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Previous permit
Date previous permit issued
E 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:
0?A ,n-ao l-l Rules attached. S C"n"r"t Permit Rules available at the following link: www.deq.nc.gov/CAMArules
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Applicant Name
Address
State Alt-ztP ?Alloo
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Authorized Agent Eltu5lt iltr- cnu9mxcnoa
Prolect Location (County)OraLD\,
Street Address/State Road/Lot #(s)
Subdivision
City
Phone
Email
0
PCity
Affected
AEC(s):
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Adi. Wtr. Body
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Type of Project/ Activity
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
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Groin length/#
Bulkhead/ Riprap length
Avg distance offshore /
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Fb1'
5
ft1
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(Scale: Nr6l
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Beach
Other
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SAV observed:
Moratorium: nla
Site Photos:
Riparian Waiver Attached:
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A building permit/zoning permit may be required by:
Permit Af,i TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
See additional notes/conditions on back
I AM AWARE OF CRC RU
Agent or Applicant PRINTED ame
*+Please read compliance statement on back of permit**
CONDITIONS THAT APPLY TO THIS PROJECT AND EWED COMPTIANCE STATEMENT. (Please lnitial)
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Application Fee(s)Order lssuing
Officer's
Date
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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 Proiect:
Tar - Pamlico River Basin Buffer Rules Neuse River Basin Buffer Rules
lf 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. lf 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:
Division of Coastal Manapement Offices
Morehead City Headquarters
400 Commerce Ave Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST Fax: 252 -247 -3330
(Serves: Carteret, Craven - south of the Neuse Rivei Onslow
Counties)
Elizabeth City District
401S. Griffin St. Ste. 300
Elizabeth CiW NC 27909
252-264-390L
(Serves: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford,
Pasquotank and Perquimans Counties)
Washington District
943 Washington Square MallWashington, NC 27889
252-946-648t
Fax:.252-948-0478
(Serves: Beaufort, Craven - north of the Neuse River, Hyde, pamlico,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
9to-796-721,5
Fax: 910-395-3964
(Serves: Brunswick, New Hanover and Pender Countes)
http://portal. ncdenr.or g/web/cm/dcm-home Revised 6/01/2021
Please ensure all debris associated with the removal or construction of th€ permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
N*trc of Property Grvner Raquccffng parnit;
Maillng Addrcss:
tl tc-cl lr-,l!Phone Nurter:
Emall Arlhess:
I ccrtifyt,iit I hanc au0rortsed
at mypmperty locfrd at
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Agglt/
b ectonmy bohdt,6rthe purpoccof applytrghrand e$ning a[ CA]tiA FImfte
nccasary for thc bllfllng propooed Oerdoprnent
n
I turthctrnoo qtfy tt,[ I en anthuiled b @?L and b tn M $"ntpsrrreecbn toDtvksm.rcoos,t Managen,,t *fr, up t& di*tid-;ffii#ffi;;;,on the afonme,dimed h.t& in *,no.'tr,a vvilt ***tg bturrffirr;i;f,d-b'il*.D€rtrnttgtr&,do,t.
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N.C. DIVISION OF COASTAL IIANAGEiiENT
ADJAGENT RIPARIAN PROPERTY OWNER NOTIFICATIONTWAIVER FORII
(Top portion to be completod by owner or their agent)
Name of Property Owner:(,hr is Rhatlr s
Addrcss of Property:
Mailing Address of Owner:5a L
Orne/s emall:Phone#: qlC- eqb-'lli4
Agent's Name:Asenr Phone#, q / c'3 A'l - t {tl 5
Agenfs Email:
WA]VER SECTTON
I understand that any proposed pier, dock, mooring pilings,boat ramp, breakwater, boathouse, lift, orgroin must be set back a minirnum distance of 1S'from my area of riparian access unless waived by me(this does not apply to bulkteads or riprap revetments). (lf you wish to waive the setback, you must siontheappropriate blank below.)
ADJACET{T RIPARIAN PROPERTY OWTIER'S CERTIFICATION(Bottom portlon to be comohted bv thp Adiacent Prcoortv Ownerr
I hereby certifo that I orn property adjacent to the above referenced property. The individual applying for thispermit has descdbed to me, as shown on the.attached drawing, the bev6npment they;; proposing. {descriotion ordrawinq.with dimensions. must be orovided wfih 6is htter.
Cll- I Do Nor have obJections to thls proposal. I Do have obiecrions to this proposat.
knaganent-Pcq in wrlflng wioiln 10 davs of nieipt of this nottie. Conespnaincc shoutd bmallad to tlul commerce Ave., lfioreher,d city, Nc zssil. DCM ipresenteflvescan also De corrEctedat (252) 80&2808, ffo response ts conslden# fire same as ii ofiecttii i v"u naii'i},n noaaea oyC*:fifled Hall.
I DO wish to waive sorne/all of the 15 setback
Signature of
-oR-
I do not wish to waive the 15' setback requirement (initia! the blank)
Signature of Adjacent Riparian Property Owner:
TypedlPrinted name of ARPO:C hr;'Ar (
llalllng
ARPO's
G
up to one yearfrom ARPO'o Signature'
o3 6af D
Date:
Addreae of ARPO:
*walver is valid for
Reyised July 2421
N,C. PIVISIOH OF COASTAL MANAGEMENT
ADJACEHT RIPARIAH PROPERfi OWHER }IOTIFICATIOH/WAIVER FOR}ICERTIFIED MAII. , RETURN RECETPT REAUESTED O;iAND DELIVERY
iTop portion to be completed by owner or their agenti
Name of Property &rner:)t t: kntiicz
Address of Property
Mailing Address of Owner:
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Orne/s amail:
A€€nt's Name:
Agent's Email:
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ADJAC EITT RIFARIAil PROPE RTY OWilER'S CERTIFICATIOH
G""ri prn*.t"'rir*"tl
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I hercby certify that I or+n prooerty adjacent to the above referenced property. The rndividual aPplying for thisp€rmit has described to me as shown on ths attached drawing the developmont they are proposing. {
i oo NOT have oojectbns to this propossr. l Do have objecflons ro this proposar.
must
o,af this notlce.Corre*llrlrndenca sfroutd bNC 2A557. DCU rcprasrnt t yes ean also bo conlectedthe same es no oqacfion ff you have b*n nodfid by
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Hi=gf ,,81?ny p:ry:gd p,er:.dock H#ffrifiX*r ramp. brtsarryater, boarrouse, rifr, orgrom must be set back a mrnimum distianc€ of r 5.iom ii "* ot iiari"n
"""ess "^iJ"rlri,ir"c Uv *"[Hiffirfj:?*,1'*',#aoi o'-n-f'.ai".Ju.t*.n,"). irivo, *iir, -to
waive rhe serpack, you ms't sian\fr'
I DO wish to \ryaive some/all of the 15, setuCk
sQnature oi Adjacent Riparian properry orner:
Typod/Frinted namc of ARPO
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t do not wish to weive the i 5. setbeck requirament (rnitial the blanki
Owne,
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ilailing Address of ARpO:
ARPO'g email:
E
/r'Phone#:
lc valid for up to one year from ARPO,s $ignature,
Drte:
Reylsed July 2OZ7
Agent Phone# 'l I /-
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i t I - 't ,l; I ti
at(252) B0&?O0/f'.
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