86374A_Foster, Randall & Robin_20220404

UCA►MA ❑ DREDGE & FILL 1
GENERA N9 863, 4 � B C �
L PERM 1 T Previous permit 8 6 G(
Date previous permit issued
evv ❑Modification ❑Complete Reissue ❑Partial Reissue As authorized by the State of North Carolina, De
SA Department of Environmental Quality and the Co Resources Commission in an area of erM
NCAC � �� ('� rommental concern pursuant to:
❑ Rules attached. ;en -al Permit Rules available at the following link.
Applicant Name
wwwde�+ mtov� emtie
Address —Ox s-
City 101'— 47- /`
Phone #(�) SJC - staterN`C —ZIP ->_ gclf
Email - Rob:.. �. _CA t: o n :2
[tiw
Affected ❑ CW YEW e
PTA❑
rs
AEC(s)' ❑ OEA IHA UW ❑ PTS
❑ ❑ ❑
ORW: yes PNA: yesV �SPIMA PWS
Type of Proiect/ ActivityW
Shoreline Length }
Access Length _
Pier (dock) length —'-�— � C. �Z. G
Fixed platform(s) r X
Floating Platform(s)
s
Finger pier(s) --
Total Platform area
Groin length/q __ —
h x
Bulkhead/ Riprap length _�;F�
Avg distance offshore
_
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
_
Boat ramp
1 ^q
Boathouse/ Boatlift
--R_
Beach Bulldozing
Other
^_
SAV observed: yes
Moratorium: n/ no
Site Photos: e no Fes`
Riparian Waiver attached: yes
A building permit/zoning permit may be required by:
Permit Conditions
=� uam u m tb, CRC RULES AND CONDITIONS THAT APPLY To _ THIS PRQ
AL -
Agent or pl' nt
x
Signatu lease read c liance statement on back of •
permit*
APPlicati-L
on Fee(s) r
Check q/Money Order
Authorized agent J
Project Location (County):
Street Address/State RoaWLot #(s)
=1`
Subdivision (C _ S l h. -
City Doti.-4- Hor
Z!P
Adj.. Wtr. Body ( („lr;� r U
�naryunk)
Closest Maj. Wu. Body r_,
�nr
,me-
4r
Signature
Issuing Date
(Scale: )UT5 )
❑ TAR/PAMMEUSE/BUFFER (circle one)
ElSee note on back regarding River Basin rules
❑ See additional notes/conditions on back
COMPLIANCE STATEMENT.
(Please Initial)
----S-t-�,_
Expiration Date

Name of Property Owner Requesting Permit: nN 14 ` �0 k 4 4J �.j�
Mailing Address: �- CIO' �C��
Phone Number: C1 cc,
Email Address:
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at
in a;'a;& / L- r-I(County.
l furthermore certify that l 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:
k j r7
Title
1113 1311
a-?�
Date
This certification is valid through ! /
RECEIVED
APR 0 6 2022
DCM-EC

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) RECE IE D
Name of Property Owner: �r�� R�bi�, Fp s I Ec APR 0 6 2022
Address of Property:
Mailing Address (oaf Owner: P a . COX ��S pdind Harbor*_ ,�
Owner's email: (i0 ,'CLO, @ Q mail ,C[)M Owner's Phone#: P,Otf- S36' lo:zb
Agent's Name:
Agent's Email:
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
descriotid-n-dr drawing. with dimensinns must ha nrnviriari with thic IPttar
DO NOT have objections to this proposal. I DO have objections to this proposal.
(r 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. 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 some/all of the 15' setback
-OR-
Signature of Adjacent Riparian Property Owner
I do not wish to waive the 15' setback requirement (ini "ilh blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO: �•d. �A 4404 k U H a W h 14C
ARPO's email: ARPO's Phone#: J; Z- -2e2
Date: -� �Q l -waiver is valid for up to one year from ARPO's Signature*
Revised July 2021
-EC

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORK C - IVED
CERTIFIED MAIL -RETURN RECEIPT REQUESTED or HAND DELIVER
(Top portion to be completed by owner or their agent)
Name of Property Owner: 910-M d QA a R 06 n i'O S+e_
Address of Property: J Via. S wolh C
Mailing Address of Owner:
C.
Owner's email: 40S�ef l-k�q q ryNqlI -LBM Owner's Phone#: 804-5'U"W-. t
Agent's Name:
Agent's Email:
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
APR 0 6 2022
M-EC
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 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. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
noted 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 LZ
l
-OR-
Signature of jac t Ripari n Property OvJner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: F. E u a en P H e f r i tt Q
Mailing Address of ARPO: PO. 13OX J11 ., l i ad Wax hor , N C . al U y
ARPO's email:
ARPO's Phone#: W - S,? 2 - d G,f I
Date: 3 - ,12-0 -o�W-Z *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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RE C rL---- I V E D
A P R 0 6 2022
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