Daugherty, Daniel & Melissa 84556C

❑ DREDGE & FILL NC 84556 A B (P D
s GENERAL PERMIT Date Previouspermit
3 Date previous permit issued
M 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 F
❑ Rules attached.
Applicant Name
Address lli)l M IX)
r
City State -_ZIP
Phone#(-_�)::�ilt�
Email : "�), 0 h0i A-Ies l
�0 General Permit Rules available at the following link: www.deq.nc.goy/CAMAruIm
Authorized Agent 6(�1 7
Project Location (County): OAX((1 W
Street Address/State Road/Lot #(s) �" 1
Fl.
Subdivision
City ZIP
Affected El CW MEW 10 PTA FOES ❑ PTS Adj. Wtr. Body ✓/rr/./� Ct '�' 10 A /�1 V' l� fna(/man/unk)
AEC(s); ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body 11JU�(❑ �?d1�rY
ORW: yes/tlo PNA:rQ/no
) � n
Type of Project/ Activity ' O&C) &'Y air) �iU M n(r(e h L A Y l (n1 i " Piil , t r) Ew( l)
(Scale:1", qp' )
Shoreline Length I i.{'
Access Length v ?. 6
Pier (dock) length �n 1 So
Fixed Platform(s) Ile)'
Floating Platform(s)
Finger pier(s)
Total Platform area "I isfe'1 Z
Groin length/q
Bulkhead/Riprap length A
Avg distance offshore
Breakwater/Sill ✓
Max distance/length -�
Basin, channel
Cubic yards O
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other) /l'/i(A117.Uj%
Lip ( i
SAY observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by: /N `iUyt ( A/,
Permit Conditions ( s ' l`--'' 410 1700M/T0Z N-P
PROJECT AND REVIEWED
Agent or Applicant PRINTED Name
Signature **Please read compliance statement on back of permit** /
Application Feels) Check H/Money Order
TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
See additional notes/conditions on back
(Please
Permit Ofhc is PRINTED Name
Signatdre ..
-1 21 i - <<
Issuing Date Expiration Date

1*1COAS74Z EICAMA ❑ DREDGE & FILL N° 84556 A B C D
ermit
GENERAL PERMIT Date previous Previous Date permit issued
0 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:
15A NCAC ❑ Rules attached. Sa General Permit Rules available at the following link: www.deq.nc.Roy/CAMAruIes
Applicant Name
Address
City State
Phone #
Email
Authorized Agent J, '
Project Location (County): 1.) / K I J
Street Address/State Road/Lot #(a)
;i
Subdivision
City ZIP
Ad' Wtr. Body..� t' f� nat/man/unk
Affected �CW �EW PTA �ES ❑PTS I•- ( )
AEC(s): ❑❑❑❑❑
�.,OEA IHA UW SPIMA PWS Closest Mal. Win Body
ORW: yes/no F, PNA,,des/no
Type of Project/ Activity t
(Scaler'
Access Length l.;, ) s
_
__-
( _.
_.__
Pier (dock) length%%,
Fixed Platform(s)
._
Floating Platform(s)
Finger pler(s)
Total Platform area
t
Groin length/q
i`
r
I
-
Bulkhead Riprap length
Avg distance offshore
—;
-
—
Breakwater/Sill
r-
V
I
I
Max distance/length
Basin, channel
Cubic yards
h,'�..
Boat ramp
Boathouse/Boatlift —
1
_
i
r
Beach Bulldozing
4
Other I G t ;,: .d /.I 17 L, U
_
.�
`
""
—�
i
I
SAV observed: yes no
Moratorium: n/a yes no
j
Site Photos: yes no
� —
Riparian Waiver Attached: ves no
A building permit/zoning permit may be required by:
Permit Conditions
❑ TARIPAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ 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) �-
i
Agent or Appicant•PRINTED Name Permit Officer's PRINTEDName
Signature "Please read compliance statement on back of permit'- /�--/�1�,�— •t Signature
Application Feels) Check #/Monti Order Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
2 h & r,-A Jk Nc
2 g' ,5
Agent I contr ctor
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 D/OSfc,,,-0 County.
1 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 0 ner Inform t n:
4Aignature
Print or Type Name
Title
�1 7-Z
Date
This certification is valid through 1 Z2 1 �Z, Z

N.C. DMSION OF CVASI AL MAXAvGM5i--1V 11
ADJACENT RIPARIAN PROPERTY OWNER NOTISCATOMA"t FORM
.. fi nwtsV
(Top portion to be completed by owner or their agent)
Name of property owner. b J
�lVla,'d s�Ks pY- -(bar �f-
Address of Property: (� / ? G
Mailing Address of Owner. Y-� % G Kr L, 5hrc s Dr. f7 d fie/ �L a r7 S3 1
Owner's email: c J,-,k 1 (3 �W� r_G«, Owner's Phone#-.
Agent's Name:
Agent Phone# �� ' S $-ql r °y'IF
Agent's Email: Q 'Y Q © W\
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property Ownerl
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 he provided with this letter.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
n you nave 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 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection N you have been notified by
CerMod Mail.
WAIVER SECTION T ti
I understand that any proposed pier, dock, mooring pilings, twat 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.) �`x «
I DO wish to waive some/all of the 15' setback
-0R- Signature of Adjacent Riparian Property Owner .,
I do not wish to waive the I& setback requirement (initial the blank) /7
Signature Of Adjacent Riparian Pro A
Property Owner.
TyPedlPrinted name of ARPO: D o M A) c k 15 u 0.P S 1 p'- R
Mailing Address of ARPO: Sl q Nr W Byrd t S I T . �u 1 �. D T f 11 T�
JaLKSunYI/Y
ARPO'semail:{�a�%w�s/k�n�I�ROS'"Qrr`Co.� ��`�' 2-ig Ltv
ARPO s Phone#: ! U - 3 y6
Dace: Il ?- Z 2v6,
'waiver le valid for up to one year h om ARPO a Signature"
Revised

N.C, DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION�MIANER
(Top portion to be Completed by owner or their agent)
Name of Property Owner:
Address of Property:
Melling Address of Owner:
Owner's email: -I'd +, /y LLA tAra t I'c°&wnees Phone#: 3 d I Qd 5 7
Agent's Name:
f� Agent Phone#:
Agent's Email: h IJr �� �" /t .J t, n yvt
,
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(19ottom nortion to be completed by the Adlecent 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
dQ1Q letl0n er drewlno. with dlmwnnlnnn ,.....6 ,._
��l DO NOT have objections to this proposal. ry 11 I `D0O have objections to this proposal.
maned to 8- Commorce A n ' Morehead City, NC 28887. DCM represer
at (262) Mail, 08. No response 18 considered the same as no objaettor
Certified Mail,
VER
ON
I understand that any proposed pier, dock, moolrin psinga,lboat ramp, breakwater, boathouse, Itft,
groin must be set back a minimum distance of 18, from my area of dparlan'access unless waived t
(this does not apply to bulkheads or riprep revetments), (If you wish to waivo the setback, you t1d t
the appropriate blank below.)
I DO wish to waive eomotall of the 16' setback
I do not wish to waive the 16' setback requirement (Inldal the
8001turs of Adjacent Riparian p
lyped/PrInted name of ARPO:
r ARPO's Phone#:
"wstvef Is valid for op to ono yasrhe 'H
m ARPo'a denature+
Revised May 202,

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