86420A_rown, Lavery & Mark; Nikodem, Susanne_20211119

KCAMA ❑ DREDGE & FILL R E COVED N9 86420 �C� C3 B C o
iffGENERAL PERMIT Nov 2 z 10 DM previous permit issued
iglNew ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As akrtirorccad by the State of North Carolina, DI>imrtrmslt of Fmrkomrtend QmNry and tMtrnna
ia+ in an area of.minolr,rerrnl ewicar„ pursuant w:
I SA NC-X '7 i� • i 0 ❑ Rues attached. ado avaYoble at this iollwi g link
AppuorttName ��tV� T4 C WICW &%ion /Sttr7anne �J�Kcte_,�_Audror>adggwtc
Addres i Project Location (County): Q r ©r t i S a n
City swe Ve. zip 2' 452 Suva AddrewritaeeReadl,*#(s) $7
Phone#( _�l9b ' 2771 10(o Pei i catty
&nall V%Vo&.%-br\ Ila.24 @ WVkl&Vl .Subd WW- SM,re.3 karjan,, e-,
C14, IkA-Asrd S ZIP 2'19'1�1
Affected p CW ® Ew ® PTA ❑ Es ❑ PTs A4• Wtr. Body L� /e�� �s hmk)
AEgs): 0 m ❑ IHA Eluw ❑SPIMA ❑ f41v5 M* Wb- Body f F t"Q. F-10 •301. './
ORW: PNA yess
lope Of Project/ ACti V C6CX�r x ' er W// tar &T"erj 4
(Scale: t P (d )
shoreeune LengthLength
1_ I I + + I I t ' 1_ I ► I , � I `�1r+ + , I r ! I 1 1
Pier ��' �p ' '^ I \_ � __I - -- I—°
(dock) length >< 1 I 1 I 1 .1 °_ r, _;mow I 'ry , '�. -- f I—r _�t1—i—� . _ I
r r° k I� 1 I
Fated Platforms) XI 16 ' ; -'-t-� ,�,T ; s
FloatingPbdbrngs)
L..1 _ 1 , I , r J I 1 1 I 1 �_ ! _I ' , ) _ ' _!_ . � __,•___�-�-�- I ° I 1 I �- I-_+ , '
FkW piers)
I
Total Platform are M2g i_i'f-0. I
{
t 1 1 I J�►"t^�
C,rDhllertgtll/$ ems-'
Bulkhead/ Riprap lengthAvg
distance offshore -k I
Breakwater/Sill
Max distance/ length
r_I-�j•_�^�" r 1 ' -r•-�-�
Basin, channel
I _ I
Cubicyards "' I T
Boat rampT-
Boatl......../ B \ 1 I t I 1 1 _�- ICI I ! 1 f - , +- f 1.-I + 1 1.__., _� I _ •.1
"`+�`+'eJ'+�/
SeacilElu ;_Y�.y I_..�._;-_ I 1 1 , 1 �. •-�-i
Other •� I ! 1.. 1- ' 1_! ' 1 1 'AWAY 5%
-_• I' , r 'I i 7 I ; I- ° I 1 ,_ 1
l_ _ 1
J. I __ 1
yes
Maratodum: rt/la.� �1f•(�� i 1 I 1'_, I
+-Le I' 'j 1 I 1 i I i- I� + ; 1
Site Photos: no -T �'�'- - r ! - r-'- �--r-e-f-�- 1�'_ I 1 It
Rlparien WaKwAttached: yes ! T I L _ .! _I Y _ 1 . 1 I
Abu ldhig permit zoning permtit may he required by �8lh 0 it in.��i Co.., hj..
Permit Condltkm ❑ T (drd. one)
See now on back regar!#ng Rhwr Basin rules
See additional notes/condklons on back
I AM AWARE OF MnM CRC RULES AND COP MIM Tully APPLY TO THIS PROIWr AND RENEWED COMPI.0 M SIATEMEIrr. (Pease Initial)
ricarrt Permit Nis
Please red complienegOtement on back of Permit • ,re w
01 „1.IA 'r /> i► r ... 'K4
l
� iration Date
Application Fee(s) check R/MoMw a I+ing Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Re
Mailing Address:
Phone Number:
Email Address:
q
G�p
uestinLA9 Permit: � o- olde-f
VI
�n
zjL- 96-,57 /
I certify that I have authorized / (4 1 C4 Ij t
Agent / Co
to act on my behalf, for the purpose of applying for and obtain' g ,all CA
AMA permits
necessary for the following proposed development:C/
J �L
at my ropert�a located at 6
in County.
I furthermore certify that I 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.
Propert caner I rmation: I ,-)
' $ pature��
V e (J f
_3 10 �
Print or T e Name
Title
l l
Date
This certification is valid through / I

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top 1� p rtion to be completed by owner or their agent)
Name of Property Owner: (fitL6 6-A-1&�' 1
Address of Property:
C—
Mailing Address of Owner: 34:T 1 /�-���%Q��Ld&&s'- '� V /f 3YSoD
Owner's emaiLb►'G1C(1owY @ yEr/ zM,�W er's Phone#: ��s7 ,I 1 � / F/
Agent's Name:
Agent's Email:
Agent Phone#:
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 Adjacent Riparian Property Owner
Ee-psa
I do not wish to waive the 15' setback requirement (initial the blan
Signature of Adjacent Riparian Property Owner;
,,/I v
Typed/Printed name of ARPO: lyaue tP Q Aano \� , V\-LR-,� �� L N�
Mailing Address of ARPO: 109
APC
aiy"r
ARPO's email: Y114S an of emd awnARPO's Phone#: o
Cam
Date: .-V --7- o Z1 *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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0.00 L=58.43'-
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LF T=33.07' a,,

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent) �/ KZd"VIUName of Property Owner:LYR�8 "(
Address of Pro bi d �c t a9 7yy
Mailing Address of Owner. F&a kulml ��� � �► T �� (Sod
Owner's ema
Agent's Name:
Agent's Email:
Phone#:
Agent Phone#:
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.
ff 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 N 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.) j ,
I DO wish to waive some/all of the 15' setback
Signature Adja nt iparian Property Owner
-0R-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner.
Typed/Printed name of ARPO: Yn 1J q- s- Q Yi`f-/l 1 u%
Mailing Address of ARPO:
ARPO's email:
ARPO's Phone#:
-xl
57
Date: dCt i �. Aoa -waiver is valid for up to one year from ARPO's Signature`
V/� d3Y �
Revised July 2021

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11 /19/2021, 9:23:54 AM
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Perquimans GIS
Address Points perquimans_nc__ easement Imagery 2020
1:1,128
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Green: Green
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p q _ _ E Blue: Blue IN� REMENT P, usGS. EPA
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