86219A - Wagoner, Gerald

r
--tAowl ` M?-*N,�(CAMA ❑ DREDGE & FILL Nn 86219 Q B C D
3 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 !7 z 2. v ❑ Rules attached. General Permit Rules available at the following Ink: mnm dgq.nc.gov/CAMArules
Applicant Name
Address
City 4
Phone #f( }
Email _ I W a
@r'a�d�j a�n
Qm7t s �� D L
State A C
— F! Z2 c r%
.0 Ck <.o%
ZIP 2'7 (. S Sf
Authorized Agent
Project Location (County):
Street Address/State Roa4q of #(s)
Subdivision •C oLK— ✓i ne: y we t .Sgt c
City a- n T b ZIPg—
Affected ❑ cw NEW U�fTA ❑ ES PTs Adl. Wtr. Body %l A n o K•-- -5% to ^ 4 Unathnan/unk)
AEC(s): OEA IHA UW SPIMA ❑ PWs Closest Mal. Wtr. Body se 14 -.
It
ORW: yes PNA: yes no
Type of Project/ Activity r% a �� 5 P i tz r �„� i 02 0 2, b"
Q , (Scale: Ao ►)
Shoreline Length 7 — = 10
Access Length 1 n b A bK C
Pier (dock) length r% Z+ r % fJ 11D AVM'
Fixed Platform(s)
Floating Platform(s)
Job f-
Finger
pier(s)
Total Platform area
b G
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Py�
,v
Breakwater/Sill
—
Max distance/ length
�!
t
Basin, channel
Cubic yards
Boat ramp
a+l
Boathouse/ Boadift
fr fC. D k L 14 k*iq
Beach Bulldozing
Other
✓y`
t
SAV observed: yes ro r`9 CA A
Moratorium: n/a yes no I U
Site Photos: <0 no
Riparian Waiver Attached: yes
A building permit/zoning permit may be required by: --D U•
Permit Conditions
A954 or Applicant PRINTED Name
Sign a "Please read compliance statement on ba k of permit••
Application Fee(s) Check #/Money Order
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
ND REVIEWED COMPLIANCE STATEMENT. (Please Initial) _
yv n n •t` <-e.r t/ q-(—
Per It Officer's PRINTED Name
e ,;
2S,g 7`g
Issuing Date Expiration Date

OPEN PIPE
1SURVEY IS SLMJM TO ANY FACTS THAT MAY HE
- EX. REHAR
DRXXOSED BY A FULL AND ACCURA7E ITTLE SEARCH
Q - 2 RIMAR SET
DL
- EX 4' X 4' CONG MOH.
CO'
2 AREA HY COORDINATE COMPUTAIION� m OWN
3. F.L&M. ZONE; AS SH01MN
MML SET
- EX MAG NAL
0 - MAC NAL
4. PIN NO.: 11 988007 77 0574
5. RECORDED REFERENCE M.B. 4 PQ 9* D.H. 247Z PG. 72
EL UMUU
SET
Z8r - CALPONT
®- M
BURDIN0 LINES (ll8 I IF SHOMN HEREON, ARE PER THE
CURRENT
M
k&-TEE R
PHONE MEPEDESTAL
®- C,A.T.V.
Y BE
APPLY AND MUST VERi M)
PRIOR TO CONSIHUCINK
7. ElEVATION3 (UAW 1955): AS SHOMRI
POLE
�:977 & PROPOSED LOT COVLRAt5.&F. (25.2*
- GAY MLRE
>L PROPOSED C A." LOT (CA" A= MIEA _ 7,,�� &F.)
- FIRE H T
1
�"{ s .a / /
�- . PL - PROPE10fY iL /
s m - WATER VALVE
HFNcmmw RIP-f
ROANOKE'SOUND
3' AG
Owl
CA/?a t''•r•
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SEAL f
L--2592 1=
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a�
'�'• YAY ``l2 fv
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LOT 14
LINE TABLE
Lw
LE140M
BEARING
L3
K8
Ns3WE
L2
30.01
!L`i
L3
100.01
S36 • 'E
L4
30.01
553 '00'IM
L.5
2136
Ld
99.27
N3 47'W
L7
Z33
'=5
LB
0.70
'pggy
L9
100.05
00
100.05
44'
Ell
13.19
5. -W
LIZ
7.09
1N i�
OVERHEAD �ilN�
uTLs. (TYP.)
FLUS,
kk-
S 37VWI4' E 102.49'(TIE) -i
tM
epic Layout Approved"
y DCDHHS, DF,'!-i, EH U
Ir N.FJ.P. ZONE: AEI B-M 5-0
—m—N;F1.P. t�
— f 30TCAlAA SUFFER— '�
I - �
I
I �
I
�O. PORCH
31
W/F D* ' NG ON I
Q i F7EN05 W/O GE
I C SLAB I
I ; PORCH 4 2&5�
S.R. 1120 (30r R/W)
(110IE NO N.0 AT. R/
v L1 a
N 36101'42'-W- G9.Rg fmrN
(23.656 S.F.)
(SOUNDSIDE PORTION)
re-0-
�75 CAMA AEC
LOT 16
0.5
IN
(fDMR"E? N 38.341 e /fly 200.02'(1iE}
0.2' e
z PG. 94 ,
ElE11i tal)!D)
C BG
N �
(NOTE ME WCACM R/# AUNT I
DA 3K PG. 284)
•30' CAMA BUFFER

%2-7/2-z
V
AGENT AUTH0Rt7_ATiON FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit t ,` `t ri
Mailing Address:
Phone Number:
Email Address: 11NOxi c- i ce-?a-c-
i certify that i have authorized_Sk
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at
in - County.
1 furthermore cerfify that 1 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:
Title
'Date
This certification is valid through 1
ReM ed Mar. 2016

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: Ell Q
Address of Property:
(� . �- 1 rcoCal
Mailing Address of Owner: C'
Owner's email: ' �(j► � �1 ' 6 c. l6tf bwnees Phone#: � ' n
Agent's Name:Agent Phone#:-„f :Dc
Agent's Email: t m e- Cc, n4a C ^
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be completed by 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
' or drawwith dimensions must be provided wtth this {ette,
�t,,Tu. (' p 1r' �� � _du 1 w �U_ ,r rY�
I DO NOT have objections to this propo 1. 1 DO ha a 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
notffred by Cued 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/ail of the 15' setback
Signature of Adiacent Riparian Property Owner
-OR-
! do not wish to waive the 15' setback requirement (initial the blank) k�
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: :F1E;j.b.5L-EFL,
Mailing Address of ARPO: �d Boy
ARPO's email: re ARPO's Phone#:
Date: "waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

■ Complete items 1, <, wtu
■ 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 mi ilpiece,
tha front if space perrtt
t t C' ne
D. If eeYESentdelivery address below,
Mail Express®
cL 0 Priority
To',tTied
e Type 0 Registered Mait""
ignature Registered Mail Restricted
II�'I�I�I IYII Ill IIII II Il� II' I�III I'I'llll I'llignature Restricted Delivery 3 iivary
d Malh9 ❑Signature Confirmation'TM
d Mail Restricted Delivery Signature Confirmation
9590 9402 6361 0296 8650 84t on Delivery Restricted Delivery
t on Delivery Restricted Delivery2� eNumber(franS� roService abel i Mail Mail Restricted Delivery
7020 3160 0001 2523 8383 500) Domestic Return Receipt
Ps Form 3811, July 2020 PSN 7530-02-000-9053
�. .
■ Comp
lete items i , 2, and I■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to fahe bacy ce permosthe mailpiece,
or on the front if space
1. Article Addressed to'
Fi
-,:•,. . R6 Amit y
0 Addressr
hw
by (printed Name) C. Date of pe1�
0 es
delivery address different f m item 1?
8S, enter delivery address below:
D. Ia YE
0 priority Mail ExpMss®
1� L L
3, service Type
❑ Registered W"
Mail Restricted
O Adult Signature
0 Adult Signature Restricted Delivery
❑ Registered
Delivery -f'matlon7m
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'I'I'I���II" II1�D I'll •I����'���
certified Mail(9 flied Mail Restricted Delivery
p signature Confirmation
I III"I
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Restricted Delivery
Be stncted Delivery
9590 9402 6361 0296
0 � on Delivery
M a�M — — -
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ri Mail Restricted Delivery
" '� 2 ` - 2523_ 8-3`1fl
__=----
DomesticReturn Receipt
381
Ps Form ,July
LL

PostalPostal
CERTIFIED MAILO' RECEIPT
CERTIFIED MAILO RECEIPT
m Domestic MailOnly
rn
Domestic
C3
Monteo:_i
Mantesr NC 27954
.�
Q' Gentled MW Fee -, rI' ..
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Certified Mad fee $3 .6�1
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Adult S.1ii Rotmlctad 06"1 $
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\� \ This map is prepared
from data used for the 301 Mother Vineyard RD Owners: Wagoner, Gerald R -Primary Tax District: Manteo Out
y' O� inventory of the real Manteo NC, 27954 Owner Subdivision: Mother Vineyard Section 1
property for tax
Parcel: 024387000 Wagoner, Lisa H -Primary Owner Lot BLK-Sec: Lot: 15 Blk: Sec: 1
purposes. Primary
'n information sources such Pin: 988007770574 Building Value: $0 Property Use: Vacant Land (Private)
as recorded deeds, plats, Land Value: $323,000 Building Type:
wills, and other primary
Misc Value: $0 Year Built:
t public records should be
����
I f f � � �R��� consulted for verification Ihp'} Total Value: $323,000 ()
of the information
contained in this map. n^_
EN

Dare County 2021-23
Local Government Permit Number
RECEIVED CAMA
J U N 1 5 2021 MINOR DEVELOPMENT
DC/� as authorized by the State of North Carolina, Department of Environment,
�J and Natural Resources and the Coastal Resources Commission for development
m an area of environment concern pursuant to Section 113A-118 of the
General Statutes, "Coastal Area Management,
Issued to Jerry Wagoner authorizing development in the Estuarine Shoreline (AEC) at 301 Mother Vineyard in Manteo,
NC, as requested in the permittee's application, dated 06-10-2021 and received on 06-11-2021, This permit, issued on
06-15-2021, is subject to compliance with the application and site drawing (where consistent with the permit), all
applicable regulations and special conditions and notes set forth below. Any violation of these terms may subject
permittee to a fine, imprisonment or civil action, or may cause the permit to be null and void.
This permit authorizes: the construction of a single family dwelling, and associated site work
(1) All proposed development and associated construction mast be done in accordance with the permitted work plat
drawings(s) dated received on 06-11-2021,
(2) All construction must conform to the N.C. Building Code requirements and all other local, State and Federal regulations,
applicable local ordinances and FEMA Flood Regulations.
(3) Any change or changes in the plans for development, construction, or land use activities will require a re-evaluation and
modification of this permit.
(4) A copy of this permit shall be posted or available on site. Contact this office at 252-475 5849 for a final inspection at
completion of work,
(Additional Permit Conditions on Page 2)
This permit action may be appealed by Ole permillee or other qualified persons
within twenty (20) days of the issuing'cipte. This permit must be on the project
site and accessible to the permit officer when the project is Inspected for
compliance. Any maintenance work or project modification not covered under
This permit, requlre further written permit approval. All work must cease when this
permit expires on: DECEMBER 31, 2024
In issuing this permit it is agreed that this project is consistent with the local Land
Use flan and all applicable ordinances. This permit may not be transferred to
another party withoul the writlen approval of the oivislon of Coastal
Management.
Check in the amount of $100, was received on 06-11-2021 for the permit
fee.
NOAH H GILLAM
CAMA LOCAL PERMIT OFFICIAL
P. 0, Box 1000
/Af TEO, NC 27954
RMITTEE
(Signature required if condillons above apply to permit)

D1 OP ll WE
—Y� SUBJECT10 ANYFACTS THATUAY
0 EX
A
0 - 1/12" REM SET
AND EA416iIS Jk RES.RICip6 NBAIm
- EX 4' X 4- CON. YOLI
2 AREA BY COOmNATE OOPUTAYM - AS 9NIM1
CONIC. YDN. SET-
S F1RIl ZDM AS SHOWN
4 PINND- 11 98M 77 0574
- EX. YAO NAB.
'S RECORDED REFERENCE Wi 2. PG 94; DA 247Z PG 72
0 - NAB NAL 4T
L WSW RUM L11ES OWLI F SIM EFMK ARE PER IE
)$(- CAIaLMED POINT
GARB LOCAL ZONING E91L "m OTHER g®AM
®- WAIER MEER
AND/OR RES11=XNS MAY APPLY AND IINBT E VERIFIED
PNOIE PEDESTAL
- CAT.V.
PRIOR 70 CONSIINJCROL
7. E1tVA7NN5 (NAND 1 AS SHOW
UTILITY POE
6 PRWOgD L6T CDNERAf�S.F77 SF. (75.2%)
GUY WARE
0. AIOP0:9® CAWL !Df COL9T'L (r, u, AF.0 AEA . 774 SF.)
HLOP. LDT COVERM N CA.HA AE.C. - 1.1E2 SF. (2T77n
- F9E HYDRANT
®- ELECT. TRANS
10. DARE COUNTY ZO SIM ' R-1'
o AB - ABOVE GRADE
1 BG - BELOW MADE
:•� PL - PROPERTY LINE
['. PC - WATER VALVE
-
(?�� - BENCFHYA7atL
ROANOKE SOUND
fi
1; VINYL BULKHEAD
p
L3
7
N
3' AB NPI.P. ZONE- AEH 11F£: 5.1
Y. LF.E: 1.0�
N.FJP.
30 e tl N 36'01'42'-W- 99.62'(71E)
„
(23.656 S.F.)
�,``;`\.\ CA%1 .� �
�
�
(SOUNDSIDE PORTION)
qV-SS
PORCH
`
SEALr=: s
-PAaP1�$rDR,�
LOT 16
•';�;
L-2592
9
I
W/P DWEIIJNG ON T'
PILINGS W/GARAGE
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sum ,.•
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. / $
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71F CAYA AEC
LOT 14 ' 40
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CR
LINE TABLE
LINE
Lf i
DEAMM
Ll
20.86
N53WOON
L2
Man
LS
100.01
9B'55
L4
30.01
L5
23-%
LB
99.Z7
4
L7
2S7
Ul
100.06
LID
100.01
L11
111.
L12
7OB
(ROM SEE 06 MB, NG0.0.6. PL R/W ACIEDeIIf
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S 37'09'14" E 10249'(TIE)
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(.LO1E SEE
/W AGREEMENT
D]A4T. R. m4 I -
30 CANA BUFFER - —--- 4
epfic Layout Approvew- +"�L70 N�
y DGDHHS, DPHB EH U """` B"` Dwow
OM
XCK
n .r7 2iOT CANAL FWNDA11�ON
y 6 S.F.) NOTE: PROPERTY EXTENDS TO
THE CENTER OF CANAL
SURVEY FOR
GERALD R. & LISA H. WAGONER
LOT 15 - SEC. 1 - moTHER VINEYARD SUBDIVISION - ROANOKE ISLAND
NAGS HEAD TOWNSHIP — DARE COUNTY - NORTH CAROLINA
40 o ro •.:�� �.' :^ SEABOARD SURVEYING & PLAMUM INC. C-1538
1 inch = 40 ft. 103F W. WOOD HILL DR, P.O. BOX 58. NAGS HEAD, NC 27959
2109706 suarY©,04/14/z1 .m OFFICE [phone] FAX: (252) 48D-0571
P0.

2021-09-03
WAGONER
,r09-03
mum
2021 - 03
-11 t$'F
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2021-09-03

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NC Division of Coastal Management
Cashier's Official Receipt
Received From:
'ermit No.:
kpplicant's Name: Q a
Project Address: —s6 a
166210s C n
Date: Z-3-20 � 'Z�
Check No.: Z - �/ /
County:
e
Please retain receipt for your records as proof of payment for permit issued.
Signature of Agent or Applicant: '
Date:
Signature of Field Representative: l
V Date: 2' /3 l2Z