86484A_Baker, George & Donna_20211221

AMA ❑ DREDGE & FILL Na 86484 @ B C D
:N E RAL PERMIT Previous permit
Date previous permit issued
r []Modification ❑ Complete Reissue ❑ partial Reissue
7 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 /i- f El ' i a1
, ❑ Rules attached. IR General Permit Rules available at the following lima- www.dea rw-ggM CAPIAruies
Applic�,tName 01ft e- l inno.--- �� Aud,octudAgent .••--
Addres`s�� tg(Q 1` 4Ce0, �kw ¢l . Project Location (County): `P14
tK� ii r tic3n3 _
city ktt3i-eJn state ` tVC zap _ 2 `q `i 4 Street Address/Sme RoadtLet #(S) 1[A # o
Phone # (7�z� 3 i Z � 54 (o`i 1R i r% 3 ( e,,, UU
Emall Subdivision Cor,,P- L9 r-MPQ„
City— �j zaP___274yy
Affected ❑ cw YIEW ® PTA ❑ ES ❑ PTS Adj. Wtr. Body yN�)
AEC(s): ❑ OEA ❑ 114A ❑ uW ❑ SMMA ❑ PWS Closest Maj. Wtr: Body - . L 1 bC4Kal !+ 50-,,j
ORW: yes/to PNA: yes/
Type of Project/ Activity epyv5 tykel Ck %S X 5 Qt�'ar- (.��% Z� ` A / r ,•� n'1
4 `, i ii�Q S C cvnS� n z5 ` k (y ,ro,c� 1 t`co� Zl/ZZ c"`�iC (Scale' i'.L j
- f
1
Shoreline Length
_ f Q
Access Length
Pier (dock) length 5 Ic-!�-
Fixed Platform(s)
!
Floating Platform(s)
Fingerpier(s) r it-`nt
Total Platform area 37 i + + t �- - 1 ;
iadt iatb
Groin length/#
Bulkhead/ Riprap length f .
Avg distance offshore
BreakwaterNil
Max distance/ length , I I � - �_.-.•�_
q 1 1 I t
Basin, channel-',--t-rt-
Cubicyards _.ra-r-t-.,
t j----.•t i i '
_L_
Boat ramp.1
_ I
�� 1
C13oantoa / Boailift ~ U ' x r 7
Beach Bulldaziinng"
Other
^—
SAV observed: yes
, . r
Moratorium- r '
/a es no -�- �-a--'
Site Photos: ,) e-- ..�)_ t (� t
Riparian Waiver r. Attached: yes
A building permit/zoning permit may be required by: Vic,.GL tyt�L>itiS eoc4�
Permit Conditions �.� �6 t1i7 t T to t7 f �+' t yyc,� _ , ❑ TAWPAM/NEUSE/BUFFER (circle one)
�� W t � " ' L$i • •^ men C�+�-- ❑See note on bade regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES CRC RULES AND CDNDTt'ICINS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) _
i1
r "t fI / V _ ' F
Agen pIicant-PRINTED Name- Permit s P NTED Nam
Signature "Please read compliance statement on back of permit" Signature
3 a cb, Qu j _ I z-/ V /Z f 4� 1zi f
Application Fee(s) Check #/Money Order Issuing Date Expiration Date
Riparian Waiver r. Attached: yes
A building permit/zoning permit may be required by: Vic,.GL tyt�L>itiS eoc4�
Permit Conditions �.� �6 t1i7 t T to t7 f �+' t yyc,� _ , ❑ TAWPAM/NEUSE/BUFFER (circle one)
�� W t � " ' L$i • •^ men C�+�-- ❑See note on bade regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES CRC RULES AND CDNDTt'ICINS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) _
i1
r "t fI / V _ ' F
Agen pIicant-PRINTED Name- Permit s P NTED Nam
Signature "Please read compliance statement on back of permit" Signature
3 a cb, Qu j _ I z-/ V /Z f 4� 1zi f
Application Fee(s) Check #/Money Order Issuing Date Expiration Date

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner:
Address of Property:
Agent's Name #:
(Lot or Street #, Street or Road,
Mailing Address: I .Y
Agent's phone #:
DEC - 2 2021
I hereby certify that I own property adjacent to the above referenced property. ThejjihJi
applying for this permit has described to me as shown on the attached drawing the detielopment E
they are proposing. A description or drawing, with dimensions must be provided with this letter.
49AI have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the 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 (252)
264-3901. No response Is considered the same as no objection if you have been notified by Certified
Mail.
WAIVER SECTION
I understand that a 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. (If you wish to waive the setback, you must sign the appropriate blank below.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
eAL�-U
Signature
irea: , fZ , Z,4
Print or Type Name
106 LY�-'Ax) 164cy A)
Mailing Address
City/Stat /Zip
Q.5.2- 3 ls;L S 916 �
Telephone Number / Email Address
Date
.Valid for one calendar year after signature'
(Adjacent Property Owner Information)
Signature*
7 e-,,
Print or pe Name
Mailing Address
NC 27?elY
City/State/Zip
408-.rfg-7/, ,�'/cimaJ'-asc17@JN.a;
Telephone Number /Email Address
is --i- z �
Date*
Revised 2017

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner:
Address of Property:
Agent's Name #:
Agent's phone #:
(Lot or Street #, Streef or Road, City`rcounty)
Mailing Address:
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.
® "66 I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the 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 (252)
264-3901. No response is considered the same as no objection if you have been notified by Certified
Mail.
WAIVER SECTION
I understand that a 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. (If you wish to waive the setback, you must sign the appropriate blank below.)
i.�
(Property Owner Information)
Signature
Print or Type Name
/0L 6C,,EAA);M,�/.A)•
Mailing Address
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
/c6 Q Al G d— ,rVY
City/State/Zip
Telephone Number / Email Address
Date/ l¢Zo�-
*Valid for one calendar year after signature*
(A 'a ent Property
Owner Information)
ignature
EI for 47K,11-t
Print or Type Name
Mailing Address
-AiL
City/State/Zip
Telephone Number I En
yKil Address
1 C
Date's
Revised 2017
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Green: Green 0 0.01 0.102 0.04 km
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Blue: Blue INCREMENT P, USGS, EPA
lmagery2016
Perquimans GIS
For lax purposes only Not a legal document or stffvey Perquimans no, '.,late of NC assume any liability restilling fiorn use of this map

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256 Ainsley Rd
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner: �L� �Cr.r:" t (U /�
Address of Property:
Agent's Name #:
Agent's phone #:
(Lot or Street #, Str4et or Road City & County)
Mailing Address:
a �'ku
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 have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the 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 (252)
264-3901. No response is considered the same as no objection if you have been notified by Certified
Mail.
WAIVER SECTION
I understand that a 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. (If you wish to waive the setback, you must sign the appropriate blank below.)
I do wish to waive the 15' setback requirement.
o
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
Mailing Address loll
City/State/Zip
02 �� 3
Telephone Number / Email Address
(Adjacen Owner Information)
Signature
- A em
Print or Irype Name
2 < 2 R d.
Mailing Address
f L,AtC- 2-79V _
City/State/Zip
4 J 8 —s/ J —7/J'J---
Telephone Number /Email Address
3-/C—ZZ
Date
"Valid for one calendar year after signature'
Date*
Revised 2017

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner: (TC,2�Ky-L"' i !l k&rp'
Address of Property:
(Lot or Street #, S
Agent's Name #:
Agent's phone #:
or Road, n y & County)
Mailing Address:
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 have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the 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 (252)
264-3901. No response is considered the same as no objection if you have been notified by Certified
Mail.
WAIVER SECTION
I understand that a 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. (If you wish to waive the setback, you must sign the appropriate blank below.)
do wish to waive the 15' setback requirement.
1 do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
koyee'lle 2, �341ee4
Print or Type Name
io6/ occ w dtv y A)YT11
Mailing Address
Ate- C) A) C9- V91
City/State/Zip
3Lo2 546 y
Telephone Number /Email Address
3
Date
*Valid forone calendar year after signature*
(Adjacent Property Owner Information)
-Signature *
Print or Type Name
Mailing Address
c-47�y
Cityyl State ip % 7
Telephone Number /Email Address
Date*
Revised 2017

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