86214A_Pilot, Michael & Jayne_20220126

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'iCOW'( `� CAMA a DREDGE N9 86214 CA) B C D
GENERAL PERMIT Previous permit
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:
I SA NCAC 1 H L�l � � Rules attached. n General Permit Rules available at the following link: www.deq.nc.yov/CAMArules
Applicant Name I - r N Rw!s&
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Authorized Agent 1 5 L M ay i � L���� �1/1 1 :5✓L
Project Location (County): OaN-e-
Street Address/State Road//Lot #(s) 9
LDS- * �'� • 1Papt ALA. %
Subdivision
City
61NL Adj. Wtr. Body — la 'r0 66. UAA (na man/ k)
Affected CW EW PTA OPTS , ^
AEC(s): OEA IHA UW SPIMA PWS Closest Maj. Wtr. Body Amoe,wilwtj')
ORW: ye no PNA: ye no J
Type of Project/ Activity 'Qit :5. V1U,CA 11 I 1 X 1 r Qd;; _�1 AA Ut k*%eiL 1
12 x 21 G-SnQek, (Scale: N-r< )
Shoreline Length I.
Access length �q V f5 fifi j Pier (dock) length
Fixed Platform(s) PL
Floating Platform(s)
j
Finger piers jvi:v
Total Platform area
Groin length/4
® © ��
Bulkhead/ Ripraplength C
Avg distance offshore 1
Breakwater/Sill m
Max distance/ length
Basin, channel A—EY*1
Cubic yards
Boat ramp
Boathouse oatli J
�xf�5fi jh
dortat� fati 4
AN
S
0
�2Xi5h►�
I(ixll�l
QVit�t �rov wl
SAV observed: yes no XRV�s
�
Moratorium: � no `4 ' r '
Site Photos: �.�not� t� eXfSfi �G� PTA' r�-
Riparian Waiver Attached: yes `J f
A building permit/zoning permit may be required by: T4 Ly :/L fl
Permit Conditions --
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a. w�:�tEn:,rnt,tenn-a14�- a _�_ (;V—n--
TAR/PAM/NEUSEIBUFFER (circle one)
See note on back regarding River Basin rules
See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES ANDCONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT.
(Please Initial)m
Monica L. M.
Small / Manager
Agent-. Applicant PRINTE Name
Permit O ' er's PRINTED Nam
S' nature "'Please read compliance state
ei on ha . of perrnit"
Signature
,
121v 12c;22.
DC
4 2-95
- 12
2 2 Z
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Application Fee(s)
"" 'cek'illAd
ngr rr11--.JU&Lin& _ ate
Expiration Dat

Name of Property Owner Requesting Permit: CLLJ v�'l
Mailing Address:
Phone Number:
SUMM,
Email Address: a, L/Ll Z-'V
0
I certify that I have authorized L S I L v-ti t' I A Li, k-1 i
Agent Contractor
to act on my behalf, for the purpose of applying for and obtaining all LAMA permits
necessary for the following proposed development:
at my property located at -"1-33
in County.
/ 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:
Signature
J (10 i /Y) L u
Print or Type Name
Title
Date
This certification is valid through'.

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: MICHAEL J. & JAYME E. PILOT
Address of Property:
Mailing Address of Owner:
1933 IVY LANE. KITTY HAWK, NC
3933 IVY LANE, KITTY HAWK, NC
ILOT(&
Owner's email: JAYME.P�GMAIL.COM
Agent's Name: SCOTT C SMALL
Owner's Phone#: [phone]
Agent Phone#: [phone] C
Agent's Email: [e-mail] / [e-mail]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed Dy the Adiacent 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 dimensigns, must be provided with this lette .
I DO NOT have objections to this proposal. I DO have objections to this proposal.
It 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
matted 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-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner'.
Typed/Printed name of ARPO: PAIR O' DICE LLC
Mailing Address of ARPO:
ARPO's email: ARPO's Phone#: 7, 7W�
Date: �-/j J�- t, *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

4
■ Complete Items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the maiipiece,
_or on the front if space permits.
1. Article Addressed to:
Ph kC Q' D>i Lv— ��
V t7061IW poor DR .
I! I fill!! Illi III I III II !I IIIII I I I Illillll II I III
9590 9402 4940 9063 8577 48
2. Article Number (transfer from service label)
120 3160 0001 2521 6169
53
A. Signature
X ❑ Agent
❑ Addressee
B. Received by Nam C. Date of Delivery �c'z _I 1
D. Is delivery address different f m item 17 ❑Yes
If YES, enter delivery address below: ❑ No
36;3� �' Cray -e
u� t-��� C•I�ta��, n��_
3. Service Type
❑ Priority Mall Express®
❑ Adult Signature
0 Registered Mail'-
0 Adult Signature Restricted Delvery
O Certified Mail®
❑ Registered Mail Restricted
❑ Cortlfied Mall RoWcted Delivery
Delivery
O Return Receipt for
❑ Collect on Delivery
Merchandise
t Colluct on Delivery Restricted Delivery
❑ Signature Confirmation*
I 1 Insured Mail
❑ Signature Confirmation
t l Inured Mall Rostricted Delivery
tr,vr•r srnm
Restricted Delivery
•ER: COMPLETE THIS SECTION• • ON
■ Complete Items 1, 2, and 3. A. Signature
■ Print your name and address on the reverse X ❑ Agent
so that we can return the card to you. ❑ Addressee
■ Attach this card to the back of the maiipiece, B. Received by (Printed Name) C. Date of Delivery
or on the front if space permits.
1. Article Addressed to:
`i>rno&1-Q ilk • Q^rA S
D. Is delivery address different from Item 12 ❑ Yet
If YES, enter delivery address below: ❑ No
loin k j v LA~-.,
II I I III IIII III IIII II it IIIII I I I Illill II I II i�l 3. Service Type o Priority Mall Express
❑ Adult Slgnatu�e ❑ Registered Mailr"'
❑ Adult Signature Restricted Delivery ❑R=ed Mail Restricted
9590 9402 4940 9063 8577 55 0 Certified ►Mail Restricted Delivery ❑ Return Receipt for
❑ Collect on Delivery Merchandise
9 Article Nt imhar (rrPnsfp.r fmm sprvirw !Phan ❑ Collect on Delivery Restricted Delivery ❑ Signature Confirmation"10
❑ Insured Mail ❑ Signature Confirmation
7020 3160 0001 2521 6183 ❑Insured Mall Restricted Delivery Restricted Delivery
— _ (over $500)
( PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt
Domestic Return Receipt

#�UsaPs TRACKING
F3�t",ir i C 275 First -Class Mali I
Postage & Fees Paid
1 fillfl I Permit No_ G-10
i
9590 9402 4940 9063 8577 48 i
United States • Sender: Please print your name, address, and ZIP+4® In this box*
Postal Service
qOMARINE
Construction, LLC
1112 W Kitty Hawk Rd. Kitty Hawk, NC 27949
1
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1112 W Kitty Hawk Rd
Kitty Hawk, NC 27949
LS 1 www.LSimarine.com
aTMn
7020 3160 0001 2521 6183 ,ona«�Fs
MARINE
Construction, LLC
D4,sA-+,,D A . NNI S
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L4 NC 9C. 7794$ 3 , r.. 258 CFg
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71
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KITTY HAWK, NCAID
27949
AMGUNN21
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27949 R2t 80

This map is prepared
from data used for the
Off-
inventory of the real
tit'
�J
property for tax
purposes. Primary
information sources such
as recorded deeds, plats,
wills, and other primary
~
i�
public records should be
Ye1l/ { NRSA,
consulted for verification
of the information
contained in this map.
3933 Ivy LN
Kitty Hawk NC, 27949
Parcel: 029773000
Pin: 986510358452
Owners: Pilot, Michael J -Primary
Owner
Pilot, Jayme E -Primary Owner
Building Value: $242,300
Land Value: $167,400
Misc Value: $12,400
Total Value: $422,100
A
4
Tax District: Kitty Hawk
Subdivision: Kitty Hawk Landing Sec 2
Lot BLK-Sec: Lot: 23 Blk: Sec: 2
Property Use: Residential
Building Type: Traditional
Year Built: 1988
' Intl
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