Gildner, Nan 84679C

DREDGE & FILL N9 84679 A B (DD
Previous permit
�� G E lit ERAL PERMIT Date previous permit issued
(lew ❑Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of North Ca/olmaa, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC n(_� " I v`J ❑ Rules attached. -54,General Permit Rules available at the following link: www dea c eov/CAMArules
Applicant Name
Addres
City
Phone # ( _
Email
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City ZIP
—
PTA ❑ CW EW PTA ❑ ES ❑ PTS Adj. Wtr. Body a r (n ma k)
AEC(s): OEA IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body
ORW:y / o PNA:y /
Type of Project/ Activity
Shoreline Length,
Access Length _
Pier (dock) length
Fixed Platform(s).
Finger pler(s)
Total Platform area
Groin length/0
Bulkhead/ Rlprap length
Avg distance offshore
Breakwater/Sill
Vc
istance/lengthchannelyards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a ye no
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/gVifig permit rtja I
Agent o pllca t PRINT D Name Permit Officer's
-
Si tgre -'Pie ad compliance statemendon back of permit"• O r Si n t re
ao
r(rphcat(on Fees) Check #/Money Order Is g ng Davb
i i1
f,J-/
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back

a`°"" CAMA DREDGE & FILL
GENERAL PERMIT
No 84679 A B (D D
Previous permit
Date previous permit issued
[1 l�ew ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of North Ca/oo maa, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC ( •w ❑Rules attached. .General Permit Rules available at the following link: wwwdeq nc eov/CAMArules
Applicant Name
City —I—
Phone # (
Authorized Agent
Project Location (County): G
Street Address/State Road/Lot #(s)
Subdivision
City fy..r _ rZIP
Affected ❑CW rE PTA ❑ES ❑PTS Adj. Wtr. Body B (n man k)
AEC(s): OEA ❑ uW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Rody
ORW:Y /no PNA: yi:� _ r
Type of Project/ Activity
Shoreline Length
Access Length
Pier (dock) lengtl
Fixed Platforms)
a?Istance/
,Clyards—
channel
Boathouse/
Boatlift
Beach Bulldozing
Other
SAV observed:
Moratorium: n/a
Site Photos:
Riparian Waiver Attached:
THAT
Agent o(Afplicaa PRINTED Name Permit
J)�
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
Si®r(atyre "Pleasy(^5ead compliance statement on back of permit"
,I♦YL�1fion Fe
Application Feels) Chec q/Money Order
Date

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: , ��/i, // (i ild zj✓/�
Address of Property: r>ys /o &V �OR /0 U /2
Mailing Address of Owner: / 7/ ,4o. /e
Owner's email:yvAhone#:
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
✓ !/ 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.
WAIVER SECTION
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 1 IP7
Signature oft4' /ent 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: /73 b4-
ARPO's email- f4( ct+.cS7'1'F' 41K� t �H^ARPO's Phone#: `t ` f
RECEIVED
Date: Z Z *waiver is valid for up to one year from ARPO's Signature*
Revised July 20*R 14 202Z
DCM-MHD CITY

1 (-)
1 z
.1
RECEIVED
APR 14 2022
DCM-MHD CITY

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONlWAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: it d 1L �f • i.F� ,
Address of Property: I �L t /�//c, 49. 6s S 4 �
Mailing Address of Owner: ��'�„,/rr /w,.I . P�Sy /Y Lr a SS/%.
Owners email: 1i/,n1/,✓9�p4t),,,A,r yrn;/, ` 9 er's Phone#:� �(Z�-
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 forthis
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.
XX 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 [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 sometall of the 15' setback 6 "
-OR-
Yt�----
Signature of Adjacent Riparian Property Owner
I do not wish to waive the 19 setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: Brian A. Vandersea
Mailing Address ofARPO: 105 Chimeneas Place, Chapel Hill, NC 27517
ARPO's email: [e-mail] ARPO's Phone#: [phone]
Date: 04/12/2022
'waiver is valid for up to one year from ARPO's Signature'
Revised July 2021
RECEIVED
APR 14 2022
DCM-tWHD C€`f`�

G-
,
3
0
91
RECEIVED
APR 14.2022
CCM-MHD CITY