87309C - Harbor Master Inc.

�° ° ❑CAMA ❑DREDGE & FILL N® 87309 A B C D
$3� Previous permit
3 GENERAL PERMIT Date previous permit issued
©New ❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC (' l '! ' ❑ Rules attached. ❑ General Permit Rules available at the following link: wwwdeq nc gov/CAMArules
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Applicant Name - ' I _ ALtharized Agent
Address Project Location (County):
City State 1 ZIP Street Address/State Road/Lot #(s)
Phone#O
Email
Affected ❑cW ❑EW
AEC(s): ❑ OEA ❑ IHA
HeTA ❑ ES ❑ PTS
UW ❑SPIMA ❑PWS
ORW: yes/no PNA: yes/no
Type of Project/ Activity _
Subdivision
City ZIP
Adj. Wtr. Body '•(nat/man/unk)
Closest Maj. Wtr. Body
(Scale:/
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MEN
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Total Platform area
Avg distance offshore - :
BreSE
akwater/Sill
MISMOSon
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NONE■
MEN
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Max distance/ length
■■■■���■
Re
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Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: ves no
MEN
M
�I
A building permit/ zonr emit may be required
Permit Conditions
❑ TAR/PAM/NEUSE/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 APPLYTO THIS PROJECTAND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name
r
Signature "Please read compliance statement on back of permit`*
Permit Officer's PRINTED Name
Signature
i
Issuing Date Expiration Date
Application Fee(s) Check N/Money Order

❑DREDGE & FILL N9 87309 A B C D
a GENERAL PERMIT Previous permit
Date previous permit issued
❑New ❑Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.dea.nc.gov/CAMArules
Applicant Name ! Authorized ,Agent
Address Project Location (County):
City State ZIP Street Address/State Road/Lot #(s)
Phone #
Email Subdivision
City ZIP
Affected ❑ CW ❑ E W ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IRA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale: / t )
Access Length
Pier (dock) length
Fixed Platforms):■:�.
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Floating Platforms)
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Finger pler(s)
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Z■■...■■.Riparian
9AV observed: yes no
Moratorium: n/a yes no
Cite Photos: yes no
Waiver �ttachecl: yes no i
MIN
IN
SEEM
A building permit/zoning permit may be required
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ see note on back regarding River Basin rules
❑ See additional notes/wnditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Pleaselnitial)
Agent or Applicant PRINTED Name - Permit Officer's PRINTED Name
Signature "`Please read compliance statement on back of permit" Signature
Application Fee(s) Check N/Money Order Issuing Date' Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: I ,rr � iY ca --
TCL
Mailing Address: �gta lax%', tJ
Phone Number: 25SL — 9W - 7y3©
Email Address: 14 J) 0 1' AIJAL ry i i\C cz t 11'tik�• 'C ern
I certify that I have authorized VonOIN12 t1� r� C
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: �ICAUi n0 LKK —^'
at my property located at
in L!csf4-e,(!L` County.
I 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:
_n.:�7y
Signature
I -
Print or Type Name
D t,L)Ne f-
Title
Date
This certification is valid through /
go owk
L
RECEIVED
MAR l 1 W2
DCM-MHD CITY

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:
Address of Property:
Mailing Address of Own<
Ownersemail:bArbDf(wsk, Zma. Owner's Phone#:R5,-aiQ-7N3t7
(ZiC7� IYka� 1, Ca
Agent's Name: 4261719- o✓nS Agent Phone#: a59- 969''16aW
Agent's Email: liar ma6-tei`S .,ned. �9 /YICi d. 41)al
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 drawing with dimensions must be provided with this letter.
V I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what /s being proposea, you must noury me mu. u,v,bwn v, a Udbga,
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 some/all of the 15' setback
Signature of Adjacent Rip ian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
,(Signature of Adjacent Riparian Property Owner: < ! 4
Typed/Printed name of ARPO: 7 -T.VSr'i e� Mailing Address ofARPO: (440I ArgrJall t>+ MI),-.h2AJ Cn%a nf,
1
4'.552
ARPO's email: SA✓YIGr "r Q-)6VJoi4 ARPO's Phone#: )S2)
Date: ? —I o 'D -D 'waiver is valid for up to one year from ARPO's Signature'
Revised MayEyVED
MAR i 1 2a??
DCM-AMHD CITY

I
r
RECEIVED
MAR i 1 ?0'??
DCM-MHD 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:
Address of Property:
Mailing Address of Owner: �0 of Lct k C I3 5V%n fry I�iRr ife_ "
Owner's email: hafhbf rAA56 6 IR10 Owner's Phone#: a59.- a Ali- 7 �3ti
omc6i, Cpry\
Agent's Name: Agent Phone#: v °J" 0' C?4v9 - `%D
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
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'famp, 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
,�A..r / /� Af/tk.0•��
Signature of AdAenf Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank) Li c�,—
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: A f r `� ��r I I M 1-) t 1�
Mailing Address of ARPO: Yt1 CC-D to
ARPO's email: tDr✓ �S-, C ARPO's Phone#: 746-- 63 7 1�—
Date: 3-- IC' QLO-1, *waiver is valid for up to one year from ARPO's Signature* RECEIVED
Revised May 2021
MAR i 1 2022
DCM-MHD CITY

CC)
I -A
11
RECEIVED
MAR I I 2022
DCM-MHD CITY