86310A_Dozier, Jeffrey & Karen_20220321

A'*rw''41& CAMA [ADREDGE & FILL n (jam N° 86310 � B c D
GENERAL PERMIT Previous permit
Date previous permit issued
[✓]/New )(Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of NorthCarolina,C��a'r[olina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
'/ I SA NCAC N • IICb * 1 2PYG ❑ Rules attached. General Permit Rules available at the following link: www.dgq.nc.gov/CAMArules
Applicant Name d l
Address ldg 6nA&J 1%f %t,e
City C'(.tt.`{G CK— State /IG. ZIP 2�l
Phone # (a5D-) 333 - Zop-1
Email ko-/ c... cis 2 ,r r @ clewccftery.t,cc
Authorized Agent //'��
Project Location (County): l�1r"-I'("G k-
Street Address/State Road/Lot #(s) IGR C16J�6 R Ot ✓('!
LC>+ 3g
Subdivision CSG Re , sl?i
City r-wr:-1L„c{'L zip D-71D
Affected ❑ CW VW PTA EES ❑ PTS Adj. Wtr. Body �.lL 1, Ci.a, +L a KS(X••-A .(nat/gunk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body �rr �'-kL'C' K � G�2t,.n C .
ORW: yes no PNA: yes no I
Type of Project/ Activity &)Pf.J 1&-I L kenJ e'/ eiiwk a¢ I -da6ram.
wwww -- New F. x 32' nor, k zwG 3- ra-1 a2 (Scale:ATTS )
Shoreline Length t )oG
Access Length �-
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total area
Gro- length/#
Bulkhea Riprap length JQ0
Avg nce offshore r
'b
d
Breakwater/Sill
v
Max distance/ length 3 '
_
Basin, channel
c�
Cubic yards
Lit
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
�C' 3 -:Z1- Z-Z-
0
�1
C(Ir r . -ir I'C'
�3Y 33 - 2 �- �r
[- 6 ' —
SAV observed: yes no
Moratorium: n/a y no 00�ier
Site Photos: e ��'
Riparian Waiver Attached. ye
A building permit/zoning permit may be required by: it
Permit Conditions
3-a9-at�-
❑ TAR/PAM/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)
Knj4f , baker- Zobf f-1' (,-Or bae
Agent or Applicant PRINTED Name P✓'*t Officer's VINTi&fAarr)R /%
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #/Money Order

t
3y. y 0 04 5WaALQ- �'_G'Wes, t 60 AA
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONfWAIVER 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: 09 G "EtL_ (XA V culWTJOt,_, �CC_
Mailing Address of Owner: � (� 1 coo
Owner's email: Yvner's Phone#:j�.
Agent's Narne: } _ Agent Phone#:�_�l_
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 drawinq,with dimensions must be provided wito 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 (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. 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 rot apply to bulkheads or riprap revetments). (if you wish to waive the setback. you must sign
the appropriate blank below,)
1 DO wish to waive some/all of the 15' setback
-OR- Signature of Adjacent ipari n roperty 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:
Mailing Address of ARPO: I(X0 G&Jvi\c I l 09 G Ve Ct)ef2,1 rUaC t\,, C_
ARPO's email: ARPO's Phone#: 2S'-2-- 2 3 2 - z2c 2
Date: � (1 I Z0Z:Z .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 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: t�z
Address of Property-, WAVC I TU CK NC_ -7 q 7-9
Mailing AdYress of Owner., SAY)
ja 14,Ldv-
Owner s email: 'Co
Owner's Phone...
Agent's Name Agent Phone4:__
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, 8
I DO NOT have objections to this proposal, I DO have objections to this prcposal.
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 401 S. Griffin St., Ste, 300, Elizabeth City, NC, 27909. 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 §ign
the appropriate blank belovv )
I DO wish to waive someiall of the 15'setback
-OR- Signature of Adjacent Riparian Properly 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: M I atr­_*A- , D Ui ic`!
Mailing Address of ARPO: o �A (x
ARPO's email: ARPO's Phone#: L4
Date: 31i-712_o-2_Z_,waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

it
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.<" • - :. c-,

N.C.DIVISION 0FCOASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIEDMAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion bJbe cVmp|Shedbxowner or their agent)
mk���\ Z.,
Namoo�P�e�yO�ner �����L/�� �
Address of Property:
&
Mailing Address of Owner: �; N
Agent's Ema|�
ADJACENTR|PAR|ANPROPERTYOVVNER`S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
| hereby certify that I own property adjacent to the above referenced property. The irdmdual applying for this
permit has described to me. as shown onthe attached dnawiog. the development they are proposing, A
dimensiono, must be provided with this letter.
. 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 _NC. Division -of -Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. 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
1 uncerstand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift. or
groin must beset back ominimum distance of15'from myarea ofhpuhanaccess uo�nswaived byma
(this does n��apply bobulkheads o,riproprevohnonts),(if you vvish8zwaive the setback, you must sign
'he appropriate blank below.)
I DO wish to waive somellall of the 15' setback
-OR- Signature of Adjacent Riparian Properly Owner
|donot wish owaive 'he 15'setback requirement (initial the olonk)
Signature ofAdiacentRiparian Property Owner:
Typed/Printed name of ARPO:
N)ai|ingAddeosof RPQ:
�� �- �C
�Z " /- /
K�`�4-
ARPO'a mme||: '- (\ }
ARPO's Phmne#:
-�---------
J`
��
~�|2m} ZCUZ,- aiver is valid for up to one year from ARPO's Signature*

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 C^''� �--- r
Address of Property: i J w�r.1 _. t (� i U � 1� 1'k�''I T ll� K, t y L c t 9 2C t
MailingAddress of Owner:
``
Owners ema1: Owner's 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 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_
descriptipli 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 (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. 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 15from 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 operty Owner
I do not wish to waive the ' 5' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: DyNLO
Mailing Address of ARPO:�{��
ARPO's email: t
Date: S( 2- 20-7— c`"
ARPO's Phone#: 7 Z 2"; �� 22C, Z.
*waiver is valid for up to one year from ARPO's Signature"
Revised Judy 2021

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Aerial Photography (202c
NRed: Band_1
Green: Barrd_2
EBlue: sand-3
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Shown on this map.

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