Teeny Tait Revocable Trust 84716C

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'oaOF COAfT41 c CAMA ❑ DREDGE & FILL Na 84716 A B n- D
GENERAL PERMIT Previous permit
y � Date previous permit issued
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the 5tate of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC 1�`t/j' / ❑ Rules attached. ❑ General Permit Rules available at the following link: wwwdegnc.gov/CAMArules
Applicant Name Authorized Agent
Address Project Location (County):
City State #V ZIP Street qres al
o Road/Lot #(s)
Phone # 47 -0- I nT'
Email - Subdivision A
Affected lcw EW PTA
AEC(s): OEA 61HA W1
ORW: yes/ PNA: yes/�yb 'W�
Type of Project/ Activity n Z 4 i1 lil
Shoreline Length lJ
Access Length 1
t i
Pier (dock) length
Fixed Platform(s) 6)
Floating Platform(s)
Finger pier(sl
Total Platform areal@ L=
Groin length/# —
❑ ES ❑ PTS
❑ SPIMA ❑ PWS
N
Bulkhead/ Riprap length
-
Avg distance offshore
Breakwater/Sill-
N
V
Max distance/ length
Basin, channel`��
Cubic yards
1
y* n
j 1�1,X•1'
Boat ramp
Y
Boathouse/ o tli
' IT
Beach Bulldozing`—�
t
OtherNO
SAV observed:
n
Moratorium: n/a yes
no
Site Photos: yes
o
Riparian Waiver Attached: yes
no
A building permit/zoning permit may be required by: Me& gin
J
Permit Conditions
u
I AM AWARE OF STATUTES, CRC RULES AND CONDITIQNS THAT APPLY TO THIS PROJECT
(Scale: '-' ('0)
b
� yr
!-2, th!
N-7' TAR/PAM/NEUSE/BUFFER (circle one)
(�
or Aoolicant PRINTED Name ' / 1 - Permit
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
COMPLIANCE STATEMENT.
re **Plead compliance statement on back of permit** _ Sig
Application Feels) , , Check #/Mon6y Order (ssuir1g Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit tonditions. 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)
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 Fender Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: '.? ✓) t
Mailing Address: 1 • 0 " Is T
uj vv, 1 N . L,
Phone Number: 'Z S Z -- ( `-) C) - L4 I
Email Address:
I certify that I have authorizedy
Agent I Contractor
to act on my behalf, for the purpose of applying for and -obtaining all CAMA permits
necessary for the following proposed development: ►`� cP �� w ��� ��
L
at my property located at L *5 t \J'
in C/4 e-4x-ef tL
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:
n
S na re
Print or Type Name
Title
Date
This certification is valid through I l
RECEIVED
SE P 21 2021
OCM-MHD CITY

ADJACENT RIOPARIAN PROPERTY 9YER STATEMENT
's
ad'acei�t to �+e'�''t `�
I hereby certify that 1 own property 1 pra Owner)
(Name
located at
property located Lot, Block, Road, etc-) N.C. .
o v SavWfl 'n M'` (City/Town and/or County)
(Waterbody)
The applicant has described to me, as shown below, the development proposed at -the -a a-
)ation-
I have no objection to this proposal.
_ I have oo�ectzurr�-ram -
pESGR1PT1ON AND/OR DRAWING OF PROPOSED DEVELOPMENT
attach se drawfi9)
(individual proposing development must fill in description
bejo,# or
/
a JI '
s
\ - — WMER SEGTION . roin must be set
--- i understand that a pier, dock, mooring pilings, breakwater, boathouse, fit, or gu
st
back a minimum distance of 15' from my area of riparian access unless waived by me ►r ou (f Y
wish to waive the setback, you must initial the appropriate bhankbelow-)
I do wish to waive the 15' setback requirement.
► do not wish to waive the 15' setback requirement-
)
(Property, C)wner Information) .
{Adja nt Property er In orma+ion)
Si --nature V"
print' or Type Name
P t or Type Name i �3 "=�r'` \} 0 � r'
�Vfailing;Wdn;ss ZY�q0
Mailing Address 3L
Lty.ZiJ�36-5 r 6cihy/Stafelzip 2- 5_ , �" ,. -7y — i -y� Telephone iVumber
Telephone Number I - 2 i
" Z I -
Data
�ate R E V2012)

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4
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?J�4CENT RIP�1Rl" PRCDPERW OWNER STATEMENT
-- =�
fS
I hereby certify that I own property adjaceht to
property located at L o
c� (Address
on
(Water b odY)
4t.- development-prb-P—MWI at-theabv�e
The applicant has described to me, as shown betow,
'lion- I have no objection to this proposal.
(Namee Pro oame�r?
w 1'�- ---
ot, Block, Read,
tCW4W„ andlor Gourtty)
v _
ENT
DESCRIPTION ANDIOR DRAVffiG OF PROP®SD4 DEVelow EL to M �e clrawinc�
nrnlFvidual proposing developrnerit must fill in d�cdgdon
blip s breakwaier, boathouse, Wt. or groin must be set
^_ I understand that a pier, dock, mooring p
back a minimum distance of 15' from my area of riparian acoess unless waived by me. (If you
wish to waive the setback. You ust initial the appropriate Wkbelow_)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 16 setback requirenr L
�~ ~^ (Adjacceftt ProPert•I owner InfoT mA-10n)
(property der information) .
_--- Si e
Si-Siure f G r ( n if • TG rcl „
Print or type dame
Pr t or Type Name �g00-Sate=---
i��- 3a Mailin c jr�,ss a �' o T
�Vtarrng Ayyddress 40 �17� i
,ci yl taterLp 9r j
Ln a77te -7 13 TetepnoneiVumber
fe ephone Number
r Days
Drzts
RE Cr1f-6vFi„° pevised 6/1"012)

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: '- ✓) q
Mailing Address: 1 C)
uj h=e(- vy, ,, N . C, (63
Phone Number: Z S Z ' 6 --) �) - L4
Email Address:
I certify that I have authorized V. �� rL� ` f`-A!�5 1 ky��
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at L#s �._,e v, q "J
in CA e 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: - -
n
S na re
"tee e n `t , �-
Print or Type Name
Title a6�
Date
RECEIVED
This certification is valid through / I SEP 21 2021
OCM-MH® CITY

...............
416
..... .....
i.0
14 if

ADJACENT RIPARIAN PROPERTY Ci1AiNER STATEMENT
4 i ,S
I hereby certify that 1 own property ad}'aceirt to `�' Property Owner)
(Name -
located at .l
property Address, Lot, Block, Road, �•)
-- - ( - N.G_ .
on `rQ.Jo cs Savyv� �n M `ptytTown and/or County)
(Waterbody)
The applicant. has described to me, as shown below, the development proposed ai the a ve ----- - -
tion.
l I have no objection to this proposal.
I have ob--
DESCRIPTION AND/OR DRA` ANG OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing}
�\
03
\ _ c WAIVER SECTION.--
-- - 1 understand that a pier, dock, mooring pilings, breakwater, boathouse, lit, 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-)
1 do wish to waive the 15' setback requiremant.
1-i- ► do not wish to waive the 15' setback requirement_
(Property, Owner Information)
(Adja nt Property er In orTnafion)
Signature
pTiU V r]" Print or Type Name
P to Type Name Q
j - a ,Mailing Addn;ss
Mailing Address 3 -Va-- N C-
f�.mdip
Cifcy/State/Zip
2,, Z —, -7 U Telephone Number
Telephone Number 2
Date r J/�sed°b/18✓20-t 2)
SEP' 21 ZU1
DCVO-NIH VTY

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I
ADJACENT RiATEMENT
I hereby cerlifythat I own property acliaceiltto
property located at L_- 0 i v
(Address, .0 Btoci� Rid, etc.)
on i .�4 v ,.rtil7 is � ltn andfor Gou0Y)
(Water)ody)
as shown below, the development-propo
The applicant.has described to me,ses at"thhe-a� v �-----�
tiort_ -
' ; I have no objecton to this Proposal.
l have ot�t��eu�-�
DESCPJP-rION AAIDfOR uRAIMING OF PRopon D©v DEVELOPMENT e drav rat
(ln&wjCrUai proposing development must fiff in des n r
m L.i -F!- ►
S
s
VI
` WAP&R SECTION
ilings, breakwater, aess unless
fit, waived
groin must be set
l understand that a pier, dock, mooring p
back a minimum distance of 19 from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must ini€ial the appropriate bIadKbelow-)
l do wish to waive the 1 b' setback requirement.
v,l VN -VA I riff not wish to waive the 16 setback requirem Il
(property Owner Information) .
(Adjacent propedy owner InfonMP-MP
e GTGrel. "i
t Print or Type Name
p " t or Type Name 57o o � i+O I a rl f^ e) a-�
�- db mailin �Jr..ss G G o
lUfarling Address 3 a 1 el --
" ' n Gffy/Stairr 0
City/Sta&EP 9l�- (o37-77-9v
Telephone Mumber
relephone Number 3
Data
'lute
RECEIVED (,devised 611"012)
CSC -M HI0 0TY

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