84558C - D Dubs Real Estate co Wilkerson, Roy

0(whit ®CAMA ElDREDGE & FILL N�) 84558 A B g D
GENERAL PERMIT Previous permit
Date previous permit issued
(New ❑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:
15A NCAC ()T N ( i 0t) ❑ Rules attached. [�Z General Permit Rules available at the following link: jN d¢o.Tt gmICAMArules
Applicant Name D R06�'6 Re'A(� A9F L% 1/. UIIGK/-:7LS�iN Authorized Agent FNN�P.WI CONSTQ,--Clt&
Address ,1-fu 5FILIS F! Pil�,} v Project Location (County): r7NSGOW ntr. VAJ�
L�
City _06 State —y(�___ ZIP � t Street Address/State Road/Lot #(s)
ro
Phone#( ) Z11 �1&r"r Qy _._
Email m—ca A/Ut141L. CDAI Subdivision _
City 5&MbS ZIP 28Z1Lo/7
Affected ❑CW gEW PTA OES ❑PTS Adj. Wtr. Body �Q R� man/unk)
AEC(s): ❑OEA ❑IHA gS uW ❑$PIMA ❑PWS ClosestMaj.WinBody
ORIN: ye?,41�o 1 PNA: yes45>
Type of Project( Activity
Shoreline Length 1.51
Access Length
Potf`
Pier (dock) length 'S�t t,.t,,,.l
,t
�'� •T'�.
''(tl
Fixed Platform(s) ,��r }(.�-L_�_
r
jft� .':—i--
Floating Platform(s)
Finger pierls
MtNA1 r,t(lls"r' 3 u t
V 1'1
Total Platform area
Groin length/B
Bulkhead/Riprap length
Avg distance offshore Z,
Breakwater/Sill
t4o
Max distance/ length l�
Basin, channel _
Cubic yards
Boat ramp
Boathouse/ Boatlift l
Beach Bulldozing
Other
SAV observed: yes l"9'
Moratofun/a yes
Site Photos:
m: s 'wo lt� �I`tilJf�s
Riparian Waiver Attached: es no
A building permit/zoning permit maybe required by: _. u L19W _ A)n
Signature "'Piefce.rOad compliance statement on back of permit"• Signa)Z
iota �5�3 _
Applicafian Feels) EI etk p oney Order Issuing
❑ TAFVPAMINEU$E/BUFFER(circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please Initial)

OteAf741 ®CAMA El DREDGE & FILL ft"l � kr N9 84558 A B 9 D
Previous GENERAL PERMIT ' 4-110 Date pre io slpermitissued
I-ONew ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the 1S1tate of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC n� TA 12c�D ❑ Rules attached. V General Permit Rules available at the following link: wwwdeg nc gov/CAMArules
Applicant Name D UUBIS
WAI. 47,A'rF ib go
IA)1t r&-a nN
Authorized Agent F-Po toi (fists IM-riop
Address 17-M 5(-,VSOA)
M.
Project Location (County): 09tow (f♦iUAITV
City 06tm
State NG
ZIP �XQl
Street Address/State Road/Lot#(s) 105 QLUfe"O.�ID b� .Ll�•
Phone # ( lo) Z79
521089(Z F!'Q {LY
Email �w.pO®BS
C m/-1-IL. ("DNI
Subdivision
..
City SNPADS —raO ZIP
Affected ❑ CW
®,EW PTA
ES ❑ PTS
Adl. Wtr. Body a man/unk)
AEC(s): ❑OEA
❑IHA guW
❑SPIMA ❑PWS
Closest Mal. Wtr.Body uLOW
ORW: ye?(<> PNA: yesO
Access Length /
Pier (dock) length��n1t1
Fixed Platform(s) ld LryI
Floating Platform(s)!
Finger pier(s
6'U ',
3 X?41
Total Platform area Y�
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill r
Max distance/length
Basin, channel
Cubic yards
Boat ramp
Boathouse/Boatlift
Beach Bulldozing
Other 1
SAV observed: yes f)
Moratorium: n/a yes o ya�
Site Photos: `lam fSftN4 �_DU1�7
Riparian Waiver Attached: es no N.IGtI�t�
A building permit/zoning permit may be required by: V 119tv L1wVQ
THAT APPLY TO THIS
Agent or Applicant PRINTED Name
Signature** Please read compliance statement an back of permit** �Siss
Zoo, Z —;
Application Feels) - Zk# oney Order Issuing
❑ TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin'rules
See additional notes/conditions on back
(Please Initial)
Date

AGENT AUTHORIZATIUN FOR CAMA PERMIT APPLICATION
"p vub5 iT Ge&( 6s+bir- / L I (—
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: _ _ 6I . SPn A II
at
in
l furthermore certify that l am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit OfiScer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Innff ornurtion:
t0 a )4 mftbw
Signat re
trpu VVl l La�m
Tint or Type Name
Title
Date
This certification is valid through
Pil a hr-

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) 1
Name of Property Owner: Tr6\j W I l k2r5Ojp ID DUbS qL
Address of Property: 135 i yz tr J e
Mailing Address of Owner: —ILr Q
Owners email: _t- OU. ��( %]��00wner's Phone#: - 1
Agent's Name: FnQn A MO i j) �yf ,161 G � aj Agent Phone#:_ CI I D - 0 a rl - 34 5
Agent's Email:�Cllleij)>Gll
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
- rD �L des�<x ptiion jor Mwlnc with dimensions must be provided with this 1ptter.
Dy) 4—V#_ f DO NOT have objections to this proposal. I DO have objections to this proposal.
N you have objections to what Is being proposed, you must not the N.C. DNlsion 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 some as no objection if you have been notllled by
Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
(A 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 rlprap revetments). (If you wish to waive the setback, you must sign
D� 51 Gt the appropriate blank below,)
J I DO wish to waive some/all of the I V setback
-OR-
Signsfur s of Adjacent Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: 1 fk
Mailing Address of ARPO: r
0A 3a k `` R 5 n s 1= r 20
ARPO'sehmail: �1 dooc�leh����y�6ARP&s hone#:g10 �1`il it �nQ
Date: 2 f t� *waiver is valid for up to one year from ARPO's Signature"
Revised July 2021

N.C. DIVISION OF COASTAL. MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
CCRTflo MAIL • RETURN RECEIPT RE%LESTFD (gAN HD DF.LIVFRY
(Top portion to be completed by owner or their agent)
Name of Property Owner:
Address of Property:
III
A906
Mailing Address of
' I� rn
Owners email: Otl,I�tJ `",gffi tll'COOw)ner'sPhone#_
Ayent'sNamo:�Il�1hT7f<IYIfIEL.Jf1.`i7i'LIGII(�AgontP/hone#:�/O
Agent's Email: C%�/)( }mull 111cG-o lru(,- Oa4'gma Com
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(f3ott2rn g9111on to be comntatod by the Adjacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
�hA"Lt\ dpermit
ohas
lon o described
vA1 a moshown
nslons. must be orovededmwith g)ithe t Qevelopment they are proposing. A
I DO NOT have objections to this proposal. I DO have objections to this proposal.
If You have to what Is being proposed, you must WO the N.C. Dlvlslon or 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
of [phone]. No response Is considered the same as no objection N you have been notified by
Certified Mall.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
(k groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
CIlt G )i (this does not apply to bulkheads or riprap revatments). (If you wish to waive the setback, you must g.Ign
t the appropriate blank below.)
100 wish to waive somelall of the 15' setba
Signature cent Riparian P erty Owner
-OR-
1 do not wish to waive the 16 setback requirement (Initial the blank)
,ale Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
✓ ch��tt Melling Address of ARPO: / t� Jam/ FYI J
ARPO's small: UtlGi Z �'L ARPO's Phone#: y/o s�
Date:. ;I' 'waiver Is valid for up to one year from ARPO's Signature`
Revised July 2021

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