Poole, Charles 84336C

'4'1,�qCAIViA IL .! DREDGE. & !
n. Previous permit
GE E R L R 0„ - Date previous permit issued
New ❑ Modification 1. J Complete Reissue [] Partial Reissue
As authorized by the State f North Carolina,'Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC �,. _ Rules attached �J General Permit Rules available at the following link: www.deq.nc.govLAMArules
n n A& -A r ., � M/../1', n
Applicant Na _ Authorized Agent
Addres _ Project Location (County): A
City _ State - ---- ZIP Street Address/State Road t #(s)
TC_
Phone #—
Email Subdivision ---- —
---- ------ � City - ZIP
Affected FICW EW PTA ES PTS Adj. Wtr. Body �-__(nat/oanl.n)
AEC(s): OEA IHA �UW SPIMA PWS Closest Maj. Wtr. Body
ORW: ye SI ] PNA: yes/ o -
Type of Project/ Activity
(Scale: � y
Shoreline Length
Access Length _
- � f
Pier(dock)length
Fixed Platforfn(s)
Floating Platform(s)
Finger pier(s) _-
Total Platform area
Groin length/tl _ --_
Bulkhead/ Riprap length-�
Avg distance offshore --
Breaktvater/Sill
Max distance/ length
Basin, channel
Cubic yards __-_—
Boat ramp--•-'-" _
Boathouse/ Boatlift
Beach Bulldozing.
Other n
SAV observed: yes no
Moratorium: n/a yes no
Site Photos:
Riparian Waiver Attached: QVI
no
A building perfnit/zoning permit may be/rreequired by:
Permit Conditions _�J i .._,.1, i U
TAR/PAM/NEUSEIBUFFER (circle one)
See note on back regarding River Basin rules
See additional notes/conditions on back
C�� -
;1) P icalion Feels)
Check Il/Money Order
Issuing Date

`O"S"1 CAMA ElDREDGE & FILL i � �� �� � Na 84336 A B &
��
y E N E RAL PERMIT Previous permit
G Date previous permit issued
�l\levv ❑ Modification []Complete Reissue [:]Partial Reissue
As authorized by the State f North Caro�lina,'Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC . , a / ❑Rules attached. ❑General Permit Rules available at the following link: www.deq.nc..qov/CAMArules
W, SIR - a L a rs. W Nd
City ZIP
Fri
•
Authorized Agent c_ Y /
Project Location (County):
Street Address/State RcadJkt #(s)
Subdivision
City
if
Affected ❑ CW EW PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/ an/un )
AEC(s): �6YJU ?! 0
❑ OEA IHA �UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yesl ) PNA: yes/I`o l J
Type of Project/ Activity.
(Scale: � y
\
Shoreline Length
Access Length
I
Pier (dock) length
Fixed Platform(s)
I�
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length--�
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel t 1 v
Cubic yards — d / 1
Boat ramp —
Boathouse/ Boatlift
Beach Bulldozing.
Other n �+
SAV observed: yes no
Moratorium: n/a yes no
Site Photos:
Riparian Waiver Attached: `.J no
A building permit/zoning permit may be requi(r�ed lk
Permit Conditions 11 %lJ1 Ji'1.f1 I? C1t, f A AA.", 1t1v I;/-'s1 �,_ [ /1/% ❑ 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.RULESARD CONDITIONS THAT APPLY TO THIS PROJECT AND RE WE
App can PRINTED Name P rmit
V
I
,ignature * read compliance statement on back of permit** Signa
pp ication Fee(s) Check #/Money Order Issuing Date
ENT.

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 F1 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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Per
mit: C[" I'f' 4 �Rry
Mailing Address: 2-7q0 51, M�n is S
Phone Number: �� �� s• �s 3
Email Address: r/ " ' "' h'!!✓+ CDC
I certify that I have authorized4-514z-ev--
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
Joc-e
at my property located at
in A-97r50k�County.
1 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:
D
Signature
n O I L
Print or Type ame
Title ( Cff.. -c,
20 21 RECEIVEDDate
NOV 12 20?.1
This certification is valid through 1 / % / DCM-MILD CITY

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:
Address of Property:
NG
Mailing Address of Owner: � / —1 a sOtS
Owner's email: {/y 7» n /L �ner's Phone#: el q ' 0 1s' �s7 j
2S2 • ' L 2
Agent's Name: D . S Agent Phone*(��7 �/ - ✓ Zf' 2"
Agent's Email: G�,�/''daku I °' fit: �� �/n
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
objections to this proposal. I DO have objections to this proposal.
Y-yo-u have objections to what is being proposed, you must notify the N.C. Division or coasrai
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 28557. 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 to waive the set y_, uli> sti-ai-an
the appropriate blank below.) ---
I DO wish to waive some/all of the 15' setback
Sign r 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: 1, ),,A,Z'(t `00o1 Ce',—( ARPO's Phone#: 749`�"
Date: `S Z�' Z *waiver is valid for up to one year from ARPO's Signature*
RECEIVED
Revised July 2021
NOV 12 2021
DCM-MHD CITY

9

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:f7/4 (l�yT1)n �ylL J6"' A/ &
Address of Property; �►'✓S�:�''� �'�`L`� NL f�S� Z
Mailing Address of Owner: 2"77y s
Owner's ernail: r, A.//• M
Agent's Name:
/1/C- 27("0,I
Owner's Phone#: 9/9. 9/5 . 8-5-73
Agent Phone#: 252' • 4,,q6, . .3212
Agent's Email; 104beWkS I '' i"L' rr. GpM
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 400 Commerce Ave., Morehead City, NC 28557. 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' setba
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian P
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email: 002d4m
Owner:
� Jr
Date: /0 A z/ "waiver is valid for up to one year from ARPO's Signature
RevisPj�lO�'rl�

w.

r,>c-:t,jsc)pj
rj
RECEIVED,
NOV 12 1021
DCM-MHD CITY

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