86362A - Godley, Robert & Lorena

` 4 CAMA ;_ 9 86362 a C D
DREDGE & FILL
Previous permit
GENERAL PERMIT Date previous permit issued
New LI Modification iLJ Complete Reissue .7 Partial Reissue
As authorized by thee State of North Carolina. Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
t 5A NCAC _ I '`` �`• `-� -- �j Rules attached. General Permit Rulesw.
esavailable at the following link: wwdeq�gcgQ.yLCAM„ itle�,
Applicant Name ...�[ � � - - `- �ti�' — Authorized Agent
Address + Project Location (County): _..... d
City $Ltl. li1FtGY'jStat __—� Zip _J` =� 1-- Street Address/State Road/tot #(s) q
({�� f.L1�� = __
1
Phone #
Email lJa b�Qtwa>im d_ ;rLQvtS .S Q Subdivision
CityiYiRt ZIP.T
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Affected ❑ CW EW PTA ES PTS Adi, Wtr. Bodyk)
AEC(sy F-1 OEA I H A UW (EI SPIMA i PWS
� Closest Maj. Wtr, Body
ORW: ye na PN . ye)no
Type of Project/ Activity
Shoreline length �,._....,,j� IF
r��...
Access Length D aA ; ,
Pier (dock) length ClNI� oev t
Fixed Platforms) t� L P4
,._
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/# __...__
Bulkhead/ Riprap length _�_
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel —
Cubic yards
Boat ramp ........_ �j�
Boathouse oath Q 1
Beach Bulldozing
Other __.........._ ___
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Do
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SAV observed: es no Moratorium: n/a yes no
Site Photos: ge, naRiparian Waiver Attached:Lno
A building permit/zoning per-Mit�maay be required by: '��t Y K -•--
(Scale: !' T9
ya'/ N (0 (01
Permit Conditions
ti
❑ TAWPAMtNEUSE/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 D REVIEWED COMPLIANCE STATEMENT. (Please Initial) —.___._ ._..--
Brandon Mitchell
A en r Applicant PRINTED Name Permi Officer`s PRINTED me
+fie i
4S' nature —Please read compliance statement on back of permit" Signature .0,.
. 1_^.,_1 rh,,,k U/N1nnev Order Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
R obe�c�- C�J
Mailing Address: UD oS
Mailing 1_-- P_—
Phone Number: _' 2' L4 8q q.
Email Address:
Q� g $uticcdS_�N� -
certify that I have authorized __-- Agenrat / Contractor
to act on my behalf, for the of purpose ur applying for and obtaining all CAMA permits
P P
necessary for the following proposed development_ v ON
at my property located at %40 T7g14cl
in Q�(-Q, County.
! 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.
Property Owner Information:
Ie6 ►�{ '6
Signature
Robert Godly
Print or Type Name
TWO
3/22/2022
/----J--
Date
This certification is valid through __/__I
RECEIVED
APR 0 4 2022
DCM-EC

RECE:
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM APR 0 4 2022
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent) DCM-EC
Name of Properly Owner
Address of Properly �_OSpr `-" ` So mrh ShtwrtS NL 779yq
Mailing Address of owner r -- — - - --- ---- _—_- .-----_-- _
Owner s emarll�Pe"r "0� )wner's Phone#: Z52.20-1_ y89y
Agents Name ?YQA\AVA "N'NL)'� C Agent Phone# _W+ yip'.��47_.
Agents Emarl h MOYAMSID CjMur)- C 641V1 — ---- , -- _
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I oxvn property adjacent to the above referenced properly. the individuat applying for this
permit has described to me. as shown on the attached drawing. the development they are proposing. A
1 - description or drawing. with dimensions. must be provided with this letter.
(Lb— 100 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 it you have been
notified by Certified Mail,
WAIVER SECTION
I undersiand 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
Me appropriate blank below.)
! DO wish to waive some/all of the 15' setback �-
Signature djacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank) _
Syneture of Nr3jacem kihanan Prupclty nwnc;I. ' P�e�Se sigt(1
Typed/Printed name of ARPO:
Mailing Address of ARPO: i r-)<l< r I ��, P,-0
ARPO's email: 't} f - ) ARPO's Phone*: �5� ` JU`1`1.53��
I'AIJ3
Date: 'waiver is valid for up to one year from ARPO's Signature"
Revised July 2021

APR 0 4 2022
N,C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or NAND DELIVERY DCM—E,
(Top portion 10 be completed by owner or their agent)
Name of Property Owner RO�X� ` OV e�o� GodI•e
Address of Properly l LV_0SPrt1� � p�*r S�1t t ry
J --S --- - - - --� Nc 179y"j
Mailing Address of O/\wner
Oxvner s email""ul:. Paur"FvuA e�wner's Phone* 257- • 20-7 - Liij 9iqq
Agent s Name VOLC A '
M1 N1��tartll Agent r'hone#:lDy_Li1g Vo(#
Ageni s
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 properly. 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
V-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 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
t 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 belovr.)
I DO wish to waive some/all of the 15' setback
Signature I Adjacent Riparian Property Owner
JR -
I do not viish to waive the 15' setback requirement (initial the blank)
Signature of hr)larxnl krlmlian Properly Owru:r V V
Typed/Printed narne of ARPO:
Mailing Address of ARPO: 10
ARPO's&mail: VJ RPO'sPhone*: /v 43
Date: I C giver is valid for up to one year from ARPO's Signature'
Revised July 2021

// �'� (�► 73-A 1CJ
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This map is prepared
from data used for the
inventory of the real
property for tax
p purposes. Primary
�. information sources such
as recorded deeds, plats,
wills, and other primary
public records should be
consulted for verification
of the information
contained in this man.
r
106 Osprey LN Owners: Godley, Robert A -Primary Tax District: Southern Shores
Southern Shores NC, 27949 Owner Subdivision: So/sh 114-117 126,127 200-
Parcel: 022299000 Godley, Lorena C -Primary Owner 202
Pin: 986709263773 Building Value: $663,600 Lot BLK-Sec: Lot: 2 Blk: 126 Sec:
Land Value: $225,500 Property Use: Residential
Misc Value: $74,900 Building Type: Traditional
Total Value: $964,000 Year Built: 2007

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