86284A_Russell, Dean_20220321

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�`°u`"`�C�CAMA ElDREDGE & FILL Nn 86284 C B C D
3 GENERAL PERMIT
�Previous permit
Date previous permit issued
�jNew ❑ Modification El 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:
1 SA NCAC �7 r / "�-� b_-_ ❑ Rules attached. General Permit Rules available at the followinglink: ww _wd�q.nc.gpy/CAMAnJne
ApplicantName _ Z)-ec- & Authorized Agent `- r7�� 4.Y �n ct < I .'c Q
Address P v r �+ l % '2 _ Project Location (County): a._ j'-
city Ft-a-ett K 1 ; n, state W ti zip. 7-3 851 Streett/'f
Address/State Road/Lot #(s _ _ �. t 13 y
Phone#( ?)-�,so Ss�Y'7 _ / 7 1 /q
Email Subdivision
4z.-x, tt ES } �
City Mc-,%-11- -O () 2 -7 % S
Affected ❑CW ®EW MM [-ES ®PTS Adj. Wtr. Body u_ �r �a rcc S.z•.•.ti )( at/ an/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body ou a S `• v� tl
ORW: yel no ~ PNA: ye no
Type of Project/ Activity _�2,
Wo d e,r• to c,-+ c.r-
.f
Shoreline Length L?
Access Length _
Pier (dock) length
Fixed Platform(s) �Z
Floating Platforms)
Finger pier(s)
Total Platform area 7 i
Groin length/H _
Bulkhead/ Riprap length
Avg distance offshore `
Breakwater/Sill
Max distance/ length t
Basin, channel t
Cubic yards
Bo
athouse tli •!C / r
Beach Bulldoz ngg
Other 7 ', :L Z, r
tan wo"A n bw/K
SAV observed: yes
Moratorium: n/a yes no
Site Photos: 4a!a5 no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
Permit Conditions D ':.t
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I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS
-THAT APPLY TO IS PROJ
A ent or Applicant PRINTED Name J�-
Sig re "Please read compliance stateme�onback of permit"
Application Fee(s) Check N/Money Order
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AND
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❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please Initial)
cd-, v
PermitOfficer's PRINTED Name
Signaturf
Issuing Date Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT FHB 2 8 2022
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) DCM-EC
Name of Property Owner: Dean
Address of Property: Mailing{(�� Address of Owner: j y -S�N:F,ILI I n
Owner's email: Owner's Phone#: l S - ��� �
Agent's Name:.i `--IL mar -1 1i _ _— Agent Phone#: C � t
Agent's Email: ���1�C�1:,t1e Yir 1C1� �� 7�J1 COiY1
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
descri tip or dra 'n with dimensions must be provided with this le r. r� l OD V-C r U k)lc_i_ t
I- i Gbo �, \ ,'2-o u� WO- Ouv-\C: cam-
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I DO NOTLve objections to this proposal" I DO have objections to this proposal.
d�nr`
b 1 d ou must notify the N C. Division of Coastal
IT you have objections to what Is a ng propose , y
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 slan
the appropriate blank below.)
I DO wish to waive somelall 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: 0,' v� � iPS
Mailing Address ofARPO: i�{�lz��i�`f
ARPO's email:;Ui�L�� IPS� gvhk i i . Cord ARPO's Phone#:
Date: z12 6 /Z7. *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

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■ 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 mailpieoe,
or on the front If space permits.
1. Article Addressed to:
fNrkorx �a&r4�'� iCC
Cln V ) uL- Qr�ex,L}- p ic-
5ibt'1 (AOow►rJ
Lert cY, , vw ,aaoq 9
RECEIVED
A. Sigrur )
❑ Agent
X �' - � ❑ Addressee
B. Received (Fifhted Name)" C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
MAR 0 8 2022
DCM-EC
3. Service Type
❑ Priority Mail Express®
II
I IIIIII
III
III
I III
I I I
I I III
III
I I I III
I
I III III
❑ Adult Signature Restricted Delivery
❑ Registered Mail Restricted
INCertified Marl®
Delivery
9590 9402 6361 0296 8618 64
0 Certified Mail Restricted Delivery
❑ Signature Confirmation-
0 Collect on Delivery
❑ Signature Confirmation
2 Alftle Number
❑ Collect on Delivery Restricted Delivery
Restricted Delivery
—
7 0 2 0 3160 0001 2 519 0940
Mail
Mail Restricted Delivery
Ps Form 3811, July 2020 PSN 7530-02-000-9053
Domestic Return Receipt
40 3 A Z /2 'Z

Northeastern Manner Construction Ca �
P. O. Box 42
Kitty Hawk, N._C. 27949
261 3642
7020 3160 0001 2522 1378 1000
V.S.
LITMYEHTq EK' NCAID
27949
AMOU�iT 2
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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit
Mailing Address: n'LA
V�
Phone Number:
Email Address:
i certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development-. , 1 e�1 f �-_SNL-
at my property located at
in - -2'l C�..-r County.
l furthermore certify that l 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 „
Print or Type Name
TTj
Date
This certification is valid through
Revised Mar. 2016

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