified Mail.
(Property Owner Information)
Signature
,,'(' if ----
Print or Type Name
(Adjacent Property Owner Information)
Signature*
t,r' wii,I d,'Ne, t of
Print or Type Name
Mailing Address Mailing Address
CitylStat&zp City/Statemp
.339- lr�
Telephone Number / Email Address elephone umberl Email Address
Date
*Valid for one calendar year after signature*
Date *
Revised Jan. 2017

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0 One Mill Road - Parcel #0389710025520000
October 15, 2021
Streets it Addresses
Streets Parcels
Main Roads o County Boundary
1:1,750
t 0 0.0125 0.025 0.05_mi
0 0.0225 QQAb: 0.09 F
Source: Es MaXaf, Ca ye, EarthstarGeographies, CNESIAMN
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