86135A_Morrisette, Alexander & Heather_20211122

Otwrk [�ICAMA ElDREDGE & FILL N9 86135 A B C D
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GENERAL PERMIT Previous 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:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # (_ )
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale:
Shoreline Length
Access Length
Pier (dock) length f
Fixed Platform(s)
Floating Platform(s)
I
Finger pier(s)
Total Platform area
Groin length/#
'Bulkheadj Riprap length
Avg distance offshore
Breakwater/Sill
ax ista / length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing r
Other
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
Permit Conditions
t
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit" Signature
Application Fee(s) Check #/Money Order Issuing Date Expiration Date

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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTFIGATN M1'MIIAWER FORM
CERTiRED MAit_ RETURN RECEIPT REQ' TESTED k r w N7 DEPJERY
(Top portion to be Completed by owner or their agent)
Name of Property Owner d 1 •e v art rl o r- fl 10 r✓i se 49----
Address of Property o!; I I L5r Aj\j- is cA '
Mailing Address of Owner: 34L G G4-} Orcl W 4.►/�- C1 C —2IftIO
o `�
Os email rV%0 r+< k t
wners Monet "1 (fi — 'T A30 ' 4410S7
Agent 5 Name Ph
AA15 -' Agent ones ZS 2 - z0'7 -day z�
jj��1 )
Agent's Email V Q G U1 E?u 1 F hec tAs �j � M r. I
ADJACENT RIPARIAN PROPERTY ONMEWS 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 indrvidual applying for this
Dermrt has described to me, as shown on the attached dravnng. the development they are proposing A
deSCr:DUOn or drawing wrin dimensions must De provided wan this letter
� c-- t 00 NOT have o"ecl*M to tits proposal- : DO t-.ave OOPearOns to tsar proPo"
if you have objections to what is being proposed you must notify the N C. DiWs)on 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 [phone]. No response is considered me same as no objection if you nave been
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed pier doer mooruNpdings boat ramp breakwater boathouse 14, or
groin must be set back a rrunimum distance of 1 S from (try area of riparian access unless waived by me
(thus does not apply to bulkheads or np(ap revetments). (If you wish to waive the setback you must sign
the appropriate blank below)
I DO wish to waive somefafi of ttre 15' setback
Signature of Ad),acent Riparian Property Owner
OR -
I do trot wish to waive the 15' setback requirement (Initial the blank)
Signature of Adjacent Riparian Property Owner
r �
TypedrPrinted name of ARPO: /I '`'"A.,d Z'.
Mailing Address of ARPO: ,Sy{Q,;+
► ySj ip G-►-
ARPO•s Mllait a '.('r tARPO's Phanert
pale- .«--'-"=`�� "waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

c
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: H 1-Q�,t CU1rl p r YVI 066Se 4
Address of Property:
Mailing Address of Owner: NCJ::L 'ct W 1 - riC
Owner's email:
Agent's Name:
Agent's Email:
1I
Go"k
rYlo Crl %e4-e ,M l- Owner's Phone#: l �i - Cl 30 %OS'
-}OS -►►�� Agent Phone#: ZS Z - Z?6 7 -(fl i Z(p
',I-C
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent 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.
✓ 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 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. 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 acent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: ?C 4na"}- Ju.�,►cc.�_
Typed/Printed name of ARPO: /ny¢4MI5 i 1 -rtje 16c
Mailing Address of ARPO: GVkt,,L' L:,+/v77>lIy 3611
ARPO's email: A27 -Ty ;� aq ARPO's Phone#: `7y all �G
Date: tzw *waiver is valid for up to one year from ARPO's Signature`
Revised May 2021

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