Chalk, William 84149C

d a"� CAMA ElDREDGE & FILL N9 84149 A B OD
Previous permit
3 G NERAL PERMIT Date previous permit issued
New ❑Modification []Complete Reissue ❑Partial Reissue
As authorized by((the
rState of North Carolina, Department of Environmental Quliry and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC _j,� / „ 0 �`J r' ^ r -- ❑ Rules attached. General Permit Rules available at the following link: dq� r�cov/CAMArules
Appal t Name Authorized Agent
Addr f C Project Location (CountvY �L�,Ly-
Cary Stree[Address(SureRoad/Lo[#(s)__.,4�
`f
Phone # ( —
Email t"i Subd1hrislon' r•�n
City ZIP
Affected ❑CW �W . TA ❑ ES ❑ PTS Adj. Wtc Body (na an/unk)
AEC(s): ❑OEA ❑IHA aU_ W ❑SPIMA ❑PWS Closes[ Maj. Wir. Body 'z �
ORW:ye /`n PNA: yes'/o
Type of Project/ Activity U - �} /
(Scale %© )
N
Shoreline length '
Access Length
Pier length F
Fixedxed PlaPlatform($)
Floating Platform(s)
Finger pier($)
Total Platform area
Groin length/g
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ eoatlift
"
Beach Bulldozing
.J
Other
UL#'
LT
4)
SAV observed: yes
Moratorium: n/a yes' no f�
Site Photos: y1-
Riparian Waiver Attached:
A building permit/zoning permit m e required by:
1
❑ TAFVPAM/NEUSE/BUFFER (circle one)

❑DREDGE & FILL �L" N° 84149 A B OD
G NERAL PERMIT Previous permit
Date previous permit issued
New ❑Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized bytheState of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC r - — ❑ Rules attached. ;)4General Permit Rules available at the following link: wwwdeq.nc.gov/CAMArules
Authorized Agent
Project Location (County)
Street Address/State Road/Lot #(s)
City ZIP
Affected ❑ CW —EW PTA ❑ ES ❑ PTS Adj. Wtr. Body (na an/unk)
AEC(s): ❑OEA ❑IHA I
❑SPIMA ❑PWS Closest Maj. Wtr. Body
ORW: ye/At PNA: yes/oUW
Type of Project/ Activity
Shoreline Length N
Access Length
Pier (dock) length
Fixed Plattorm(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/q
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: 4me
Moratorium: n/aSite Photos:
Riparian Waiver Attached:P nA building permit/zoning pequired by: �\ \ ne, K -Al)
Agent oro.ppint PRINTED Name `� Permit Officer's
❑ TAR/PAM/NEUSE/BUFFER (circle one)
ElSee note on back regarding River Basin rules
See additional notes/conditions on back
Sigpy[ rye e'•Pleread compliance statement on back of permit(y Signatur
el o
Affillication Fee(s) ClAeck It/Money Order Issuing Qatel

N.C. DIVISION OF COASTAL MANAGEMENT n,I 1
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:
14,
Address of Property: _ h [ A Sj,.�tt , Nt 1 y Si 2-
Mailing Address of Owner: 5'5�, F:.1d is 1 Al h p/G .2
' l
Owner's ema1l:krntk.lk45'0q�A;c Owner's Phone#: si3 K/ - d'i6'—a-.o;L
Agent's Name:
Agent's Email:
Agent Phone#:
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 des jbed to me, as shown on the attached drawing, the development they are proposing. A
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 (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 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 iparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). u 'sh to waive tt)e setback, you must sign
the appropriate blank below.) /
I DO wish to waive some/all of the 15' setback
Owner
mof
I do not wish to waive the 15' setback requirement (initial
Signature of Adjacent Riparian Property Owner:
TypedlPrinted name of ARPO: C k P� r j eS o- VY.,L t
Mailing Address of ARPO: S5 a F •. c1 J I c..1 /Z.' 4 s�_�eO 19, tV t 185( 2
ARPO's email: C— ey, a I S,r 'l0 e .40ARPO's Phone#; 914) - 1011 O tI K(
Date: va b 6�> :-71, *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

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)
Name of Property Owner:
Address of Property:
Mailing Address of Owner: SS S F , �rJ d s t,, /J v a, ,.� P - , ��w, �i (, r f� �: a ?S/
Owners email:ally rdtg„ :I,ro nOwnersPhone#: 336 916^01 of
Agent's Name:
Agent's Email:
Agent Phone#:
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 forthis
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.
WtiI 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 (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 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 sion
the appropriate blank below.)
I DO wish to waive some/all of the 15' s ackr�%L" LL rutti✓
-OR-
Sigrikure of Adjacerlt Riparian PjopertyOwner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owners yr wy
Typed/Printed name ofARPO:1\eyt tor- rza, N), - I i c�/11V1G ina_I
Mailing Address ofARPO: � cl f� 7ldrie Tine Rnpll Sn01e5,_,1%L J c6.51,2-
ARPO'semail: rCli� Ionu%trird,(f.WIARPO'sPhone#: 33(0 `i8'a"S(ob8s
Date: 0,?1/,� /,2o,2 2 *waiver is valid for up to one year from ARPO's Signature*
Ravlaod May 2021

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 14•
Mailing Address: SS 6 F j td I ma's V3" e'
p: k, - ll 5*kA, .ems,I A14 a p s, a
Phone Number:
Email Address:
I certify that I have authorized
33 6- 8/d- a1na
It<er�(,�lk4.56? 4,,.-, 1.&e
5k,oA*vT cjc,K gua(, cays7-. /;VC
/ Contractor
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 �S 6 r. 9 , t Y), P. e,
in G P ✓�o✓e+ 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 Owner Information:
Signature t
v-''.Ll k. Ckwl/- I<'t;, t4.
Print or Type Name
Title
ba 1 13 1 a9a1
Date
This certification is valid through I I

wu�op$ov2
Ken Chalk
From: Connell, Brad <[e-mail]>
Sent: Thursday, February 24, 2022 3:50 PM
To: [e-mail]
Subject: FW: William Chalk
Mr. Chalk,
Please submit the $200 dock permiLtee payable to the NCDEQ in order to process your request.
Thank you,
Brad Connell
Environmental Specialist II
NC Division of Coastal Management
400 Commerce Avenue
Morehead City, NC 28557
httr)://Dorta l.ncdenr.ore/web/cm/dcm-home
[phone]
[e-mail]
'Nothing Compares_
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Low and may be disclosed to
third parties.
From: SVC_DCM.MHC.Admins
Sent: Thursday, February 24, 2022 2:14 PM
To: Connell, Brad <[e-mail]>
Subject: RE: William Chalk
No check was received for this address.
MaoteZK'e' Keefe,
Administrative Support
Division of Coastal Management
Department of Environmental Quality
252.515.5400
252-515-5401 Fax
[e-mail]
I