GOODLOE-MURPHY GP83942

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ENFRAL PERMIT Previous permit #
le w DModification O'Complete Reissue ElPartial Reissue Date previous permit issued
As authorized b0heState of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
A C;J Rules attached.
Applicant Name
Address
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City State (4 ZIIP
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Project Location: County . .... .
Street Address/ State Road/ Lot #(s)
Phone # J
E-Mail.,,
Subdivision
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AuthorizedAgent
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City
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Y"PTA
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Phone#
River asin
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Affected
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0 IIH
F1 UBA Cl NIA
Adj. Wtr. Bod
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F] PWS:
,no
Closest Maj. Wtr. Bocly_l�..
0111W: yes 1 PNA
yes Vno,�
Type of Project/ Activity
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Pier (dock) len-th
Fixed Platforr
Floating Platfc
Finger pier(s),
Groin length
number
Bulkhead/ Rip
avg dista
max dist
Basin, channe
cubic ya
Boat ramp
Boathouse/
Beach Buildo2
Other
Shoreline Len
SAV: j n
Moratorium:
Photos:
Waiver Attact
(Scale: /,/ �
A building permit may be required by: See note on back regarding River Basin rules.
Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant
Signature P
Application Fee(s)
read compliance statement on back of permit
P.
Check#
Officer's Printed Name
....... . ..
Signature
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Issuing Date Expiration Date

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CAMA PERMITTING PLAN
REVISIONS
......
MD
WRY T FELEN GOODLOE-MURPHY
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CA
24006 NC 12 HIGHWAY
& [ATES, LTD.
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ANKAKEET TOWNSHP OW OWNTY
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AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
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Name of Property Owner Requesting Permit: A40V I-WeL-
Mailing Address. i it
Phone Number:
Email Address:
I certify that I have authorized jT& jue?�"
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMP p
necessary for the following proposed development:
at my property located' at —1
in — a County.
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I furthermore certify that / 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
Print or Type Name
Vbvn6e —
Title
& / -:?v I '2-o;?-, I
Date
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This certification is valid through 1 '-?/ 1 0 Z—

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Dame of Property owner: Mary Helen Goodloe Murphy
Address of Property: 24006 Nc 12 Hwy, Rodanthe, NC 27968
Mailing Address of Owner: P 0 Box 147, Rodanthe, NC 27968
Owner's email..;
Goodloe-Murphy, Mary Helen <[e-mail]'s Phone#:
� 252 987` 1 303
Agent's Name: John M. DeLucia, Agent Agent Phone . [phone]
Agent's Email: johnd�7a albemarleassociates.com
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent.Prop2gy 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. L
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. ©CM 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 somelall of the 15' setback
Signature df Adjacent Riparian Property Owner
I do not wish to waive the 16' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO; Eleanora G Hersman
Mailing Address of
ARPO's email.4fil
t
Date: G' �'�-
*waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

. ............ 7,
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner:
Project Address:
(Lot or Street #, Street or Road, City & County)
Agent's Name M j2cl< Mailing Address:
Agent's phone #:
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 draWip.g_the development
they are proposing. A'describtfon or drawing" with dimensions, must 'be'provided ,with this letter.
ZVI- I have no objections to this proposal. --- I have objections to this proposal.
If you have objections to what is being proposed, you must notify the 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 (252)
264-3901. No response is considered the same as no objection If you have been notified by Certified
Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back minimum distance of 15'from my area of riparian access unless waived by
me. (If you wish to waive the setback, you must sign the appropriate blank below.)
I do wish to waive the 15'setback requirement.
I do not wish to waive the 15' setback requirement.
(App ` ant/ r � e, y Owner Information) (Adjacent roperty Owner Information)
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Si titre Sig nfa'l-i ire
Print o Type Name Print 6r Type Name
Mailing Address Mailing Address
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Telephone Number / Email Address
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Date I "Valid for one calendar year after signature*
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CitylStatelZip
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Telephone Number/ Email Address
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Date*
Revised 2017

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