86460A - Mathias, Mark & Rhonda

`ASTA, ❑CAMA ❑ DREDGE & FILL n NI? 86460 A B C D
GENERAL PERMIT Previous permit
i 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.dgq nc.gov/CAMArules
Applicant Name"'\ c" r r, ti_ n S
Address
City t ,•. ? State ZIP 7
Phone #
Email
Affected ❑ CW
AEC(s): ❑ OEA
ORW: yes/no
FEW ❑PTA
❑ IHA ❑ UW
PNA: yes/no
Type of Project/ Activity
Shoreline LengthAl' + 3 rl 2---
w
Access Length
Pier (dock) length ':>/ 7(
Fixed Platform(s) ! O r JC
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length r
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/"iloatlift/.2 / 2.
Beach Bulldozing
Other
SAV observed: A-S.
Moratorium: n/a no
Site Photos: no
Riparian Waiver Attached: no
A building permit/zoning permit may be required by:
Permit Conditions
❑ ES ❑ PTS
❑ SPIMA ❑ PWS
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City ZIP
Adj. Wtr. Body (nat/man/unk)
Closest Maj. Wtr. Body
,t
E
4
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND
Agent or Applicant PRINTED Name
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #/Money Order
Permit Officer's PRINTED Name
/° Z _- (scale:
C".✓t
`r
#
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please Initial)
Signature
Issuing Date Expiration Date

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(PC C, SL 199J)
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62.12'
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SHORE LINE 1.8' BELOW F
LINE c
5/8 IRF
1.8' BELOW FG WATERS R/W R/W
N46*03'23 11 W (DB 1814, PG 356
X(PC B, SL 140)
37.76'
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JAN 0 5 2021

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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)
Address of Property:
Mailing Address of Ownei
Owner's email: fn-)GDXAiU0,(11 Owner's Phone#: ]- 70166LD
Agent's Name: Owne` Agent Phone#: pu,ne C
Agent's Email: nwl1 f . r
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 Adjac nt Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank)
J AN 0 5 2021
Signature of Adjacent Riparian Property
JOwner
/ DCM-EC
Typed/Printed name of ARPO:
Mailing Address of ARPO: 2 /J A/C 21
ARPO's email: l A, ?r,;- �'�'`�� /S �� b, �"rdRPO's Phone#:
Date: Z = Z / *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: b - MCA f �,
Address of Property:
Mailing Address of Owne
J
Owner's email:'( M7 Js�O t� WCxlI 61Y) Owner's Phone#: 1J)(„- (Yl 13
Agent's Name: L \k)(1 e,1r' Agent Phone#:,­)i ,)n e_r
Agent's Email (--)W
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.
A&19-1 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 b�
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
JAN 0 5 2021
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO: Z qd
ARPO's email:
Z. c7 ?,r'q'-
ARPO's Phone#:
Date: o`69 � of , *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

RECE NE
JAN 0 5 2021
DCM-EC
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JAN 0 5 2021
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