86389A - 2207 Pike Road, LLC

1L1,;GAMA DREDGE & FILL N(� 86389 a C [�
Previous permit �% 33A
GENERAL PERMIT
Date previous permit issued
E] New i'Ll Mlodification vVComplete Reissue C Partial Reissue
As authorized by the State of North Carolirm, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC _.� 1 4� U ._m Rules attached. F-General Permit Rules available at the folkymng link: wynx.dea.nc.Qov/(;6MArules
Applicant Naaame ��ie_,�y t,& 20"1 Authorized Agent_ Gt.�._4T4��:•G S� �____..__�_
Address f O _02k._. %t _,) Project location (County): --t( ''"t_-1-c ,
City V trS�� r C� _ State V A ZIP _ fit $ i' _.._ Street Address/State Ro"Lot #(s) D 2� p }-
Phone # ( — y t! l _ 39 -
Email.Sr�.Gv{Y rto ,n.�u{ lr,^
_............._._......__ subdivision C61,0(,Q4 r2o,,.h.
City_ frai,o, r ZIP��i�.X.._ ___..._..
Affected 7 CW EW TA E5 � PTS Adj. Wtr. Body: Cj. � r Y t£.rt � * (nxounk)
AEC(sy O£A t__ i 14A ;] UW E] $PIMA L__i PWS Closest Mai, Wtr. Body CLt • G ¢Ili __— C� -
ORW: yes/ PNA: yes/(DO
Type of Project/ Activity /Vft_� r- X 31t f tgaT—cJ rLar Crr jyu
&[tr1< s _ {State: /VTS }
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s) _
Floating Platform(s) _
Finger pier(s) _.__.
Total rea _ 7-2
_
Groin length/N
Bulkhead/ Riprap length
Avg distance offst'
Breakwater/Sill. _.
Max distance/ length
Basin, channel
Cubic yards ..».._._.._ _...�_.....__._..
Boat ramp
Baathause Boatli#t
Beach Bulldozing ._.... ,_...
✓
Other Capt-
l r_ -1-tct w
1�x 314 rlrl
Pk-�t «,.
Gt
18r ,l ✓ f
Gk tr. l w_�
r n L- --°- i ' —j - s' -i
SAV ooserved: ,_,y yes no (, �l Mo�.. "5 • & _ -7_ P, �e, k _ t
Moratorium: n/ yes no 4 _, { •LAC! T i�
Site Photos: . no t cf ( .
Riprrian Waiver Attached- yes t no 1
A building permit/zoning permit may be required by: 1_ t t . si Lc �L l--m—
*_XL .................. __._...
4— ! )
�t,artctic� ter x 1�r
A�,.�1,�t�Yscl
TAR/PAM/NEUSEAUFFER (circle one)
See, note on back regarding River Basin rules
See additional notes/conditions on back
t AM AWAR€ OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. ;Please Initial)
Agen nt RRh Permit Officer's PRINTEName
Si ,nature °'Pi ease read co pliance statement on back of permit— _ Signature
Application Fee(s) Check #/Money Order Issuing Gate Expiration irate _.

Uqgamwu; [#10 Ir-kIl 1101 ff M*W#9
Name of Prop" Owner Requesting Permit-�� le
Mailing Address: 'PC, i?gx
U1
C�-
4�
Phone Number:
Email Address:
I certify that I have authorized
Agent t Contrador
to act on my behalf, for the purpose of applying for ard obtaining all CAMA permits
tecessarY for the following proposed development:
at my Property located at P. Le
in LY'i`�G-� County,
I furth6i'MOre certify that I am authorized to grant, and do in fact grant permission to
UWWOn Of COSsW Management -staff, the Local Permit Officer and their agents to enter
on the aftmnentbW lands in connection wr#7 evaluating information related to this
Permit application.
Sj g rtatcre
Print or Type Atom
Title
This Certification is valid through 10, 1 f --f- —/-*-�Z-

11 /22/21, 4:55 PM
North Carolina Secretary of State Search Results
• File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online • Add Entity to My Email Notification
List • View Filings • Print a Pre -Populated Annual Report form • Print an Amended a Annual Report form
Limited Liability Company
Legal Name
2207 PIKE RD, LLC
Information
Sosld: 1885062
Status: Current -Active O
Date Formed: 8/26/2019
Citizenship: Domestic
Annual Report Due Date: April 15th
Currentgnnual Report Status:
Registered Agent: Northwest Registered Agent Service, Inc.
Addresses
Mailing
4030 Wake Forest Road STE 349
Raleigh, NC 27609
Reg Mailing
4030 Wake Forest Road, Ste 349
Raleigh, NC 27609
Principal Office
4030 Wake Forest Road STE 349
Raleigh, NC 27609
Reg Office
4030 Wake Forest Road, Ste 349
Raleigh, NC 27609
112
https://www.sosnc.gov/online_services/search/Business_Registration_ResuIts

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: P; k -e Pc) //(
Address of Property: -)-a b -2 P, Le Rd
Mailing Address of Owner: P. 0 : /3L, �N
Owner's email: J,c..Owner's Phone#: 757 — P,�i�
Agent's Name: 3c-u�11 /�. l� �t Agent Phone#:
Agent's Email: /J,ecr
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
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 SL, 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
Signature of Adjacent Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: L)o^-a _ 09 Scq (,1 .v c� F r S i
Mailing Address of ARPO: � �� / �� ' C j
emu, cv _ C,
ARPO'semail: i��M��� .t111)�MARPO's Phone#:So2 3 /—
Date: __/ 0 (�° ( *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
V ic-
I �II�'I I'I IIIII III II III II II III I I
9590 9402 3209 7166 6720 56
2. Article Number (Transfer from service label) I
7020 2450 0002 3104 087
A. Signature
X 0 Agent
7.,Djte
❑ Addressee
B. Rece�EH by ( rintVla og ,live
D. Is delivery address different from item 1 T U Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Adult Signature
❑ Adult Signature Restricted Delivery
&Certified Mall®
❑ Certified Mail Restricted Delivery
❑ Collect on Delivery
❑ Collect on Delivery Restricted Delivery
flail
3 flail Restricted Delivery
❑ Priority Mail Express®
❑ Registered Mail —
El Registered Mail Restricted
Delivery
❑ Return Receipt for
Merchandise
❑ Signature Confirmatlon7m
❑ Signature Confirmation
Restricted Delivery
Ps Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONfWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: P; k r Pe-) //( T4lrt -QC 2
Address of Property: �2a b `7 Pi k1 )Z d
Mailing Address of Owner: P. 0 y S 4 n *Sj
Owner's emai1:_X�C Q0y,6.erlAtclf)1 ' j,c�Owner's Phone#: 757 _ PZ-e-.—
Agent's Name: i�wch �,1L �tiGcl Agent Phone#: Z5L— Ze? 1%r.,ti z 4,
Agent's Email: /�{�< C�'I v�IC �G+<15./Cr� �i YICtl C 0"
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.
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
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' setbacks--=_ - -- �•
Signature of Adjacent Riparian Property Owner
-OR-
1 do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email:
ARPO's Phone#:
Date: *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

iW,09)

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