84678C - Prevatt, David

0"" CAMA ❑DREDGE & FILL Nd 84678 A <DD
Previous permit
ENERAL PERMIT Date previous permit issued
New ❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized by the State onh Carolina. Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I $A NCAC o ❑ Rules attached. General Permit Rules available at the following link: jn , ig gov/CAMArules
Applicant Name
Phone # (Om
Affected ❑CW
AEC(s): ❑�Go
CRW: ve$' -
Type of Project/ Activity
Shoreline Length.
Access Length....
Pler (dock) length
Fixed Platform(s).
Floating Platforms)
Total Platform area !
Groin length/g
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp Or
Boathouse - Hall!
Beach Bull '"
Other
SAV observed:
Moratorium: n/a
Site Photos:
Riparian Waiver Attached:
A building permit/zoning 1
.z
ZIP
❑ Es ❑ pTs
❑SPIMA ❑PINS
Authorized Agent D?6t
Project Location (County):
Street Address/State Road/Lot
City
Adj. Win Body
Closest Ma). Win Body
E
❑ TAPJPAM)NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
1
--------- ---------- 11 see additional notes/conditions on back

❑DREDGE & FILL N° 84678 A e'c D
3 ENERAL PERMIT Previous permit
�� Date previous permit issued
New ❑Modification []Complete Reissue ❑ Partial Reissue
As authorized by three State o orth Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC G e %:;�aO ❑ Rules attached. TK General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name bkV
r Authorized Agent •^S' I V
Address Project Location (County):
Ciry l:. to ZIP Street AddreWState Road/Lot
Phone # ( )
Email Subdivisio
r
City ZIP
Affected ❑ CW W PTA ❑ ES ❑ PTS Adj. Wtr. Body 1r l nk)
AEC(s): ❑DEA IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body
OWN: ye4-\ PNA:y /n
Type of Project/ Activity
Shoreline Length
Access Length
Pier (dock) lengtl
Fixed Platform(s)
Floating Platform(s)
Total Platform area C
Groin length/M
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp /
Boathouse oatli
Beach Bull
Other
SAV observed:
Moratorium: n/a
Site Photos:
Riparian Waiver Attached:
A building permit/zoning I
❑ TARJPAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
t
❑ See additional notes/conditions on back
TATLIS,CRCRULESAND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED
PRINTED Name Permit Officer's
(Please
SignPlease ced � compliance statement on back of permit'* Si t e
'1 M�FY�n*7i7�W my
t' r
Application Fees) Check N/Money Order Issui gDate

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: DAVID PREVATT
Mailing Address: �n 15 FAQW)p 'D T-)-DI\D
Phone Number:
336-616-1989
Email Address: [e-mail]
I certify that I have authorized DENNIS 6 SONS MARINE CONSTRUCTION, LLC
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
INSTALLATION OF 16,000 LB BOAT LIFT
at my property located at ate? 5b4 & V4TE D21ve tJ� oWFO R.T , tJ G ,
In CARTERET 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 OwTrInformation:
signature
Print or Type Name
HOMEOWNER
Title
Date
This certification is valid through t2 131 ,!Hz
RECEIVED
APR It 2022
DCM-MHD CITY

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: l7PV kT3 1V QEVIL-(T
Address of Property: M b SER 61nTC DRIVE "VWPoQ-r r. c 0(b510
Mailing Address of Owner: -1515 Fo,a-wooer P-D G iHSon>y r t t 6 NC J 7a49
Owner's email: Owner's Phone#: 3�10 61ty-\9Q,c}
eo,v,
Agent's Name: bgmK)6`.5m5kkAyjmr com t: L_C Agent Phone#: a5a a41 t�t(od
Agent's Email: V5hAGLLCPG"Al1- ConA
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.
1 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.
Pi7n►Il4 NIM X9lLOR
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
Signature of Adjacent Riparian Property Owner
rem
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 ARP\O:
ARPO's email: OT�ny�b2o(�\��C.�V Q``ARPO's Phone#: a 5Z), - kayo -6�)23
Date: `a'oZ *waiver is valid for up to one year from ARPO's Signature*
Revised Ju/LIVED
APR i 1 2022
DCM-MHD CITY

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:.'DNMAN:) TV
Address of Property: IP;� nep CATS bRIVE WEWPo21,IJC 3651D
Mailing Address of Owner: "-1 r-'D i 5 F a2. w 000 R:D ( 185 oNV I LI-C , JC, ae)5_10
Owner's email: Owner's Phone#: 33(o
COoA
Agent's Name:lXNKA'5 i SoN5 MAr 1rJG fot.,sr Agent Phone#:
LLG
Agent's Email: Tp3rnccut,e @D (s,MRIL CCbM
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent 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.
13you 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 waiveSvme/all of the 15'
of Adjacent Riproperty Owner
la
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent
Typed/Printed name
Mailing Address ofARPO: )3a 5FA C2RTE 212 tJ6wPOPT \)G ai�57D
ARPO's email:
ARPO's Phone#: 912 - 5W 7 H5
Date: 3 '�1 aa. *waiver is valid for up to one year from ARPO's Signature' RECEIVED
Revised July 2021
APR 12022.
DCM-MHD CITY