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0E0"r4 CAMA ❑ DREDGE & FILL N9 87317 A 1 �cc
� ENERAL PERMIT Previous permit
Date previous permit issued
New ❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized the. State of North C olina, Department of Environmental Quality and the C astal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC _ ❑ Rules attached. General Permit Rules available at the following link: wwwde nc qov/CAMArules
Scale:
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R (circle one)
River Basin rules
lions on back
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Type of Project/ Activity
Shoreline Length
Access Length��
Pier (dock) length
Fixed Plattorm(s)
Floating Platform(Sr�
Finger pier(s)
Total Platform area��
Groin length/# -
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Silly � V
Max distance/ length '
Basin, chanrVt
Cubic yard_-- -
Boat ramp 1
Boathouse/ thft
Beach Bulldozing
Other
i
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: kes
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Riparian Waiver Attached:
A building permit/zorA
or Applicant PRINTED
N.J
,
WAM
❑ TAR/PAM/NEUSE/BUFFE
❑ See note on back regarding
❑See additi s/condi
read compliance statement on back of
Feels)
Date
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
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Mailing Address: �
`7� I �,11L ' K[ C- , . �7/Aar
Phone Number: % — �{22-- 3-
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Email Address:
I certify that I have authorized
to act on my behalf, for the purpose of applying for and obtainkg all CAMA permits
necessary for the following proposed development:
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at my property located at ,) y 0 /TCtt�
in County.
I 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 Owner
Print or Type Name
Title
&,3—I 2bZ2—
Date
This certification is valid through I I
RECEIVED
MAR 2, "a 7077
DCM-MHO CITY
8:43 AM Fri Mar 25 ,,, 9 ^ 100%(M—.
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N.C.O MIONOFCOASTALMANAGEMENT
Ani ENT RIPARIIWpROPERTY IOWNERNOnFiCATIOWWA1VEi� CFRnFiFn MAIL - RETURN
(Top portion b be oompleted by owner or Ides apart)
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AMCENTRIPAIIIAN PROPERTY OWNER'S CERnFICATION
(Bottom Parton to be eomdetea by d e /mod anent Ao2erH1O
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RW3@dWY2021 MAR 25 2022
ACM-; HD CITY
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: se E7�/1,a
Address of Property: T i / &/ITLG e���4Grr
Mailing Address of Owner:
Owner's email:
Agents Name:
Agent's Email:
Owner's Phone#: sz - < Z6 - q
Agent Phone#:__
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 drawinP with dimensions must be Provided with this Ietter-
�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 (252) W8-2808. No response is considered the same as no objection if you have been
notified by Certfied 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). (It you wish to waive the setback, you must sign the
appropriate blank below.)
I DO wish to waive some/all of the 15' setbac!`_ �7�
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: z e 5 /, e ram, 4 rt✓L 5-
Mailing Address of ARPO: y 1 fo 147_L q,41'7�1 G 13 e cic% L cZ et s �w y
ARPO's email:
ARPO's Phone#:
Date: -3 1 2 L� 12 z— -waiver is valid for up to one year from ARPO's Signature*
Revised "FiF EIVED
MAR 2 5 2022
DCM-MHD CITY
;i
CIQ
I
RECEIVED
MAR 2 5 2022 }
DCM-MHD CITY --
March 22, 2022
To whom it may concern,
We recently received an Adjacent Riparian Owner Notification which does not indicate what is being
proposed. There is no description or drawing attached. In order to consent to the permit, we would like
to know what is going to be built. Kindly forward a description or drawing promised as stated in the
Notification/Waiver form.
Thank you for your time,
Matthew and Tamara Gola
RECEIVED
MAR 2 5 2022
DCM-MHD CITY
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONANAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portions to be completed by owner or their agent)
Name of Property Owner: (/ eA17' L.fAii*el-
Address of Property: 1",? ,3 ee4,
Mailing Address of Owner: A-1 / zLr/��C A/C -
Owner's email: r : r tvr�t ..&" Owners Phone#: ?/a ri
Agent's Name:
Agent's Email:
Agent
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.
Ades criDtion ordrawina. 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 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be
contacted at (252) 808-2808. 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
Signature of Adjacent Riparian Property Owner
m
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 ofARPO: 1�: 1_3 t(Al
�/�irlI,,,A"Z—c
w i
ARPO's email: ? r�C ARPO's Phone#: !J B
n
Date: �--*waiver is valid for up to one year from ARPO's Signature* tr1
TIPS FOR ADJACENT RIPARIAN OWNER NOTIFICATION & WAIVER FORMS 0
Revised M6(20?•i y j
N fy
,V 41