Harvell, Cecil 84720C

D - ..ftIVEKAL PF.KMIT Date previous permit issued
P(Ne'w [-]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 NC AC � � ❑ Rules attached. ❑ General Permit Rules available at the following link: wvvw.deg.nc.gov/CAMArules
Applicant Name
Address+�q 4�
City ll, i _'k 1
Phone #
Email
Affected ❑ CW
AEC(s): ❑ OEA
ORW: yes/ o
���XW PTA
���❑ IHA W
PNA: yes/
Type of Project/ Activity
Shoreline Length
Access Length
Pier (dock) length.
Fixed Platform(s)
Floating Platform(s) ^^^
Finger pier(s)
Total Platform area �~
Groin length/#
Bulkhead/ Riprap length �---
Avg distance offshore""--
Breakwater/Sill`
Max distance/ length ~
Basin, channel
Cubic yards
Boat ramp
Boathouse/ oa ift i
Beach Bulldozing
Other
_r
SAV observed: yes o
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes o/
A building permit/zoning L permit may Perequ�
Permit Conditions a 0 LA3\die%
by:
ZIP
Authorized Agent I V JLA i
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City _ 1' —
❑ ES ❑ PTS Adj. Wtr. Body _
❑ SPIMA ❑ PWS Closest Maj. Wtr.
(Scale:JA)
f
i ❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back

'p.-pE COASr41 c�CAMA ❑ DREDGE & FILL 9 84720 t A B 0 1)
erm
y 3 GENERAL PERMIT D to previous ipermit issued
XNew ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the S y
to of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC , I Q 10 ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name l,:
Address
City
Phone #
Email
Affected ❑ eW
AEC(s): ❑ OEA
ORW: yes/ o
X E W PTA
❑�VIHA UW
PNA: yes/(Cer`
Type of Project/ Activity
Shoreline Length(j
Access Length
Pier (dock) length
Fixed Platform(s) _—
Floating Platform(s) '—
L
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore-
Breakwater/Sill "
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ oa lift i
Beach Bulldozing
Other
SAV observed: yes o
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes o
A building permit/zoning permit may e re(
Permit Conditions
Application Feels)
by:
ZIP
❑ ES ❑ PTS
❑ SPIMA ❑ PWS
Authorized Agent
Project Location (County):
Street Address/State R ad/Lot #(s)
Subdivision
City
Adj. Wtr. Body
Closest Maj. Wtr. Body
(Scale: I
Y-1
1 �(Zp' J J
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back

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)
IV
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 MITHORIZATION FORM FOR PERMIT APPLICATIONS
(Name of Property Owner Applying for Permit: C ec,<O UarvLe,."
Mailing address: Qyk,-j Z. y
Telephone Number: Z 52. - 2 y I - FL585-
I certify that I have authorized CAA !Sk%'25(agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all LAMA permits
necessary for the proposed development of
C' 7":&.A-
at my property located at -1 ti-Lwv 2 �JewQJc� ,� Z'WS 7o
This certification is valid through
(Property Owner Information)
�L,7 G ` .=v__- ..
Signature
Print or Type Name
Title, co. otener or trustee for properly
I Le
Date
Z�Z) 2,41
Telephone Number
Email Address
a ([(K,( , 6 ,0
(date).
RECEIVED
OCT 028 2021
DCM-MHO CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to C2c o ` \� aC vel 's
(Name of Property Owner)
property located atliq-1 WAQ ,T 2-� , ,yc&AJQQC-A- �Aic ZirS"70
(Address, Lot, Block, Road, etc.)
on &%x. in ,,.)cw d- / C�N.C.
(Waterbody) City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
X_ 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)
/ `'sue WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 do not wish to waive the 15' setback requirement.
Owner infon'na Ion) ----
lt� �/
Signa Mcc
'-
Print or Type e
6 CT
.�'i
Mailing A� r s i �—
City/State/Zip
Telephones Gtumber
Date
(Adjacent Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/Stateaip
Telephone Number RECEIVED
Date OCT 4 8 2021
(Revised ,- 2 Y T9) I `v

I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to c9c t ` \. Qc ve l ` 's
(Flame of Property Owner)
property located at ,� y'� j-1,u, v ?--I N) c pork � j <_ Z'kS "7o
(Address, Lot, Block, Road, etc.)
on 6Q% e SouvJC , in _ A Jcw CA+- / C-w
(1Naterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location,
1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development insist fill in description below or attach a site drawing)
T WAIVER SECTION
i understand that a pier, dock, mooring pilings, 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 do not wish to waive the 15' setback requirement.
t ph�� um �'
T®—
Date
(Adjacent Property Owner Information)
Signature
Print or Type Name
Mailing Address
Ciiy/State2ip
Telephone !Number
Date
PIFCF
RIF
OCT 0 8 U21
(Revised 6118/2012)
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