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KCAMA W DREDGE & FILL NQ 86414 ® B C D
GENERAL PERMIT Previous permit
Date previous permit issued
UgNew ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission In an arm of environmental concern pursuant to:
I SA NCAC _ 'IN- 1100 j Rules attached. �f General Permit Rules available at the following fink.- y02W dea.n4,gav/CAMArules
Applicant Name E'r j'K a VN,61� In et C,,Vse— ' Authorized Agent _�i-t, A
Address 9 ei� J YYta �� �T. _ Project Location (Couruyr �rICL-TtU A n-ic
City State UC. ZIP -7Cf 0q Street Address/State Roact/tot #(s)
Phone # (3c�) JQ — _ 3S3 4xa srm ki ') f
Email �r1_ 'MO, �ICa/h Subdivision �k'�x3�rtPci
city t a. �' G zlP
Affected n CW NEW ® PTA ES ® Pfs Adj. wtr Body W 3 ll __ rV ra man/unk)
AEC(s): j7t OEA E] IHA t _J UW sPIMA ❑ PWS Closest Mal. Wtr: Body
ORW: no PNA: yes ro (�
Type of Project/ Activity yz� 11 t `%5{ W K ke d _q
Shorellne Length }�" 1% S / (Scale.
Access length !
-T�
Pier (dock) length-
FixedPlatform(s) �' + +_._ _n_F".'-.-. a� ' *-i i�`?_._T ` _. _.a...._ ,
,
-.L-4 1 . i I r
Floating Platform(s)
1 r
Finger Pier(s) i I !
Total Platform area -i�.�_�'._*-�
•-----s.R_ ,� . - r j
Groin len #A. { ! { rLJ
t ti Riprap length i i i-,
-SPX
r
Avg distance offshore
Breakwater/Sill - i---i
r t , r r I � ` i 1 1 r � . ! 'i "�"!- �-- L,•-BV.rJ^ -
Max distance/ length t-- -• -.� f ?--i -+--.4 _ �.,
Basin, channel ;-' t !_ :-,-1-,-i-•-� -•� ' 1Ti..,.._:. Qf, j
r r
Cubic yards , i r-r"�•`--yr---i +-� i r -, -: i ._�+__•.
Boat ramp"-
�,.
Boathouse/ Boatlift { i ' ' 1 I - - r -•�-
Beach Bulldozing ;
I i + I i 1 i 1 _. _
Other ., I Trt - _,_�._!_ - '-T__e
1 A;;,
SAVobserved:yes -p+Moratorium: _yesna
Site Photos:
—
-2-�-'� a
no
Riparian Waiver Attached: yes
A building permit/zoning permit may be required by: r
Permit Conditions TARMAMINEUSE/BUFFER (circle one)
_..... _ _ See note on back regarding River Basin rules
USee additional notes/conditions on back
I AM AWARE OF STATUTES CRC RULES AND THAT APPLY THIS PROJECT AND REVIEWED COMPLIANCE StTTXrIEMENT (Please Initial)
jAgen�,tAppl)cantPRIN mePermit r' PRINTED Name
"Ple se a m liance statement on back of permit'* Signature
3
Application reels) Check ti/Money Order Issuing Date Expiration Date
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: EMI IC t KptS-n E �ttJ�,�nt P�AG tI
Mailing Address: '9Z SMal,tr DP-,
EL�Z�.�,E?►-t- C sry �tC a`I�o 5
Phone Number:
Email Address:Q,Y
certify that I have authorized C AP --Ito
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
I fJST-7\LL- kPPjeo L I`IG r ol., \4flr\IL i3uuv-[ACA0
at my property located at_ Q ab sMNL-t, -D9-
in _'t�GUoT A1Sl�County
l furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property 0 ne n rmation:
Signature
Print or Type Name
I�Uq_ s353
Title
Date
This certification is valid through C)LI l�_/
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
— r9t'
I hereby certify that I own property adjacent to �V /�1I( lPi TI i A� GiftJf-hAUtE(L. 's
n (Name of Property Owner)
property located at �� SI BALL R.
(Address, Lot, Blo Road, etc.)
on �Vjht a G.t twit—. in N.C.
(Waterbody) (Citywn and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
!15' V ny L {julkh-cad
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 waived by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I dq not wish to waive the 15' setback requirement.
Information)
Pri� a 7 yInuu teDK-.
Mailing Addres
City/State/Zip
��tr«tnb�Uh.c►- an �„��;1 .CGn�
Telephone Nu' mber / em ' address
/ t, I a- I
Date
*Valid for one calendar year after signature*
(Adjacent Property Owner Information)
IL--.,nQ
Signature *
ire{nie��R��bra 4KKi
Pri t or Ty e Name
1� grfloAlk.
Mai ing Adores
�Izahe +k w a179019
City/State/Zip
Telephone Number/email address
// f, /,;z- /
Date*
(Revised Aug. 2014)
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to �K �oRag7jy pha&(}� 's
n 1 CAI-LDR
Property located at "1 n (Name of Property Owner)_
(Address, Lot, Blo Road, etc,) _
on 1� �(Wate�rbody)
in , N.C.
(City/ wn and/or County}
The applica as described to me, as shown below, the development proposed at the above
location
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
)t164-tw AT*ro�-. Ir/5' Viny L &Ikhead
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 waived by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I ds not wish to waive the 15' setback requirement.
Intormationj
Pri t or Tye Name
a, ',S .a,r..t. 'DA-
Mailing Addres
Fl ,t"ti}efL� � ANC' � 71M
cityistate2tp
�i��,�z��tu,-Q a,►� ., . o�
Telephone Number/em ' address
Date
*Valid for one calendar year after signature*
(Adjacent Property Owner Information)
9?0 j
Telephone Number/ email address
2S 2 233 2-76V
Date*
(Revised Aug. 2014)
This map was created from historic snaps, recorded deeds and surveys.
It CAN NOT be used to convey land. settle land disputes or build fences.
Pasquotank County. NC
Parcel ID: 894104713524
Map: P1278.27
LOT: 0
02-b
00000 SMALL DRIVE
Eto K LAu4EtJ6►,catER
&-WE-f# r->3 q art 5n&AU- t7t2 .
ELIZ.C'*y. 21go9
Deed Book. 1215
Deed Page: 665
Date: 20141126
Land Value: 155000
Ag Value: 0
Bldg Value: 0
Total Value: 155000
Taxed Acres: 0.719
>fa
Date: W2;2021
Property Ownershipi
Lines as of July 1. 2021
c:i aZ-6 5r, a tt 'fir.
Pasquotank County NC
November 8, 2021 W S , rnmS 1:564
i\6rv��Jij
0 0.01 0.01 0.02 mi
w r,
0 0.01 0.01 0.03 km
;09 10 NC CGIA Maxai. Microsoft
MEMO- -.W-
Untitled Map Legend
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