E P Properties 84847C

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GENERAL PERMIT Previous permit
Date previous permit issued
ew [] Modification ❑ Complete Reissue [-]Partial Reissue
As author] ed by the State of Nortb Carolina,
, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC 4._�_ z�/ 4� n Rules attached. neral Permit Rules available at the following link: vyww.deq,n���
Applicant Name .Lr� rr Addressr-�
City N Stat (--zip �
Phone # AM `R
Email
Authorized Agent C�
Project Location (County): _,,...
Stl'eet Addi'ess/State Road/Lot # ,,I ,
Subdivision
City ZiP�._
Affected [I CW - W PTA ❑ ES ❑ PTS Ad). Wtr. Body
AEC(s): ❑ OEA ❑ IHA [� UW $PIMA ❑ PWs Closest Mai. Wtr. Body
Type of project/ Activity
Access Length f { f�49
Pier (dock) length _ m f. ~ f(
Fixed Platform(s) _
FloatingPlatform(s) µx
Finger pier(s) _
Total Platform area
Groin length/N
Bulkhead/ Riprap length I_
Avg distance offshore
Breakwater/Sill
Max distance/ length _
Basin, channel
Cubic yards...._.....----..._�___.._..._..__-.
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed:
Moratorium: n/a
Site Photos:
Riparian Waiver Attached:
A building permit/zJo� I
Permit Conditions
N
yes ler'qui
'
yes
yes
yes
it rgayrFd by:
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i AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REV
Agen rApplicantPRINTED
�Narn Tp Permit
Sig **Please r ad c pliance ment on b k of permit** Sign
�_
Apl ication Feels) Cheek N/Money Order Issuing
Date
s l ❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please I

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ti
i 3 GENERAL PERMIT Previous permit
Date previous permit issued
ew ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authori ed by!the State of No Carolina,
Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC � [_j:a=L/ V ❑ Rules attached. r�h eral Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Address ij
Email
Subdivision
City ZIP
n
Affected ❑ CW W PTA ❑ ES ❑ PTS Adj. Wtr. Body � nat/ an/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/0 PNA: ye no
Type of Project/ Activity /V / C
�, " ✓ (Scale: )
Shoreline Length
Access Length ' Ls/
Pier (dock) length
Fixed Platform(s)
Floating Platforms)--- - LL- �-
(jam
Finger pier(s)
Total Platform area -
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore < — T-
Breakwater/Sill /� �� ��
Max distance/ length /.� Cyr ej�
Basin, channel /✓ :L N
Cubic yards > > y
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes
Moratorium: n/a yes o/
Site Photos: yes
Riparian Waiver Attached: yes
A building permit/zo ' pe it ay e r quirt d by: �v`7
Permit Conditions ! f- ' 1 G I ` d CI e � i�/� ❑ TAR/PAM/NEUSE/BUFFER (circle one)
Ji% v t U ce ✓t ❑ See note on back regarding River Basin rules
J C �� , ❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEVq OMPLIANCE S ATE ENT. (Please Initial-
Agent or Applicant PRINTED Name Permit O 'ce 's INTED Name
Sig **Please pd Compliance statement on back of permit** Sig tuf'V
J
Ap ication Feels) /1 �� Check #/Money Order IssuilnDate Expiration ate

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 F-1u 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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLtPATION
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Name of Property Owner Requesting Permit: _ u '� 1� C7� .1Q��1� VD
Mailing Address:
Phone number:`
Email Address: o C
I certify that I have authorized
Agent 1 Contractor
to act on my behalf, for the purpose of applying for and obtaining ail CAMA permits
necessary for the following proposed development:
at my property located at
in County.
t furthermore certify that t 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
-4AC4 il --), '-Ctn 4iSOr�
Print or Type Name
Title
� \ _ 1 \ (3 l-1\_
Date
This certification is valid through t 1

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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONANAIVER FORM
CERTIFIED MAIL . RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner. Jt_, _ Utt s ri� �L'.. \
Address of Property:
Mailing Address of Owner.
Owner's email: tr cc��o Owner's Phone#: 1L ME T IZ5 t` A
Agent's Name: �L1Tit�_45 Agent
Agent's Email: to
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed bu the Adjacent Properjy,Owner}
i hereby certify that 1 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 90 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 somelall of the 15' setback
Signature of Adjacent Riparian Property Owner
-OR- F�A
1 do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
—
Brad Haste 8509EIVWC4C7...
Typed/Printed name of ARPO:
Mailing Address of ARPO: 295 Wilmington Hwy 7acksonville, NC 28540
ARPO's email:
[e-mail] ARPO's Phone#: [phone]
10/26/2021
Date: *waiver is valid for up to one year frorrr ARPO's Signature*
Revised May 2021

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