Hidden Harbor POA co Robert Feller 84687C

���� .CAMA ElDREDGE & FILL ITT° 84687 A B(S
GENERAL PERMIT Previous permit `�
Date previous permit issued
,WNew ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of
rth C olina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
1a
15A NCAC�r p ❑ Rules attached. General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant
Address i
City
Phone #
Email
Affected
AEC(s):
ORW: v9
State [ V 1 I-) ZIP
Authorized Agent IDS{ ~
Project Location (County):
to —
Street Address/State Road/Lot #(s)1'2,()U0
Subdivision AEA
w
City ZIP
❑ CW / PTA ❑ ES ❑ PTS Adj. Wtr. Body t1%ff mg n ` man/unk)
❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body / A/P a se
Type of Project/ Activity
Shoreline Length_ f
Access Length w'
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 �) � `
Oe
Boat ramp
Boathouse Boatli
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes
Site Photos: es
Riparian Waiver Attached:
A building permit/zoning permit may be required by:
Permit Conditions rey pp
TAR/PAMUFFER (circle one)
ElSee note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUS, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWE�COMPkd NCE STATEMENT. (Please Initial)
PRINTEn n�Z j �- Permit Officer's
statement on back of permit"
s) Check #/Money Order Iss

�a�,(WhV GENERAL PERMIT CAMA ❑ DREDGE & FILL ��/ N9 84687 A B�D
t Previous permit
Date previous permit issued
,)6ew [:]Modification ❑ Complete Reissue [-]Partial Reissue
As authorized by theStateof
orth C olina, Department of Environmental Quality and the CCoa/stal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC ❑ Rules attached. Lyl t eneral Permit Rules available at the following link: wwva deq c gov/CAMArules
Applicant
City
Phone #
Email
Affected
AEC(s):
ORW: ys
Authorized Agent
Project Location (County):
zip Street Address/State Road/Lot #(s)
Subdivision
City
N
❑ CW _A+519 PTA ❑ ES ❑ PTS Adj. Wtr. Body 2W 115jVC/\n man/unk)
❑ OEA ❑ MA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body-' Ale"se R 1 vie-liz-
Shoreline Length 61s( l
Access Length •�
Pier (dock) length
Fixed Platform(s)
Floating Plafform(s)
Finger pier(s) K
Total Platform area _
Groin length/# _
Bulkhead/ Riprap lens
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel_
Cubic yards
Boat ramD /J'C
SAV observed: yes
Moratorium: n/a yes
Site Photos: es
Riparian Waiver Attached: ys n
A building permit/zoning /) I'
Permit Conditions AA II
PROJECT AND
PRINTED
Permit Officer's
zfi Oiiq I
Al TARIPAM495�UFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
Sig�ptu "Pie ead compliance statement on back of permit'" /
Application Fee(s) Check #/Money Order

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CyE(271FIkC\ MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
r
Name of Property Owner:.._,__.,..
%� CtY f.`
Address of property: .. ` ` 4— —_
`l•`/ 'i �: \. .:r, i'"-1,i �i tiril�'.Y-r �.t�-'.y'4r1 x:,.-=✓-.
Mailing Address of Owner. 1 e ��.:z�rar t` •�..c_- - —, � " '"
.�v_s.;:Y-+t ll`1a-rrtf..0ivnersPl3ane#: `-\!1` .t=d>". ky_=��v
Owner's email:_,
1
Agent's Name:
Agent's Email
Agent Phone#:--
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
Bottom portion to be completed by the Adjacent Property Owne
I hereby certify that I own property adjacentto the above referenced property. The Individual applying for Otis
permit has described to me, as shown on the attached drawing, the development they are proposing. 9
description or drawino with dimensions must be provided with this letter.
`e.)-r— I DO NOT have objections to this proposal. _ I DO have objections to this proposal.
fl you have objections to what is bcing proposed, you must notify the N.C, Division of Coastal
Management (DOM) in writing within 10 days of recelpt of this notice. Correspondence should be
malled to 400 Commerce Ave., Morehead City, NC 28557. OCl1 representatives can also be contacted
at (252) W8.2808. No response is considered the some as no objection if you have been notified by
Certified Mail.
WAIVER SECTION
t 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 do" not apply to bulkheads or riprep r le I. (If you wis eve the setback, Iou must sign
the appropriate blank below.)
f DO wish to waive some/all of the f b' setback
Signature o ANd,t Riparian Pmpert wrxo
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property
TypedlPrinted name of ARPO:;`_, r__Ri_vlt—,,--
Mailing Address of ARPO* ` `r � L.� b `A. A= " 'o—itav
L 05�
ARPO's email: ti,l,I__ ou,-\ ARPO's Phone#:
Date- _ ___._"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 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:S
Mailing Address of Owner %4 hu 0.+-�v0.r� •'���. `�Ci
aJ�eGtoi�, o,. 9 \ q-
Owner's email: .` Owner's Phone#:
Agent's Name: 33 "�' " " �T�6Agent Phone# ._
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom ,)ortion.to be com,, feted by the AdiKent Property Owner)
I hereby certify that t 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. Q
descri, lion or drawin; with dimensions must be ; rovided 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. Division of Coastal
Management (DCMj 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 sic n the
appropriate blank below.)
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 ner
Typed/Printed name of ARPO:
Mailing Address of ARP IV�-j¢_! ?� �+-� iG'4 ✓7�, yT✓ C ���`!
ARPO's email: ri • r rARPO's Phone#: C�S2 ,J�O ���% l
Date: Lwaiver is valid for up to one year from ARPO's Signature'
I Revised May 2021

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date I / a t3� u,_
Name of Property Owner Applying for Permit:
&1349 L OCU k H I DP�N fVW6P '" �60T r 6LU00 y9 FIC t,
Mailing Address: / ktS C' ) �
Wl-
I certify that I have authorized (agent) " , act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) M 1 !P-� Y f A) 6,FJ g ;Q& SL(p 1
at (my property located at) a / 11�iZ `c )1 /AJ f'7�1fh'b'
��st6
This certification is valid thru (date)1+2
Property Owner Signature Date