84610C - McGowen, Mark

1*10MT41&OCAMA ,❑ DREDGE & FILL N9 84610 A B C D
Previous permit
3 GENERAL PERMIT Date previous permit issued
❑New ❑Modification ❑Complete Reissue El 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:
I SA NCAC ❑ Rules attached. © General Permit Rules available at the following link: wwwdeancgov/CAMArules
Applicant Name
l
Address
n
City State lur i ZIP
Phone # (_ )
Email
Affected ❑ CW ❑ E W ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS
ORW: yes/noPNA: yes/no
Type of Project/ Activity
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Adj. Wtr. Body
Closest Maj. Wtr. Body
(Scale:'- �J )
MEN
0
on
M
M
Finger pier(s)
Total Platform area
Groin length/e
distance offshore
distance/ length -7FE
Basin, channel
Cubic yards
Boat ramp
Boatlift
Beach Bulldozing
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:Boathouse/
ME
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MEN
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SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
milli
No.
...
....
A building permit/zoning permit may be required by:
❑TAyPAM/NEUSE/BUFFER (circle one)
Permit Conditions
❑ 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
Agent or Applicant PRINTED Name
Signature "Please read compliance statement on back 6permit••
Application Feels) Check R/Money Order
Permit Officer's PRINTED Name
Signature
Issuing Date
Expiration

'jte"'"' OCAMA , ' DREDGE & FILL N9 84610 A B C D
fA GENERAL PERMIT Previous permit
Date previous permit issued
M.F\]New ❑ Modification []Complete Reissue ❑ Partial Reissue
As authorized by the State of No Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC '' ! ' ❑Rules attached. General Permit Rules available at the following link: wwwdegS.gov/CAMArules
Applicant Name - r l Authorized Agent
Address Project Location (County):
I
City State ZIP Street Address/State Road/Lot#(s)
Phone#O
Email Subdivision
City ZIP
Affected ❑ CW �.❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
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■■■■■■mom
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Floating Platform(s)®
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MEN
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Finger pier(s)
NM
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IN
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PlatformTotal area
Groin length/it!
BulkheadiRiprap length
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Siteo
.. �Photos:yes no
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A building permit/zoning permit may be required by:
i
Permit Conditions—
1
El
❑ 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.
Agent or Applicant PRINTED Name Permit Officers PRINTED Name
Signature **Please read compliance statement on back of permit" Signature
Application Feels) Check q/Money Order Issuing Date
(Please Initial)
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
1.
Name of Property Owner Requesting Permit: MAzlc r /4.fi21 A h 660W )
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
l93
203- S5&- 3%1
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Kt ) 6 k�iL&�, , )b com'0
AW
at my property located at 19 3 )v &L PJJ Q 9 I Vc—
in ���er�County.
1 furthermore certify that 1 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.
Title
,3
Date
This certification is valid through I /

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: Jy getL C✓lSJf/r� �COtOly
Owner's email: M1%/,Mwner's Phone#:
Agent's Name: l� �?� ^�!1 "h1 CZ, Agent Phone#: k 1Or-�yt � �"
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.
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 me rv.c. uiwsron or %.odsidi
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 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 I T 1
Signature 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:
Mailing Address of ARPO:
ARPO's email:
ARPO's Phone#:
Date: "waiver is valid for up to one year from ARPO's Signature"
Revised July 2021

U.S.
Postal
Service'm
CERTIFIED
MAIL°
RECEIPT
Domestic
Mail
Only
For delivery
information,
visit
our website
at wwwusus.comfD.
..._ _ ,.
tLIr
CaUOed Mail Fee
Services BFees lcheckeor. eae�A inE.us.,.� 10
0 I ❑ROWM necelpt lelec=Ic) $ $�Il}•1}fl I Postmark
❑Ceaaletl Melt Re Msa Delivery $ $�:I) Here
p OAaultsipvt.nequlrea $ ,, r.n
O Postage
Ln $ $1J.53
0 TotalPostegeendFeea 03/23/21,22
s $4.33
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