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Home My WebLink About86437A_Southern Shores Civic Association_20211210CAMA U DREDGE & FILL `F � 8643 f Ate` B c D V • Q4 tt3.kilid x ' 1 r1 Previous permit " GENERAL PERMIT Date previous permit issued 'kNew ❑ Modification ❑ Complete Reissue ❑ Partial Reissue As authorized J�y 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 A • Rules attached. u General Permit Rules available at the following link: www.deg.nc.gov/CAMArtiles Applicant Namer� �C' i,1.. 1 X ii 4D iii c ✓t"J C1 d i C_ ��`7j C . Authorized Agent L iAM Address `1 }� 11(fa/i Yi i %Z.. iJ (,�ii CV4id Project Location (County)- G�+ City J�oy151'A Vitate � N e- ZIP_ 2 " Street Address/State Road/Lot #(s) tt _ Phone #( ) (,I-r2"NPn_-+ 5 k1 Email f�_)QVi Subdivision City - �j' , �•tri'it.� W ri 62'm IL%e -ZIP _ i �, Affected CW X11EW XI PTA ES OPTS Adi.Wtr.Body. lavvI I'(.,Lck .dLrC,� _ek*+anfunk) AEC(s). OEA IHA ❑ UW ❑ SPIMA ❑ PINS Closest Maj. Wtr. Body I L ✓ ✓t H t.lC ORW. ye. no PNA: ye no a t^ Type of Project/ Activity C c 4. , j 1 fc y A f }A,, � at I(-) V Avg *W- JinL k-e K, Q -11 —C ✓Al Ei J i X � `'5ef C ) iCA li (Scale: Shoreline Access Length `� _— 1� . , Pier (dock) length Awt, � s �® �tL��VIA :A �fixed Platform FloatingPiatform(s) ¢f ¢>( a o f,.1N 1J�u.tu'� Finger pier(s) �� Cwcuv>°v tal Platform a V K L Bulkhead/ Riprap length Avg distance offshore Breakwater/Sill } {) �f u j x4 ` C j{ Max distance/ length /`- 4 W, 90 cif A Basin, channel jJ Cubic yards _ Boat ramp i K/t � `a .4 �- -• Boathouse/ Boatlift Beach Bulldozing Oth t 44zO� Q9(.lJ� i if1G1 �i W(ti�1QC-1M' ��t SAV observed �� no Moratorium: n/a yes no `/� U ��•�} ,�` Site Photos: , e 3 no �. Riparian Waiver Attached:[yes',r� no A building permit/zoning permiCmay be required by' � �` ' Permit Conditions 1-.}- N-C LL TAWPAM(NEUSElBUFFER (circle one) �Lw I -_V' ySL�r t� �t T � M t� See note on back regarding River Basin rules tt --- __-!'S� See additional notes/conditions on back r — AWARE OF 5*TUTES, CRC RULES AND CONDI ION5 THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) _ Kee) ... _........ — 21U* zts_ U e- UU r Agen( 1 Applic; nt�PRI E Name Permit Ofjjcer's PRINTED Name ----- - - Signature "Please read compliance staternutt On back of permit" Signature OF Application Fee(s) Check #/Monf y Order Issuin Dal Expiration gate � AUI-- AU 111VKILAI-IVN t'LJK WWA M MI I At'.rW(:AI WN Name of Property Owner Requesting Permit: Southern Shores Civic Ass._ Mailing Address:5377 N. Virginia Dare Trail, Southern Shores, NC 27949 Phone Number: 252-261-8617 Email Address: jrnewton@eharternet 1 certify that I have authorized Lyn Small Inc Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: Installation of 8'x12' dock with stairs connected from bulkhead at 4'x7'. at my property located at 16A Kingfisher Trail, Southern Shores, NC 27949 in _Dare 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. Property Owner Information: 1 Signature J o � P' . NIG- 1-U>4 Print or Type Name Title N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY (Top portion to, be completed by owner or their agent) Name of Property Owner: Sat ►'1--*, skkyQS (2;V i C Asc. . Address of Property: l �� A Kin fy (I s ht& Tru i I - sott+h ►I GVv"e'5, rIG 2l9 4 4 Mailing Address of Owner: i55q ( Ji' "t nl a- DoAc-T► 4 • 1f'awK. ►JG 2llo Owner's email: 5�n>✓wton� '"Owner'sPhonai: 25�'a(►�-841� Agent's Name: Lyl Slhat �tt``� wl fie,(n C. Agent Phone#: Agent's Email, t5l rrArInf o �)(. CAV" ADJACENT RIPARIAN PROPERTY DINNER'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 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 (252) 264-3901. 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.) { DO wish to waive some/al{ of the 15' setback \ h /� -.,N� Signature of Adjacent Riparian Property Owner -OR- I do not wish to waive the 15' setback requirement (initial the blank) Signature of Adjacent Riparian Property Owner Typed/Printed name of ARPO: Mailing Address of ARPO: ARPO's email: ARPO's Phone#: Data: *waiver is valid for up to one year from ARPO's Signature* Revised July 2021 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: W �"U1 s4a-$ ci U, Ci Address of Property: m �f rl6sRjK 1 ao " sw�� A NL �?qql Mailing Address of Owner: 0 t t Vt ;iiti 0�Dime, TrAl ! -14 2?ggq Owner's email: S ( 1WJ4 P'rxW . rl6 t Owner's Phone#: .15of--oft [' S (e1T Agent's Name: Ltr5nwl IhL Agent Phone#: -qq�-�3 ' Agent's Email:Com 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 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 (252) 264-3901. 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 -O R- I do not wish to waive the 15' setback requirement (initial the blank) Signature of Adjacent Riparian Property Owner: Typed/Printed name of ARPO: th � G h� zrL6C-4, Mailing Address of ARPO: �� 'tn� EsW- ,�jUL Ktn 3 ,Qrts, 0C, ARPO's email: ARPO's Phone#: Date: waiver is valid for up to one year from ARPO's Signature* Revised July 2021 This map is prepared from data used for the V 0/ 7 inventory of the real property for tax .sae purposes. Primary information sources such as recorded deeds, plats, - wills, and other primary public records should be consulted for verification of the information contained in this map. 15 A Kingfisher TRL Southern Shores NC, 27949 Parcel: 029702954 Pin: 986805075722 EM i Owners: Southern Shores Civic Assoc Inc -Primary Owner Building Value: $0 Land Value: $3,200 Misc Value: $0 Total Value: $3,200 2 p r Tax District: Southern Shores Subdivision: So/sh Blk 61-a Lots 1-25 Ph 1 Lot BLK-Sec: Lot: Sound Access Blk: 61a Sec: 1 Property Use: Vacant Land (Prop Owners Association) Building Type: v— R,.ilf- 741