Mitchell, Don 84520C

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0 1*FCOW41. ❑CAMA ❑ DREDGE & FILL Na 84520 A B C � D
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Previous permit
GENERAL 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 Authorized Agent
Address Project Location (County):
City State ZIP Street Address/State Road/Lot #(s)
Phone # (_ )
Email Subdivision
City ZIP
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
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s) x v
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
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:
t rot?g i"!. l re, C1.1r%C
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

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 F-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)
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

1*�jCOA N&EICAMA ❑ DREDGE & FILL NQ 84520 A B C D
Previous y `GENERAL PERMIT Date previous Ipermit 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 Authorized Agent
Address Project Location (County):
City State ZIP Street Address/State Road/Lot #(s)
Phone # ( )
Email Subdivision
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body t
ORW: yes/no PNA: yes/no
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/ Boatlift
Beach Bulldozing
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
i
(Scale: )
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
1 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

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:
F� 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)
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

<z'>
70'
3*
i
* Lift move
16' % to clear exisiting doc
Will not change dis�z
3' <3'> <3'>,'1C 3
PROPOSED
N NEW
<a' > E LOC ATION
w OF BOAT
LIFT
D
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_. ,__. _ .... ....... ,.
I hereby certify that I own property adjacent to 90,1 / zol-CX e 1 / as
(Name of Property Owner)
property located at � � "N e
(Address, Lot;, Bock, Road, etc.)
on ��°' , in C�qd.5 FerrJ 2L&ahi. .
(Waterbody
(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must flit In description below or attach a site drawing)
WAIVER SECTION
understand that s pier, dock, mooring pilings, breakwater, boathouse, Ilft, or groin must be set back a
minimum distance of 15' from my area of riparian amass unless waived by me. (If you wish to waive
tl setback yo gust Initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 16' setback requirement.
(Property Owner Information) (.Adjacent Property OwnerrII formation)
r+
Sigwr re Si ure
Print or Type Name Print or T� Name
u /6,
Maffing Address Maffing Amdre
cftymatelzip ity/state, fp
Telephone Number Telephone Nurnber
Date ` Date
(ReVfsed 6/1W012)

<2'>
70'
DOO ,Uli-'GHP--LL-
qlq 364 �321
16'
<4'>
3ii CoN L/��
This is how

I have to enter lift currently

<z'>
I
70' 3'
Lift move
4 16' — 0 to clear exisiting docl
Will not change dista
<3'>
PROPOSED
N NEW
<4'> E LOCATION
W OF BOAT
LIFT
D
O
C
K
hJ .

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to .r., // s
� (Name of Property Owner)
property located at � �% Coy L,ANe
(Address, Lot, Block, Road, etc.)
on s � /� O in J1Ve1jriS %ell c N.C.
(Waterbody) (CltyfTowrn and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
ref 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)
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.)
)M__ A I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) ( scent Property Pvgner Information)
Signature
le
Print or Type Nam©
I r�-1v e y s` 2Z.—a .i Liz
Mailing AddressA?ifAldZ VC
/y
it
cail��rC[
Telephone Number
Date
or
Mailing Arid
3—tylstat
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Batts !
(Revised 611812012.)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Oa/� 77 TC%e- /f s
property located at Ne (Name of Property Owner)
on �tQe >
(Address, Lot, Block, Road, etc.)
C�flr� ., inNeArt�S �err� ��
(Waterbody) (City/Town and/or N,C.
The applicant has described to me, as shown below, the development proposed at the above location,
I have no objection to this proposal.
I have objections to this proposal,
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing}
WAIVER SECTION
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, yoW Must initial: the appropriate blank below.)
lz I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signatr re / 1L
Print or Type Name
-1l/11' All J/r. r%tit LL%
Wiling Address
City/State/Zip
Telephone Nunybor
(Adjacent Property Owner Information)
Sign ttre
Print or e game
y� QCui7
Mailing Addre ,s
/�rrY
city/Statelzip
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Telephone Nurnber
- / -3'u
Date
(Ravi -sod 6/1812012)

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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIirICATIONl11 AIVER FORM
CERTIFIED MAIL k RETURN RECEIPT RE UEUEIr_HANO �IVERY
(flap portion to be completed by owner or their agent)
Name of Property Owner, R)C21z'J
Address of Property; _ J t/ c k ° y Iv
Mailing :Address of Owner. 3 ' ` %ta /VeL
Owner's erna t , &2 Owner's Phone#,
Agent! s Name* Agent 'hone#JV
Agent's Email:
AD ACENT RIPARIAN PROPERTY OWNER"S CERTIFICATION
(Bo.t1gM port to ccneleted Srt e Adiacent RroseM erj
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
dgscription or drawing. with di.. ensioos. must be provided wath this_lett�r.
I DO NOT have objections to this proposal. 100 have objections to this proposal.
if you have obfecUons to what is being PrOPOS60, you must nuury Ulu rr.e.,, wv+arure ur ww.swa,—
Management (DCU) in wdfing within iD days of receipt of this notice. Cormspondence should be
trailed to 400 Commerce,Ave., Morehead City, NC 28587. DCM representatives can also ha contacted
at (252) 8084808,. No response is considered the some as no object/on 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 r prap revetments)- (if you wish to waive the setback, you must s
1911
the appropriate blank below.)
I DO wish to waive sornelall of the 15' se5t2a7natur'
u rl rope` Owrtrar
.OR -
I do not wish to waive tho ,15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: � QN—P-0 2 CalFols �d(2—
Mailing Address of ARPO: Th
ARP'O's email,., AI'RPO's Phone: _.._ _
Elate; --*waiver Is valid for up to one year from ARPO's Signature`
ReOsed May 2021
RECEIVED
DEC 15 2021
®CM-MH® CITY

tt .

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIfICATIONIWAIV'ER FORM
CERTIFIED MAIL ETURN RECEIPT RE IJE T D or HAND DELIVERY
(Top portion to be completed by owner or their agent)
9�
Name of Property Owner:
Address of Property; G F t & m2 .- ,i lv a
Mailing Address of Owner: J ��' Ji%L' ` _ &� _ fZ,/
Owners ennail, o,,Z,2�`f�rrAw �`�.���' Ownees Phone#: +�
Agent's Dame: Agent Phone /J
Agent's Email, ..
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(RAI-rn_c rtion tca _ e comtt+Iet d by ttie AdlA(;Qnt Prc- nee}
!hereby certify that I own prraperty adjacent to the above referenced pr erty- The individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing. A
I n or drawing, ith dimerC nL ust be provided with Chia leittar,
I DO NOT have objections to this. proposal. I dC have objections to this proposal,
tf you have objections to whaf is ,being roposed, you must noVfY the N,L;, urvisran yr "of
Management (DCINl) in writing within io days of receipt at this notice. Correspondence should be
mailed to 400 CCornmerce Aver., Morehead City, NC 28557. DChlrepresgntatives can also be contacted
at [phone]. No rosporase Is considered the .some as no objection if you have been notified by
Certified Malt
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin roust be set back a minimum distance of 15' from my area of riparian access unless waived by me
(thls does not apply to bulkheads or riprap revetments)- (if you wish to waive the setback, you us I t1
the appropriate blank below.)
I DO wish to waive somehall of the 15' set
no lAdjacerat Riparian ` Wiper y Owner
,OR -
I do not wish to waive the 'ia" setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner;
TypedlPrinted name of ARPO � oNP�E �� GG�`. �' N_#'
Malllt�g Address of ARPCa: r S "'tf •r%
ARPO's email' / 6 , i'' ARPO's Phone#:
pate.: / ) ` f ( 1 -waiver Is valid for up to one year from ARPO's Signature*
Revised May 2021