84579C - Osprey HOA - David Dalsimer

❑DREDGE & FILL N9 84579 A B 07D
Previous permit 11�-
.GENERAL PERMIT Date previous permit issued /
j�New ❑Modification El Complete Reissue ❑Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Co tal Resources Commission In an area of environmental concern pursuant to:
15A NCAC —1I�❑ Rulesattached. General Permit Rules avallable at the following link: wwwAqq.nc.gon,/C MA rules
Applicant Name O r Authorized Agent 4 ( l, coo
Address wm, Project Location (County): 1 o rJ
City N T l flue Nr . ZIP � StreerttAddress/State Road/Lot #(s) A
Phone#(q1G) la"14. 5b2�3 1�2 11nwilim �aL
Email- eel "Or ie trY Go)OA � . rO (Y> Subdivision
city N •Try QA 1 alp ZIP
Affected ❑ CW �EW PTA ES ❑ PTS Adj. Win Body I An r1C1r'(itryEd r, pr rI(e (nat/manjunk)
AEC(s): ❑ DER ❑ IHA ❑ UW ❑SPIMA ❑ PWS Closest Maj. Won. Body
ORWeleyno PNA: Ves9
Type of Project/ Activity
Shoreline Length J
Access Length
Pler(dock) length
Fixed Platform(s)
Floating Platforms)
Finger
Total Platform area
Groin length/p—��
Bulkhead/Rlprap length
Avg distance offshore
Breakwater/SIII
Max distance/length /
Cubicyards
Boat ramp _
Boathouse/
Beach Build
Other
SAY observed: yes
Moratorium: n/a yes n
Site Photos:
Riparian WaiverO.(t ached: es no
A building permit/zoning permit may be r
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TAPVPAM/NEUSEIBUFFER (circle one)
See note on back regarding River Basin rules
See additional notes/condldons on back
I AM AWARE OF STATUTES CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATE ENT. (Please lnitial�._
Q
%gent or pl Name Permityi{)fhcer's PRINTEp N„me,
iig a " ease read compliance statement an back of gnat
per miN' Siure -
# 55IC; IzmZ -9
%ppllcationFee(s) Check Jf/Money Order Issuink DaR6 Expiration Date

❑DREDGE & FILL N9 84579 A B O'D
$ 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 Co tal Resources Commission in an area of environmental concern pursuant to:
I5A NCAC T ' �d� ❑ Rules attached. General Permit Rules available at the following link: wwwdegnc.gov/CAMArules
�I
Applicant Name r — Vt ( Authorized Agent ,
Addrf*es�s� ��� Project Location (County): U ur71 Z) � 1 , /�
City LVT ,JI ' tLYfiSTate N�, ZIP (ie4('d Street Address/State Road/Lot#((ss)) �-`� IAVA
Phone # (� j0-14 — 502"R Comm U"ll'�Txl >ocY4
Email eel marine (W af()OA cc) rl1 Subdivision City N .T LU I �+ �•ZIIPZ 6(D
Affected ❑CW [ KW �TA ES ❑PTS Adj. Wtr. Body JAn nC%f1lQ6—Ce4ek— (ntat/t/man/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body PO��PCW] /A111 rJN
ORWeyno PNA: yes
Type of Project/ Activity
Shoreline Length
Access Length _
APPLY TO THIS PROJECT
Applicant PRINTED Name
Signature "Please read compliance statement on back of permit••
Application Feels) Check #/Money Order
•tng2�
AR/PAM/NEUSE/BUFFER (circle one)
ee note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please Initial)
PermiwHicer s PRINTED Name
Signature
sl�lusy2 91��2byZ
Issuink Cat& Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: �hi ✓i -6C dS 1 P''n -2 T
Mailing Address: ZK C S,00ecy i)r'i✓�
Phone Number: 9/6 — G 7V - SU Z &-
Email Address: Z Z Z Jet IS (dY,;le, i /, C'
I certify that I have authorized Joshua Barber/ PFL Construction
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Installing a boatlift on Slip 10
at my property located at a gele P r f C�14 C or" na gai
in Onslow 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:
Signature
014VIO DAL.f/&EIL-.
Print or Type Name
7 l �t � ell c� P H'{' 77 oT
Title
j l LV l c:J22—
Date
This certification is valid through

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 Iowner or jthbira�gent)
Name of Property Owner. �,�[ Q( .V-J �f41%1 l� 1l CilS- i rnrr
Address of Property:
Mailing Address of Owner: N IJR) AL./
owner's email: ZZZ (-1 C� r)MI :i3Owner's Phone#:
Agent's Name: Josh Barber/PFL Construction 910-330.5569
Agent Phone#:
Agent's Email: [e-mail]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Ownerl
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 or coastar
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 CommerceAve., 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 nprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
1 DO wish to waive some/all of the 15' selbaclyt-- , - �—
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 Ownern ( r (h, . \ I , A
T TypedtPrinted name of ARPO: aA K i% [.'� �l'� rt:! i' c in
Mailing Address of ARPO:
ARPO's email:G f L1)1�t 111 iY,4 j �'Lc ARPO's Phone#: � j • i)7F 1��'i,K
Date: Zt�c Z 'waiver is valid for up to one year from ARPO's Signature'
Revised May 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top p''o11rtipn to be completed by owner or their agent)
Name of Property Owner: 7U�7�� 1 tD AM -.k\65 s, i m C'
Address of Property: 28 Kz �..
Mailing Address of Owner:� r NL 28460
Q
Owners email: ZZCCk'Iii50,5mw�n5wner'sPhone#: 910'U.mot 6H -;50Z8
Agent's Name: Josh Barber/PFL Construction Agent Phone#:[phone]
Agent's Email: [e-mail]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be completed by the Adtacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
oermit 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.
it you have objections to what is being proposed, you must noury me mu. umsron or �Pasrar
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 '
SignatureofA scent ipa ian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
13
Revised May 2021

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