79275A_Jefferies, David & Christine_20210622

)(CAMA / DREDGE & FILL ' "- a(L
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GENERAL PERMIT Previous permit # B
XNew Modification Complete Reissue Partial Reissue Date previous permit issued
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 �'{ • t
ules attached.
t L
Applicant Namexatian: County
Address � Z 1 "�1/Le Df rve_ .:.__ - Street Addr WState Road, Lot #(s) 121,Zat0%.
City _._•- - -- -- — State _N L Z1P T` f�_
Phone # (_*A _'&O_1:n?iU _ E-Mail 41 GY t Ch e er4lg L� Subdivision_. W -- -- --
0� ii • Co rh --
Authorized Agent Ctq' -- t U �..- -- ZIP._27f-_qT q_
Affected CW WW )(PTA ES PTS Phone # (-- I River Basin PQ,%Aidlfdfl`k-
AEC(s): OEA HHF IH USA NIA Adj. Wtr. Body --pit!_ _.-.._I liar Lam)
PWS: D
Closest Maj. Win. Body. - P7_VY
ORW: yes In tw PNA yes / j
Type of Project/ Activity "�rY��1,�e �-i i'r L (' f a- i (C
L•t• f X 24' Lo vvw-v p { aJ t f% K^_ X i S+yyt G Di Ie.✓ (Scale: f '(• �j )
Pier (dock) length
' T"�wW7V Fixed Platf s — ; ; 1
Howe t
Finger pier(s)_ -- ' / w
Groin length
number
Bulkheadl Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
.,� exi5" o�►
Boat ramp ---- ___ - - _ - p
- VI e�j,\ --► .^..
Boathouse! Boadift vv��
-- ----- ewSHhq x •u'MS
Beach BUudo=i -\ ex i 5 i rq
Other _0�
Shoreline Length
�Y tbt
SAV: not sure yes ®. �
Moratorium: n/d yes no (�tT // Loves •� Q�VI .101*-
Photos: (P no
Waiver Attached: yes no — ✓
A building permit may be required by: t See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Aptst App*l-nt rated Name Permit 01111icer s Printed Name
.. s. Si nature
S' nature Please read compha a
It 2V(D . 00
tement on back ofpermit
m.----
8
_ z! ✓�^�-- --
-- --- '
Appkation Fees)
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Expo

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner: �Ql�(1� 'I" �h� s Soh 6riQ. Cfco t' c
14
Address of Property: ( ����CI'1 �I �C �- 1J Ir + � L � ( 1&1 O � f 1 4
(Lot or Street #, Street or Road, City & County)
Agent's Name #: N )A Mailing Address:
Agent's phone #:
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.
y I have no objections to this proposal. I have objections to this proposal.
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.
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 15' from my area of riparian access unless w ' c:
me. (If you wish to waive the setback, you must initial the appropriate blank belov� 1
I do wish to waive the 15' setback requirement.
)UN % 2021
I do not wish to waive the 15' setback requirement. G
n ,M-E
(Property Owner Information)
Signature
Cis
Print or Type Name
ia,laeerh `Iac'Dr
Mailing Address
(91 c 16R , Id L -7q
City/State/Zip
Telephone Number/Email Address
��ab
Date
*Valid for one calendar year after signature*
(Adjacent Property Owner Information)
Signafftre
Print or T pe Name
2-.4 �/
Mailing Address
City/State/Zip
7-!:';17
Telephone Number/Email Address
�8
Date
Revised Jan. 2017

}
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner: Ch rls-�t ne-,- `D&u to
ress of Property: ( AA li�ee Ch
(Lot or Street #, Street or Road, City & County)
Name #: N I fc� Mailing Address: _
phone #:
-)q
I here y certify that I own property adjacent to the above referenced property. The individual
applyi g for this permit has described to me as shown on the attached drawing the development
they re proposing. A description or drawing, with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
i have objections to what is being proposed, you must notify the Division of Coastal Management
1) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 401 S.
in St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
. No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION n
iderstand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift,
=1EIVED
st be set back a minimum distance of 15'from my area of riparian access unless w
� (If you wish to waive the setback, you must initial the appropriate blank below.) 202�
\ JUN 0
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
,_.(Property Owner Information)
L
Signature
Print or Type Name
(J1 ?e T-A l Imo.
Mailing Address
Telephone Number
Date
[)CM -EC
A 'acent Property Ow er Information)
aw
/�G X
rgnature
&SSCL."64-cx-
Print or Type Name
l 420 -&eC-1-7 re e �r
Mailing Address
'!S'f-1b/-►
City/State2ip
Telephone Number / Email Address
5Xk)
Date*
*Valid for one calendar year after signature*
Revised Jan. 2017

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122 Beech Tree Drive, Shiloh - D. Jeffries
Streets f Addresses
0 0.01 0.02 0.04 km
Streets parcels
Source : Esri, Maxar, GeoEye, FaMstar Geog2phics, CNESlAirbus DS, USDq
-- - USGS, ZroGRID, IGN, and the GIS User Community
Main Roads a Esrl HERE, Garmin, (c) OpenStreetMap contributors, and the GIS user
County Boundary community
2021

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