84644C - Chapoton, Theadore

"`°"" [ CAMA C7 DREDGE &FILL W 946,14 A 8 JDD
Previous permit
a G NERAL �PERMIT Date previous permit issued w �_�Modification [_Complete Reissue [_-]Partial Reissue
As authorised by tth�h,}ee State of N rth Carolir , Department of Environmental Quality and the Coss 1 Resources Commission in an area of environmental concern pursuant to.
ISA NCAC ___L.2'._" ._ . .._ �,-L1---- �� Rules attached. the
Prank Niles available at dx Wowing fink ,.Q�q, ,ygv�
Affected PCW
AEC(s): [JOEA
ORIN: yes sa
PNA yes/&
Authwized Agent _. _,.___� _�_ ,,-..y_�� ,�
Prolect Location (County) ��".LY:�..1.---- �.._.,�...�..»
Street Address/State Road/Lot M(s)
Type of Project/ Activity �Qf�'t) �t� Ut : /�
t (Scale " /j
shoreline Length„_
Access Length��_
Pier (dock) length
Fixed Platforms)
Floa _g tloitnis) _
Finger pier(s)_
Total Platform area _
Groin lengtt/a ,__,_
Bulkhead/ Riprap length
Avg distance offshore _
Basin, c annell�
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse
Beach B 7i g _ ,,, ('
Other niRc; i J2
0 canal
leivr
$AV observed'
Moratorium: n1a yesMlklliV
Site Phetoz: ss -hed
Riparian Waiver Aac
zoningP, it a
A building permit/zoning pe d may be required 6y�
Permit Conditions ...
Agent QtAtfolilant PRINTED Name
of permit'•
TO
Permit Officer's
PL-
TARrPAKNEUSEMUFFER (circle one)
See note on back regarding River Bann rules
See additional notes/conditons on back
Date

❑DREDGE & FILL W N° 84644 A B C0D
G NE PERMIT Previous permit
Date previous permit issued
9
New ❑Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized bythe State o� h CPar lin Depaa, rtment of Environmental Quality and the C t I Resources Commission in an area of environmental concern pursuant to:
15A NCAC — /) /y /(,-���� ❑ Rules attached. eneral Permit Rules available at the following link: wwwden nc gov/CAMArules
Addr — 1 Project Location (County): t� I C^ t:, (
Ciry l@ ZIP Street Address/State Road/Lot #(s)
Phone # ( ) t
Email "� Subdivision
City _ ZIP
Affected ❑CW*EW
PTA ❑ES ❑PTS Adj. Wtr. Body \ (na man/ k)
AEC(s): ❑ OEAA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body a
ORW: yes& PNA: yes/0
Type of Project/ Activity ` S S
(Scale //�)
Shoreline Length
Access Length �!
Pier (dock) length
Fixed Platform(s) l
0
FloaWg PIAHor(n(s)
Finger pier(s)
Total Platform area
Groin length/# ,( ,� ' f1�/
Bulkhead/Riprap length rJ I (,I%,,A ✓�-�it.�
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel \
Cubic yards �[tt7D vvC�
Boat ramp
Boathouse oatI
Beach ByNdpzing VVV
Other rr II Ci r
C7ciS iM
SAV observed: yes
Moratorium: n/a yes
Site Photos: yes
Riparian Waiver Attached: e V.
A building permit/zoning pe it may be required by: Pi v
I AM AWARE OF STATUTE , CRC P
Agent nt PRINTED Name
Permit Officer's
1�
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please
Signa re •'_ Please read.rompliance statement on back of permit"
Applic tion Feels) Check #/Money Order
Date

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PERMIT ISSUED USING
STATIC LINE EXCEPTION'
YES ❑ NO
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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: jiy olkg ' CLV—o % 0,A1 /i
Address of Property: j l 66i—m zwood ©K, P1iS
Mailing Address of Owner: SIP" iE,
Owner's email: Qrrir, &ner's Phone#:
Agent's Name: Agent Phone#:�Z
Agent's Email:
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.
100 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 me iv.(;. uivision or uoasrai
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 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 16 setback / }` � -i I ,{
Signature of Adjacent Riparian Property Owner
Irwza
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: l0 , G _
r � � - elr)b IM
Mailing Address of ARPO: / I
ARPO's email: ARPO's Phone#:
Date: �- _`walver is v lid for up to one year from ARPO's Signature'
j 2� iZZ 4 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: i71YO&f
Address of Property: I )
Mailing Address of Owner:
Owner's email: "'� i��L h << Owners Phone#: > `
Agent's Name*- Agent Phone#:
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that 1 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. 100 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 sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
Sigma of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: l t t �1�1ti 1A k S G?
1 1� -L.ik lZ S //h
Mailing Address of ARPO: /% nt, �r f /�'"� d
ARPO's email:
ARPO's Phone#:
Date: �� L% /� 'waiver is valid for up to one year from ARPO's Signature"
HA'? //e.c�f��
Revised May 2021

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