86497A - Climer, Jerome

[NCAMA DREDGE & FILL N° 86497 B C D
GENERAL PERMIT PreviousDatepreviouuss itpermitissued
® New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of North Carolina. Depatmun of Env4nnmenal Quailty and de Coastal Resource: Commission In an area of emir onmenta) corKam pummm to:
I SA NCAC -7[j - 1100
Rules atawhed.
General Permit Rrdes availabie at the following Ndc
Appricant Name ap rO -V\Q 0.1 t j!0
P r
Authorized Agent i`-t thlCitOaciY� ldcert,.a
de �TMLaVrt
Address I od 14r rA,, n 6 \i
L.n,
Project I oacion (County} VI�II r.tQn
City State NC-
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ZIP a'T 13Z
Sues Addrasd5taaeRovd/Lot*(s)
Phone ( ) Ai$Z—Vi5-1
jm' a LOON,
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Email C � Dr iPS . COYIN
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Subdivision
city FAMA� 21P
2-11 bZ
Affiotad M ®Ew ® PIA
© ES ®Prs
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AA. Wtr. Body E ol•P.i iv, C1 ll►v
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AEC(s): OEA IHA UW
SPIMA PINS
Closest Maj. Wtr: Body f!�ii�a7tY
q
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ORW: yese PNA:yes,
Type 0 Project/ Activity
t66
Shoreline Length - 90
Access Length .�
Pier (dock) length
Fixed Platform(s)
Floating Platform(s) _�
Finger pler(s) `I
Total Platform area
Groin length/M -
Ikhea ipraplength Ct
Avg distance offshore
ereakwater/Srll
Max distance/ length
t
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatift
Beach Bulldozing
Other
�'4
SAV observed: Q i �iR1 h r j( i i I i r � 1_'�_i� �•..1
_ -; 1-,--r-r-rr-;
Moratorium: n/a yes
Site Photos: CVF no
Riparian Waterer Attached: n2
A building permit/zoning permit may be required by:
Permit Conditions
Agent or
(Scale:i~'� )
TAR/PAM/NEUSE/BUFFER (dude one)
See note on back regarding River Basin rules
See additional notes/wnditions on back
..< —Ti rTct rRr aulES AND CONDmOivS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT.! (Please Initial)
Signatu Ple eat complbnce statement on back of permit-
statement
Check p/Money Order
Application Feels)
Signature 6/3%ZZ
z/ 312E
Expiration Date
iuuing Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: JGIrOVVZ
Mailing Address: 100 HardUS 44, 11Lavy
Lj
Phone Number:
Email Address: c 41 aAt rA? Ad h sf . c o Al
I certify that I have authorized JA f!1 ill�cq�1 �q�ear�Sid�Cohtrctc�tcs
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: CO✓15tykc-+ R() LF
0 � 0AW 1 Jou 1 V-1,&j
at my property located at 100 +44 rduS l l La ✓,e EAee)idn 219 3Z.
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I furthermore certify that / 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 Infonmation:
Signature
M, r—, M ZQ
Print or Type Name
"Title
�lI l4 IV -
Date
This certification is valid through l:;-2 -� 7 _

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM ,:CEIVE®
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent) JAN 0 6 2022
Name of Property Owner: ck1 ome— Clime-f DCM-EC
Address of Property: Ix �4ar^d�s 14'1 a LAn6 Ei ieA yn � 2'i132.
Mailing Address of Uwner, Sgme-
Owner's email:
Agent's Name: OC&A506 (!ar +yZkCf1NS
Owner's Phone#:
Agent Phone#: 252.,-3)2 -` -7LIL 1
Agent's Email: QC�eaa✓ $&d C . co►if-raGby� ® G✓21�g ,' I . c-pM
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(F3ottom nortion to be completed by the Adjacent Pronertv 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
aescnption or arawina, wlin almenslons, must be Droviaea with finis 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 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 ofARPO: i'bHOA
Mailing AUUMS of ARPQ; 2c 3 �;LtMee- Pvi ve_ 1P(Jentn,-\ � 2-1y37- - 9to22
ARPO's email:
Date:
ARPO's Phone#:
*waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

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IN Complete items 1, 2, and 3. A.',Sig to
■ Print your name and address on the reverse X r _
so that we can return the card to you. EY _ Ad
■ Attach this card to the back of the malipiece, ecelved C. Dat of I
or on the front if space permits.
1. Article Addressed to: D. Is de a ress di rent from it CI Yet
If"Y nter deliverddress below: No
f3arr� FI!)m n ,
tol Hardt j.s N t'It iaA e- f
1 eve NC-e
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I 3. Service Typ 4�.� Registered MaIiTM
I�'I" I'� I�III) f I'I(I(II�(II II�III'I�I) ❑• Adut Signature
Adult Signature Restrict ❑Reeggistered Mail Restricted0CertNied Mail® De very
9590 9402 6413 0303 3775 26 O Certified Mall Restricted Delivery O Signature ConfkmatbnTM
O Collect on Delivery ❑ Signature Con*maWn
�. Article Number (fiansfer from service label)0—
Collect on Delivery Restricted Delivery Restricted Delivery
❑_ Insured Mail
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7020 1290 0000 7857 5357uRestricted DO"
PS Form 3811, July 2020 PSN 7530-62-000-9t)5� -- Domestic Return ReceiptIle
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C'v'-1NER' CLIMER, JEROME F
C'A'NER2 CLIMER, MARYANN
VAILADDRESS1 100 HARDY HILL LN
K'Alir^.DDRESS2
SsL�rY\

Untitled Map
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Legend
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