86172A_Foster, Jeffrey & Angela_20211115

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0(O"F441 �CAMA ❑ DREDGE & FILL 0 \ ` `- ®g c °
Previous permit 913 A
s .= GENERAL PERMIT Date previous permit issued. 6- IV';L,
JNew ❑ 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 Q _ ❑ Rules attached. General Permit Rules available at the following link: www.dgq,nc.2ov/CAMAruIes
Applicant Name
Address E_ LY I *X 7% i
City _ ---- State �_--------, ZIP
Phone # ( ^ =C
Email Z5,F
c2a�r V 0
Authorized Agent _-_AC.f_i!�—_— _—_
Project Location (County): '
Street Address/State Road/Lot #(s)Y-X6__&X-
Subdivision _&xr _4Fs ft 4e s
City _ PN01At.0 K ZIP
Affected ❑ CW VEW VPTA ❑ ES ❑ PTS Adj. Wtr. Body /` r f 1�11iG �__(na an/unk)
AEC(s): /❑ OEA ❑ IHA ❑ UW ❑ SPIMA ElPWS Closest Maj. Wtr. Body _ (1� t tf.'t SJi/M
ORW: yes/tto J PNA: yese
Type of Project/ Activity A!v QL6'X I!' 0,_+ ►s St- + 42i,GJ Z/'k r )-otxr
T;e e 1 (Scalers )
Shoreline Length
Access Length
Pier(dock)length r{ At�h�%otiLtcj i(e `C"es
y�
Fixed PlIalorm((sl r �`�i r \\ Ctnik.4' s ( �olt�• It(,6� S� ri
Floating Plafform(s) ry( ?;e
Finger pier(s) �3�(� r�q
J t� -r\Total Platform area y� �� AG`Thort LGC WX eO-L-V tw CLOWC)
—6rem•la %*Oi6_ t J 4 6 r P�
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
r
d(�°
►{�
�1
Max distance/ length
Basin, channel (� ��ot, C j ae
Cubic yards��e
Boat ramp
Boathouse Boatlift
( tl'
Beach Bulldozing
p
Other ck 1. e
SAV observed: yes
Moratorium: n/a yes no
Site Photos: ye no St,erSky s�J>-
�5
Riparian Waiver Attached: yes no Q top I
k
?rot
�
A building permit/zoning permit maybe required by: (7_t_ i r �(j
C",i,_ V�__�
�
Permit Conditions LJ—�A1_� }i�I, dock: ^C�s
T
SL_AA---
w; ,: I S'. .�_�! 7J • . e _ash ex "e'y —
/
,',C-P
❑ 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)_
.'r, e
Agent o"pplc.nMTEDName Permit Officer's RINTED to
Signature "Please read compliance statement on back of permit" Signature
--- a6 ,e )I- is
A Ii(Ttion Feels) Check q/Money Order Issuing Date Expiration Date

AGENT AUTHORIZATION F
Name of Property Owner Requesting Permit.
T
Mailing Address: X
Phone Number*.
Email Address,
I certify that I have authorized
to act on my behalf, for the purpose of applying for and
obtaining all CAtAP pQcrosts
necessary for the following proposed de,4e\apme1'\t-
at my property located a
I-
f -County. fact grant perMISSiO' to
in t rant, and do in 0 eater
that / am authorized to gra, , nd their agents t
I furl
herMore certifY t) aff, the Local perro��Qf'ge� rrnat,on rei'lled to this
F coastal Management st n'ection with o
Division 0' ntioned lands in connection
on the
aforerne
permit ppjicati0n,
property owner Information:

13
g�ent's r�ast�e �.
"Qent's Email
ADJACENT RIPARIAN PROPERTY OWNER'S CIERTjr-lC ➢4 s'i
(Bottum 2miu i s de cos sslct by tam P its '
_
i '`leFe L £ 'Itv that I own property aac l;lCent to the above reterencer4 pr perti
err- t haai Jes-: rhbed to me, as shown on the attached drawinq, the
descrri to o dras_r,�in th mush �,e�rculded..�v �h this setts~.
s CEO N t have objecttons to this pr opor.al, t 7: have abjec',; r':
Bf~eta }tare crc► tei s tv w>t t is tieing proposed, you MUst 170fify the�rt,sf r u DZV`
Management ( M) in wriVna within 90 clays of receipt of this notice. Ccrres orolersce should be
t7jaiied tee jol S. Griffir St., Sze, 300. Elizabeth city, NC, 27109, DC,,represent itivas kan also
^orracted at i252,' 264-•3s.00", sVo i'etsponse is co,,Isiclered tije same aS rc,4 cbjec Nor; ."" t -r ;`l� • � i'�*:'•
notified by certified Mail.
WAIVER S G f30N
understand that any prcposeci Pier, dark, mooring pilings, boat ra nt?
rain must be sel bacK ,a r lnlrnurn distance of 15 fsorii m& afea of r§Pana esS of , 5' 4ai s c,
this does not 3}J ii' ' to bulk tle dS or r='.p rap r="tettT': t Li i 5`
the appropriate wank below.
%)(-sh tc, waive someiail of the , , sett ac--,
Signature t 3 A,,j,,acer t P,,Icarail ' 3 - £-r
o not wish to waive the 15` setback: requirement i4iittas t..
tAdjacent ipar a>r : °�v 'e
I
ARPO' email: ARPO's PhoneW�.�
Date: 'waiver is valid for up to one year from PO's

Na~, Of Plopefiv
Addre,4.1; of Pr-0E-rtY ILI',
,Vafling Add ss of C)Nwwr,
0%vrx-Cs PM'Alt Phof)e
7,/ - — - ------
Agent's Narrie Agent
IY
Agent's Email
e- I
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
{Bottom portion to be completed by the Ad'acent 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
descn' tion or draMangALth dimensions, must rqyidLed with thLs letter,
I DO NOT have objections to this proposal, 1 DO have objections to this proposal
-objections to -7Wh--at ii-ti—ei—n—g proposed, you must �tt N.C.ej �Jvision--6—fCoa-stil
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, 279,09, CC, representatives can also be
contactea at [phone], Ato response is considered t97e sarne as no objection if you have been
notified by Certified Mail,
WAIVER SECTION
i understand that any proposed pier, dock, mooring pilings, boat rarnp, breaKwalef, boathouse 5ft. or
groin must be set back a minimum distance of 15, from my area of riparian access unless waived t1i rr,,,e
(this does not apply to bulkheads or nprap revelments). (if you wish to waive the setback, you nj!Ad sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent 54pariar Property Owner
i do not wish to waive the 15'setback requirement (initial the blank)
A - ;
Signature of Adjacent Riparian property owner'.
TypodlPfinted name of ARPQ'
Mailing Address of ARPO:
F-1 TZT.-10-WT--=
A-11
x
r
ARPO's Phone#,

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