86352A_Beres, Mary Emma_20220413

3��C0"'k ❑CAMA ❑ DREDGE & FILL Q� N9 86352 A B C D
a Previous permit
GENERAL PERMIT
Date previous permit issued
0 New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue w'
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.dgq.nc.gov/CAMAruies
Applicant Name _
Address
City
Phone # (_ )
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
P
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale: . )
Shoreline Length.
Access Length
Pier (dock) length
Fixed Platform(s)
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
Boathouse/ Boatlift _
Beach Bulldozing
Other
SAV observed: yes no _
Moratorium: n/a yes no
Site Photos: yes no -
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
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 APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name
Signature "Please read compliance statement on back of permit"
Application Feels) Check #/Money Order
Permit Officer's PRINTED Name
Signature
Issuing Date
Expiration Date

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: MW- - eW� r Nv� C*'? ' 1
Address of Property: (Ql (; L�Kfaa - 'vt,,�y �\ II
Mailing Address of Owner: q' " 1.0 `& t '
Owner's email: µlG ��✓� � � ' ' Owner's Phone#: 3�u "
Agent's Name: Agent Phone#: �&
Agent's Emaii: �Jlk
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.
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
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 somelall of the 15' setback
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank) V
Signature of Adjacent Riparian Property Owner:
TypediPrinted name of ARPO: 64K /
Mailing Address of ARPO: to
ARPO's email:
,0v S
AeelPot 'off n'Ieruzw .-t 1
ARPO's Phone#:
Date: -3' I A - 20 Z z-- *waiver is valid for up to one year from ARPO's Signature*
�2 W 5-7
Revised July 2021

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: /*Z l CWA f NoCWU
Address of Property: 4 - �� ( - � `i (� ILL, l fi
Mailing Address of Owner: -i (i"p�, I�iG-
Owner's email: µt�� Owner's Phone#:
Agent's Name: N�&, _ Agent Phone#:Ulk
Agent's Email KA
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. A
description or drawing with dimensions must be provided with this letter.
r'
I DO NOT have objections to this proposal. , I DO have objections to this proposai.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastwl
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). 0f you wish to waive the setback, you must sign
the appropriate blank below.)
i
1 DO wish to waive someyall of the 15' setback f,t
-OR-
Signature dt Adjacent Riparian Property Oi+rier
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner. iA jtl, rW cL tj �
Typed/Printed name of ARPO: �ti", Ld r74'T j t�,w
Mailing Address ofARPO: 'y0k S- S:t :��ir�Cj's1' Ao(
ARPO's email AR
iyti .� PO's Phone#: Z i 7
� �7 `t ..f � - .. Tif 3r x i`
Date: a. Cy'_ 2-2-_ •waiver is valid for up to one year from ARPO's Signature'
R©vised July 2021

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MAR 1 6 2022

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION (MINOR PERMIT)
CERTIFIED MAIL, RETURN RECEIPT REQUESTED or HAND DELIVERED
mx2y—Ste"' 1 A • W21! bate
+,Iknpf S"ian Property Owner
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i►�S
City. State Zip
To Whom It May Concern:
s c s ' to ) ff, ou a n n pro -n wrier ha applying for a C'AMA Minor permit to
on my ro my at L
in County, whic is adjacent to your property. A copy of the application and project
drawing is attached/enclosed for your review.
If you have no objections to the proposed activity, please mark the appropriate statement below and return to me as soon
as possible. if no comments are received within 10 days of receipt of this notice. it will he considered that you have no
comments or objections regarding this project.
If you have objections or comments, please mark the appropriate statement below and send ,your correspondence to:
(LOCAL PERMIT OFFICER, NAME OF LOCAL GOVERNMENT. MAILING ADDRESS CITY. STATE, 'LIP CODE)
6yKift(1\ 01~- z{01 C- G'�rYV0'1TR C= Sulfa. 3w RDAW14CtT tic 7q iDf
If you have any questions about the project. please do not hesitate to contact me at my address/number listed below, or
contact (LOCAL PERMIT OFFICER) at (PHONE NUMBER). or by email at: (LPO EMAIL).
Sincerely. Z57 Z&f 35o1
Property Owner's Name Telephone Number
litkatc� e j39,lc l Tf >? 5Z "799 a151
IZ?0l
tAd re�s'3 Tti�
City State Zip
�l have no objection to the project described in this correspondence.
I have objection(s) to the project described in this correspondence.
Adjacent Riparian Sig"re
Print or Type Name
Address City
llate
2_5Z
Telephone Number
State lip
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APR 12 2022
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