86210A - Smith, Garry & Barbara

NCAMA [] DREDGE & FILL N° 86210 ► B C D
GPrevious permit
GENERAL PERMIT
Date previous permit issued
NNew ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State ofppNorth Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC I J Q Rules attached. ❑ General Permit Rules available at the following link: www.dgg.nc.gov/CAMArules
Applicant Name C- I It I: k r f✓ t"
Address C rLa LteU vi
c a el
City C C1 VV. /'I i' —,_ State N Z i
Phone # (� t� �G? — 5 3
Email G(: VCt T Q W4�i I,c d. Lt .✓t CY . r L S/4A
Affected ❑ CW EW
AEC(s): ❑ OEA ❑ IHA
Authorized Agent t /i" "" L`L-a. f ul ik r f Y1
Project Location (County): S (fy,4
AjcA
Street Address/State Road/Lot #(s) '" ��6, L Y at t Nt'
Subdivision �_iL1) � r�� �_ a t�! to V �
City !''r..t. V tAt .1.. ZIP
{'��j Ad' Wtr. Bod Y�(L ' i ; t ° '" V—& nan/unk)
PTA ;K ES ix PTS I• Y T�7 �'
❑ uW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no" PNA: ye no
Type of Project/ Activity !,I ' ! { - + 2 q & ' ! V ✓' { ,�f ( ,,,. -t.� t �" �^ ..�. -{r` {^. l r? i
0 '1 f i yya,yik q (Scale:
Shoreline Length + i
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length 4— LCI I
Avg distance offshore 't - 2
Breakwater/Sill
Max distance/ length �J t
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed:
yes no
Moratorium: n/a
yes no
Site Photos:
lyeno
Riparian Waiver Attached:
yes no
,ry
A building permit/zoning permit may be required by: �'14
❑ TAR/PAM/NEUSE/BUFFER (circle one)
Permit Conditions
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT.
(Please Initial)
Permit Officer's PRINTED NamErj
f !7
Signaturerr "Please read compliance statement on back of permit"
Application Fee(s) Check #/Money Order

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: dlo. er `N *Z>"t`bcr.- S'V
Mailing address: J33 Cooks dtni R
-13
ln.•0. N.0 �.� 9.Z J
Telephone Number: 757--,S 33-- X886"O
Ab&W.*1 L a *"�- �v' �,s �` n W*--'
I certify that I have authorized 0e o (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of itiEo-� Su1K1gGnc:�
at my property located at / 3 3 GooK S �,a.r•ci.nc� ToaE- �'�� N. C .
This certification is valid through Aq& 3i S� 202 Z (date).
(Prop e O e Inf mation)
Signature,
Q—� S'Yn
Print or Type Name
Dw tiL.(2 -
Title, co. owner or trustee for property
f /2 ZZ
Date
-75-7- 37Z - 82 3 I
Telephone Number
R E `
JAN 12 2UZZ
Email Address

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: d , Us- Lof C C=aLL::�._
Address of Property: Co OkLs �� i {,G� fe-OC�I
Mailing Address of Owner:
�1
Owner's email: �cra,� GrG> Owner's Phone#:
/�llx;�+�r1L r1i�Ti: ram•'` Cto-'�`>T_
Agent's Name: e/2,C'6 Agent Phone#: i�-/o
Agent's Email:wl��L
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.
�)Z_ 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
-OR-
.� n1i
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: X/4r%�� f���f s. <<< ,151 W I
Typed/Printed name of ARPO: 1�r% TT m ^NS%.i l�
Mailing Address of ARPO: ;.It/ s A 14 Ga rWY*P' �_�knritN--A tj c
ARPO's email:
ARPO's Phone#: 2S'L-3 3y - ,2s'.Z8
Date: Y&!� -/&1 ".2012 "waiver is valid for up to one year from ARPO's Signature*
Revised May 2021
JAN 1 2 2022
DC{-

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:
Mailing Address of Owner:��/
TY1�T
ACner's em ail: l:AmbuI¢nC�.Owner's Phone#: �4535
"w%, L VI -ter ra:% r (,r, C
Agent's Name: )APV, /�so+�-� Agent Phone#:6/0
Agent's Email:
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. � e - �✓� '
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
-O R-
I do not wish to waive the 15' setback requirement (initial the blank)A-6//
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of AR
Mailing Address of ARPO: C%�1 wT�r����/���7%
ARPO's email PO's Phone#: 2�s�-6z —
Date:ZZI waiver is valid for up to one year from ARPO's Signature*
/
Revised July 2021
1 A N 1 2 2022

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