Gray, John 84577C

CAMA ❑DREDGE & FILL � O 84577 / A B (DD
PreCyENERAL PERMIT Date previous
�jDate previous permit issued
New ❑Modification ❑ Complete Reissue ❑ Partial Reissu
As authorized by t1he, State of North Carolina, Department of Environmental Quality and the Coastal Resources ision In an area of environmental concern pursuant to:
15A NCAC ❑ Rules attached. Q Genoml Penrnh Rules available at the following fink vmwdee nc env/CaMa� b
Appllcane WIarne Authorized Agent rlq�gy( dj
Address l P olact Logsdon (County): 4 Lt�
Chy m ZIP Street dress/State Road/Lott s)
Phone
#(Yo)8�6• Z r� _Qu (OGfIZ
Ettwl 9Xln2fi^itA(prtndr nncarl tr.rin IJn rVtn t I n nnA. ..... .
Affected ❑CW gEEW HPTA
AEC(s): ❑ OEA ❑ IHA ❑ u W
ORW: yes/no PNA: yes
Type of Project/ Activity
Shoreline Length Ci(d t
Access Length
Pier (dock) length— -- L
— �—
Fixed Platform(s) -
Floating Platform(s)
Finger piers)
Total Platform area
Groin length/p / _'_
Bulkhead/Riprap length
Avg distance offshore'-
Breakmter/SIII-
=-
Maxdlstance/length
Basin, channel
Cubicyards
Other_f�11�_((�
SAV observed. yes
Moratorium: n/a yes o -'(
Site Photos: n
Riparian Waiver Attached: yye;no
A building permit/zoning permit may be required by:
�—,/ City V , ( t
Up
ES ❑Prs Ad). Wtr. Body V A an/unk)
❑ SPIMA ❑ PM Closest Mai. Wtr. Body
` rmir
(Scale:
"j � T
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Permit Conditions {') U TAR/PAM/NEUSEBUFFER(circle one) _
❑ See note on back regarding River Basin rules
nn �t ^ i ^ / y �o� L�Q 2� — ❑ See additional notes/conditions on bade
IAM AWARE OF STAMFS,-"RIILE�""IT10N57HAT�IPPLY T°T�iIS PROIELT AND REVIEWED LONr1PUANLF�STATEMENT (Pleaselnldal)
`�'�� —�
ck_ ' ' / _'Ir f
•-Please read ricestatement on
Application Feels) Check M/Money Order

❑DREDGE & FILL NO 84577 / A B 0 D
NERAL Previous permit
PERMIT
Date previous permit issued
New ❑Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by t11he11 State�orf �Ntort'lh Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC -1 H I I Ly t/ ❑ Rules attached. dGeneral Permit Rules available at the following link: wwwden nc goy/CAMArules
Applicant N*A�)Authorized Agent i I� ! �✓I
Address t// Project Location (County): �J
Cityat l.P ZIP StreettAddddress/StateRRoad/Loot3t(s) ��O'61U17
Phone # ( L-
Email M 0A-1f\�ft a1J(I'fD11 ro(Ld. r )rA Subdivision
City ZIP
Affected ❑CW MEW [?PTA ES ❑pTS Adj. Wtr. Body an/un`rk,)'
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body X\ W �'v
ORW: yes/no PNA: ye no 1
Type of Project/ Activity 1p YYY—, a fit i '1 ` ry Rr pkir '� �f11'�iJ U5' rC71r 'F I D �... ?50A
-(- 1?�' k 2`7 ' c-�/ 2X?0 IOD0.S' ili3l.( (Scale: N15T 1
Shoreline Length
. Access Length
Pier (dock) length
Fixed Platform(s)
W
Floating Platform(s) � /�� I"' / �� a � bs N �✓ V
Q 3 2,`1,� Qr' t
Finger pier(s) �aFLIS -i-
Total Platform area
Groin length/#
Bulkhead/Riprap length / L]
mox
Avg distance offshore
g /
Breakwater/Silly
Max distance/length / I �' �^'�— J
Basin, channel / 4
Cubic yards (�
Boat ramp Y\ (�rT,t'� //��Ilf�ryj�1 I I _
ahous Boatlift
Beach Bulldozing
Other '!:iSITO
SAV observed: yes a
Moratorium: n/a yes o�`Y
Site Photos: y� n
Riparian Waiver Attached: Yyed, \ no
A building permit/zoning permit may be required by: r`r'ro
Permit Conditions 1 f� ❑ TAR/PAM/NEUSE/BUFFER(circle one)
i' See note on back regarding River Basin rules
07
See additional notes/conditions on back
(Please
Agent or Applicant PRINTED Name
Signature "Please read compliance statement on back of permit" Signature
4?A� - c 5 ��� 2fl ZZ
Application Fee(s) Check#/Money Order Issuing Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: SJ OLD & L4
Mailing Address: to arinnn _&w CaUj 'f
Phone Number:
Email Address:
1 certify that I have authorized
S t '
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
a7' covered &athoo5t
at my property located at t
in ---P&j)L4Cr 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 Information:
— L C,-I, �, �.
signature
Print or T pe Name
Owner
Title
I l I I oZ
Date
This certification is valid through 1.

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION(th1AIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner:: /� J b�_h n f % Q
Address of Property: to An rAr l-6L au SGU I Q�AG C a�'
Mailing Address of Owner: ,SG 1't1
q,rail•com
Owner's email: 1061f 1etAA �JJrg II Owlner's Phono#:
Agent's Name: rUQLJi M(IYI an DY)5Ltj(-hlgAgent Phone#:
Agent's Email: if
rF
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. 8
r1�c� description or drawing with dimensions must be provided with this letter.
I DO NOT have objections to this proposal, 100 have objections to this proposal.
If you have objections to what Is being proposed, you must notify the N.C. Divlslon of Coastal
Management (DCPdg 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 Mall.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
LC groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
t� (this does not apply to bulkheads or riprep revetments). (If you wish to waive the setback, you must sign
5 t/�the appropriate blank below.)
O� I DO wish to waive some/all of the 15' setback
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: •;�4��
Cot \y1 Typed/Printed name of ARPO: A h a. (,d A e f
kl�` D� �G z8A4 eC� Mailing Address of ARPO: [ 4 2 `L 3A /l/L &
5 ARPO's email: �H e may) Craw ARPO's Phone#: C19-3/IS-
Date: Y% 'Z /2 9 'v✓aivor is valid for up to one year from ARPO's Signature"
Revised July 2021

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ARMS eeeiatl;
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RQvfsed AAY 2021

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