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`TCAMA ❑ DREDGE & FILL No 85578 A B gC3P
t!GENERAC PERMIT Previouspermit
Date previous permit issued
[]Modification []Complete Reissue El Partial Reissue Zo u
As authorize by the State of North Carolina, Department of EnAronmental Quality and the Coastal Resources Commission in an wl, f �inmvnental concem pursuant to:
I SA NCAC Q ❑ Ruts a-Ched. i`-•' General Permit Rules available at the folkswing Nnk: www.dea.nc,pQv!
Applicant Name PA t f to a r t
Address
city �kt.�IuState
�_t* _ ZIPR
Phone # (9L16)
Email MwC�fsk!/2fyiJew:
/.
Affected ❑ CW ® EW
PTA ❑ ES ❑ PTS
AEC(s): ❑OEA ❑IHA
❑UW ❑SPIMA ❑PWS
ORW: yes / PNA: yesAO
Type of Project/ Activity
Authortsed Agent Ut
Prolect Laotian (Courtly):
Street Addrtas/Stam RoadfLoc #(s)
SubdivWon
city ZIP
Adj. Mr. Body
Closest Mal. Wtr. Body
did
-�-IAI wl.\/
(izc. A SG
Shoreline Length 9U w (Scale: &/#S
Access length r-._..__.....- m7-_
Pier (dock) length i j'� ~ - f -- ` ' I
; _ . ��' ... 5 �fn` � l- U rj'e.: �-\ v C,Jt!'' -77�>. .
d P"omn
FloatingPlatform(s)
Finger pier(s)J j� _ • �t i { ' i
TotalPlatformarea �10�_; �- �E�C.. f, Mo
Grainlength/ll_ { t7rta Plyl lo...s - - - •-•- _ -1_ ��_ - -
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Silt i bo�{IF_ _ .C-wA. (p xCly t _�_
Max distance/ length
F�CCiS .Q�✓"-( -_,
Basin, channel _. - -- Q �41 JM / t ---t • . _.�
Cubic yards
Boat ramp
Boathouse fro-atUft ! L 1 -T_ p 6 �Ci57 a a a� ���i�`o� a o D�'A •� a o,C' arc. -
Beach Bulldo mg
Other _ .....__.i - • •-- _-r-. ..-. t ��! .... .._. _.t._.....: .�'
SAV observed: yes
Moratorium: n/a yes n T-��.el�jS -•_' - _•- 1 ,
Site Photos: yes a\ • (is O \io�i+ (q1J' �1,Vv6lT1(J L) U ttU`,
Riparian Waiver Attached: yes
A building permit/zoning permit maybe required by:
A-(IIIVf �.. nSwc\�PermitConditions�
+ ❑7AR/PAMINEUSEIBUFFER(circle orte)
r r e ev --,% S Q Eb4 L It- 7-1 iCA � , t,L, k n t ❑ See note an back regarding River Basin rules
PKIK -21
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Age r scant PRIr:7fQ Name-
_ ..J
Signat•'PINse read complunce statement on back of permit"
Application feels) Check g/Money Order
Signature
Issuing Date Expiration Date
3&'jFCS',M ❑CAMA ❑ DREDGE & FILL N9 85578 A B
Previous permit
GENERAL PERMIT
Date previous permit issued
[] New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorize8 by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuar
15A NCAC ❑ Rules attached. General Permit Rules available at the following link: www.deq.nc.gov/CAh
Applicant Name
Address
City State C ZIP i4 j
Phone #
Email "Sk /2 1 t� fAIA.Of
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body n a .
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body i 1 '- �'� 141
ORW: yes/no PNA: yes fio
Type of Project/ Activity c% �_ �c r , � — t iLi �j /� 2--r c(
(Scale: N
Shoreline Length f 9U
I i
Access Length
i
Pier (dock) length ( ��
'x d Platform(s) L'b O l
IL t,
Floating Platform(s) j
Finger pier(s)
Total Platform area u
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/,-9oatlift V0
Beach Bull doz'n
Other
w
SAV observed: yes
Moratorium: n/a yes
Site Photos: yes - -'-
Riparian Waiver Attached: yes
A building permit/zoning permit may be required by: _
Permit Conditions(-- Z)
i4.0VC:.c lL
VXc-V1_� Pki CA A,. o1<r
+1
❑ TAR/PAM/NEUSE/BUFFER (circle or
2 (( , {, l� �� ❑ See note on back regarding River Ba!
1;.,<-
❑ See additional notes/conditions on b
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVI
Agent or Applicant PRINTED Name
(Please Initial)
Permit Office?s PRINTED Name /
ment of Compliance and Consistency
)ermit is subject to compliance with this application and permit conditions. Any violation of these terms may
ct the permittee to a fine or criminal or civil action; and may cause the permit to become null and void.
)ermit must be on the project site and accessible to the permit officer when the project is inspected for
iliance. The applicant certifies by signing this permit that: 1) prior to undertaking any activities authorized by this
it, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the
land use plan and all local ordinances, and 2) a written statement from the adjacent riparian property owner(s)
een obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(s).
tate of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
nation and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules 1-1 Neuse River Basin Buffer Rules
iicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules
he River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the
)ivision of Water Resources. If you have any questions, please contact the Division of Water Resources at the
hington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
!s/Additional Permit Conditions:
ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
t area and disposed of in an appropriate upland location.
n of Coastal Management Offices
ead City Headquarters
mmerce Ave Morehead City, NC 28557
18-2808/ 1-888-4RCOAST Fax: 252-247-3330
s: Carteret, Craven — south of the Neuse River, Onslow
es)
!th City District
Griffin St. Ste. 300
th City, NC 27909
4-3901
Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford,
Washington District
943 Washington Square Mall Washington, NC 27889
252-946-6481
Fax: 252-948-0478
(Serves: Beaufort, Craven — north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
910-796-7215
Fax: 910-395-3964
(Serves: Brunswick, New Hanover and Pender Counties)
AGENT AUTHORIZATION FOR.CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: rke- iVeI't.5
Mailing Address: 1 7q 8 5A,-411 o-
S�G A/<— a13470 _
Phone Number: �� l�� a ! — 9 as 9
Email Address: rn r,✓Qi P s k l t d-i q (,
I certify that I have authorized ge-4et, G cles Pa-�r d+ 60.+ Lip d- (9C14C MCI
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Bu; 1 j �04 fi Qdc/c C„ '
s o r,
at my property located at 1 7 1 S S4 c, i/o
in � cvnsL.,- c.K County.
I 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:
>(
' �-f�j
Signature
ffil(-Lda WIeItEltV
Print or Type Name
Title
RECEIVED
Date FE@ 19 2022
DCM WILMINC?ON, NC
This certification is valid through .`� I 3� 102z
N.C. DIVISION OF COASTAL MANAGEMENT
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)
Name of Property Owner: /M,• ke-- s t
Address of Property: 1'7?8 Ski 1/� fir,/Q� ✓�^; Sw, S�a 1/o-f{e t k-c_ L
i, 41
Mailing Address of Owner:
Owner's email: Mr✓e; sk., i r a f as n,nea.'/ Owner's Phone#: 309 ^ 56 3 3
Agent's Name: l.—Je_n, 6,'1-s -E-r`r'u� Agent Phone#: (c/o si a- 01i /
Agent's Email: ddc- /e
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that l 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 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 fDCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 127 Cardinal Drive EXT, Wilmington, NC 28405. DCM representatives can also be contacted at
(910) 796-7215. 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 16 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
-OR-
Signature of Adjacent Riparian Property Owner (ARPO)
I do not wish to waive the 15' setback requirement (initial the blank)`r
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: (' �. e / ( /1'i ,
��-
Mailing Address of ARPO: .1 7 4 C, � � � { /T7, � �-�.�� �_ �► � � �� �% c
ARPO's email, n 1cl1Ce i? tVe-- y$e�hucARPO's Phone#: `� 7 a `S- G Z 6 L
Date: _ z ,/ () V/,-) 09 -L *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021
o 9�ZOK
DCM WILYWiNGTON, Nisi
N.C. DIVISION OF COASTAL MANAGEMENT
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)
Name of Property Owner: M i Ke Sk
loop
Address of Property: I % 9 8 Skk l to -H e Tn 1A-4- �� `„z Sc✓ 5,�,, //a {{C ,vc
� T
Mailing Address of Owner: 1759 S r !td tFe T^ Je 1 6r, ..t- S L✓
Owner's email: M wai r s 1�� rr a l D J Owner's Phone#:
Agent's Name: Pe, -if, (:;i-(As Pa:4s'04 Agent Phone#: ('Ffo) 5-1.9-09 It
Agent's Email &Ifnv4dot4 sv r��,`s�,,.. �..'/ G9•-�
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 description or drawing with dimensions must be provided with this letter.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is bein 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 127 Cardinal Drive EXT, Wilmington, NC 28405. DCM representatives can also be contacted at
(910) 796-7215, 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 ❑O wish to waive some/all of the 15' setback
8i nature of Ad
-OR-
jacenf Riparian Property Owner (ARPO)
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: 8CX , 'T i*^-' 0 4A
Mailing Address of ARPO: 1717 .S ti- 1-,11
ARPO's email: ARPO's Phone#:
V
Date: *waiver is valid for up to one year from ARPO's Signature*
O)ep IeW rer Ca..✓ �4L1 OL- //v /Qt��!/�l�S ?"D j�l� lAc y Z . Zf Revised May 2021
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!NCJUsers!Patriot Operatiors/Desktop/1798 Shallotte International Dr Dock.wecp �/�
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Chock Fran Name
N&Parm&H0dW
Vendor
Chock numlwr
Ch-k
amount
POMM Numb&YCommanm
RaWpt or Rehmd/Rrlbutad
Cdumn2
Caumn]
Column)
Columns
Column0
Column7
Cclumnk
Columno
122
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122
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