Riewestahl, Michael 84102C

Previous permit
A GENERAL PERMIT Date previous permit issued
(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 environmental concern pursuant to:
i SA NCAC Rules attached. 0General Permit Rules available at the following link: v;dleq.nc.I;oviCA Arul
Applicant Name " Authorized Agent 4' ,< a-i r
AddressProject Location (County):
City State ZIP Street Address/State RoadiLot #(s) Xf n
Phone # ( }
Email
. Subdivhkin,�___�„LL___
Affected f-11 CW
AEC(s): Q OEA
ORW: ve no
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E]SPIMA
0 PTS
El PWS
City~
Adj. Wt� t i
Closest Maj. Wtr. Body
Type of Project/ Activity'41. C3k,0C-1—'[)Q
(Scale/ % l
Shoreline Length=
Access Length
. a
Pier {dock) length 7)x�-
Fixed Platform sr� e ra !Ay
Floating Platforms)
Finger piers}
Total Platform area
Groin length/#
"
Bulkhead/ Riprap length
Avg distance offshore
'
Breakwater/Sill
Max distance/ length
,»
Basin, channel
Cubicyards
f
Boat ramp
Boathouse/ Boatlift
Beach Sul o 'n
"
`
other T
p,
SAVobserved: yes no
Moratorium; n/a yes no _
Site Photos: yes no jfi
Riparian Waiver Attached: yes no k�y� f4e-
A building permit/zonin permQ may be required Co
Permit ition Wei M _ TAR/PA ondM EUSE UFFER (circle one)
See note on back regarding River Basin rules
4
See additional notes/conditions on back
I AM AWARE OF STATUTE$, CRC RULES AND CONDITIONS THAT APPLY To THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
"*Pleaa read * ompllance statement on back of permit* Signaturej
Jns
Application Feels) Checks /Money Order iss ng ate Ex irati n Date

30�0`°"'N tACAMA ❑ DREDGE & FILL N9 84102 A B CAD
Previous permit
GENERAL PERMIT Date previous permit issued
>rNew ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State /ofnNo/hC
North Carolina, men Clina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC u • I /J c ❑ Rules attached. g General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
ORW: ye no ✓
Type of Project/ Activity
PNA:
Closest Maj. Wtr. Body
Shoreline Length 1 f2
Access Length
Pier (dock) length 5, � � K i V 24 sue-
Fixed Platform s)
62
Floating Platform(s)
(
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill r
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bul o�j'n } �
Other c'C I/)t gr f Ii S
SAV observed:
Moratorium: n/a
Site Photos:
Riparian Waiver Attached:
A building permit/zonin I
Permit Conditions J Vn
I AM AWARE OF STATUTE$, CRC RULES AND CONDITIONS THAT APPLY TO THIS
Igenl or Applicant PRINTED Name
Sig ture **Pleas read compliance statement on back of permit**
0 7A'
Application Fee(s) Check /Money Order
K eL,�. 14 I
N
(Scale: )
.4v
See note on back regarding River Basin rules
See additional notes/conditions on back
AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Permit . er's P INT Name
Sign ure n
Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit conditions. Any violation of these terms may
subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for
compliance. The applicant certifies by signing this permit that: 1) prior to undertaking any activities authorized by this
permit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the
local land use plan and all local ordinances, and 2) a written statement from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
1-1 Tar - Pamlico River Basin Buffer Rules 1-1 Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules
for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the
NC Division of Water Resources. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST Fax: [phone]
(Serves: Carteret, Craven — south of the Neuse River, Onslow
Counties)
Elizabeth City District
401 S. Griffin St. Ste. 300
Elizabeth City, NC 27909
252-264-3901
(Serves: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford,
Pasquotank and Perquimans Counties)
Washington District
943 Washington Square Mall Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Craven — north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

Jul 1421, 12:10p
p.3
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: PAj C1,11t✓1 Kjt;-W1 4 L)eJ®re. 1tLk3e--)fah 1
Mailing Address: �5 1-0D Q.!`) GroVo- C- UU tc� P�o�
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Phone Number: q (G - y as - 3-�)a S
Email Address: (//1')Kr+�+�es-ahl �grrlcu l mom
I certifythat I have authorized Ln,f-
L-Sz-'T 24._ 3 22 f ' Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: �P h� ,�" lcylt ;0
C(-io' ho s-%} a&U; 4" , 7y X3Z` t4�ke-ij'`6
at my property located at C 1(4 MC)C) re,,, ,rum �rj 11 a0° tt InCk , N L
in O Qutev-� County.
1 furthermore certify that 1 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 Owner Information:
Signature
mrchaei K 91A-k '�E;
Print or Type Name
Title
I Iy f �aa k
©ate
This certification is valid through ! i /' i Z-J)%/ RECEIVED
SEP 0 9 2rj
01 —j� `HD CITY

Jul 1421, 12:10p
p.2
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • R rI tRN IPT REQ tl, FS�'D or HAND DELIVERY
IVERY
(Top portion to be completed by own er or their agent)
Name of Property Owner; 1, 11 y -�a -�) wen4aki
Address of Property: iyt7r^ rn� r n a ( 14.QjP.(C&DL
Mailing Address of owner: �j(�Lj � �t p fry -� Rk�Ana i A)c- 0-7S d I
Owner's email: IY1KY i :+ } 1 dDo naL r�nOwner's Phone#: Q f QI - 4�a - 33� a�
Agerrt's Name: 01ts mQe-)*&[, /<U Agent Phone#: ,Llrn - 21-5 3
Agent's Email: bbtyic -71 Fd ��Jrnaj, 60yy)
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be completed by the Adjlacent Prouerty Owner)
I hereby certifythat I own property adjacent to theabove referenced property. The individual applying forthis
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. 100 have objections to this proposal.
r`L 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
rnalled to 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection if you have been notified by
CeMf7ed 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 ordprap revetments). (tf you wish to waive the setback, you must sign
the appropriate blank below.)
I Do wish to waive some/all of the 15' setback
-OR-
Signature of Adjacent Riparian Property Owner
do no ' ish to waiv he 15' s"tack re iremept�(ini iai lie blank) I3. S .
Signature of Adjacent Riparian Property owner:
Typed/Printed name of ARPO:1t-�
Mailing Address of ARPO: _ -1 YYI,—,Y--n4,, u n Yh �` �`l L �,� 0 41 �5 �
ARPO's email: \j i +�O n� RPO's Phone4: - G e,7-�51 Zt
Date: 'waiver is valid for up to one year from ARPO's Signature*
Revised May 2021
RECEIVED
SEP 0 9 2021
DCM-MHD CITY

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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by)\LJ_e owner or their agent)
Name of Property Owner: 40 � \C,Y1 u � I ` -k Vo(,�
Address of Property: i 'A' iyoGfe� (--,5ot'n li ��v-t iaJ_1, t')C a
Mailing Address of Owner:S*U© ©(ate L-tV-f. C,Iht.Lc,�) M.- Atr1C1 I-er C L9­ 7
Owner's email: & A rActI � , c b.,,t `rOwner's Phone#:
Agent's Name V,lo &nkS `n1�AnWA I �nS1. Agent Phone#: %M �Sd '� 4� o
Agent's Email: W-rvC—1 \ e- (Z 0--1
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent 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 or drawing, with dimensions, must be provided with this letter.
�9 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 400 Commerce Ave., Morehead City, NC 28557. 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.)
I DO wish to waive some/all of the 15' setback
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:
Typed/Printed name of ARPO: \-0[► cL-1'/P10.h 1MvM► 0tC h Ar p�
Mailing Address of ARP, �2.� rE cker cre& �hCj 4tyckc e, We 2�p`2
J✓2,
ARPO's email: V o►')I/)du'►'!Ir%a ��9"'t1f4 ARPO's Phone#: �d IfJi�— ✓ J/�
Date: �' �2v �Z� *waiver is valid for up to one year from ARPO's Signature*
DECEIVE© Revised May 2021
SEP 0 9 2021
0C M-MHD CITY

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