88410C - Channel Marina Builders

%❑CAMA [I DREDGE & FILL
3 I GENERAL PERMIT,
N9 88410 A B C D
Previous permit
Date previous permit issued
[2]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 ❑ Rules attached. ❑ General Permit Rules available at the following link: w Aeq.ncgov/CAMArules
Applicant Name L It, Authorized Agent
Address Project Location (County):
City - State ZIP Street Address/State Road/Lot#(s)
Phone # (_ )
Email
Affected -U CW ❑ E W ❑ PTA
AEC(s): ❑ IDEA ❑ IHA ❑ uW
ORW: yes/do,�' PNA: yes/no
Type of Project/ Activity
ES ❑ PTS
❑SPIMA ❑PWS
Subdivision
City
Adj. Wtc Body
Closest Maj. Wtr. Body
ZIP
(Scale: i_j )
MIME
MENno
mom
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aINESE
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No
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mom
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SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Pi 0
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 Permit Officer's PRINTED Name
r`
Signature**Please read compliance statement on back of permit** Signature
Application Feels) Check g/Money Order Issuing Date Expiration Date

,Acamr" ❑CAMA ❑ DREDGE & FILL N° 88410 A B C D
2 GENERAL PERMIT Date previouspermitissued/l
❑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 ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.goy/CAMArules
Applicant Name Authorized Agent
Address Project Location (County):
City State ZIP Street Address/State Road/Lot #(s)
Phone#(_)
Email i . - Subdivision
City ZIP
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:
Access Length
Pier (dock) length..1_
Fixed Platform(s)
MENEM
III
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ONEFloating
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Platform(s)
Finger pler(s)
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No
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A building permit/zoning permit may be required
Permit Conditions
I
❑ 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 PROIECTAND REVIEWED COMPLIANCE STATEMENT. (Please
Agent or Applicant PRINTED Name
Signature **Please read compliance statement on back of permit**
Permit Officer's PRINTED Name -
Signature
Application Feels) Check #/Money Order Issuing t
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: C Gi nn ed /I la r Gy hLLu IJ P-rs
Mailing Address: _ I J4 jar_ I rl
Phone Number:
Email Address:
1 certify that I have authorized
I Contractor
to act on my behalf, for the purpose of applying for and obtaining all LAMA permits
necessary for the following proposed development:
w
at my property located at
In 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:
r,
Signature
Print or Type Name
u)LQe,E
Title
Date
This certification is valid through /_.__.._.._L--
-t,610— t) V/c;
`70 ` -�YD Pq 14Cl Gh eS

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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 Ownen haim Pl 1141grker & %diem
Address of Property: l_lnad wick 5 arr4 A
Mailing Address of Owner: _ U C I, ha ]�� i d e f r a uq5'
Owner's emalc ia5Dn5m iTr ,%Jeh4nnel "I' " Owk®ra Phonee#r5 9L-t]17
Agent's Name: Enucif Ma r i inn,5 f a 66Agent Phone#: [phone]
Agent's Email: L1/l�i IYlG1 jt1 �,CO!]5�T UC lSn gi'. cL6m
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom 0011910 to be comoleted by the AdlMrlt Prooarty Owner)
\ I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
`i permit has described to me, as shown on the attached drawing, the development they are proposing. A_
t1;& My1ded with this letter•
I DO NOT have objections to this proposal. I DO have objections to this proposal,
H you have objections rl whet k Neing pr Ofrsc, you must n tke fhe N.C. Division of sbe
ManagemenP (DCM) In wrhYng wlthJn 10 days of receipt of this notice. Correspondence should ba
mailed to 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at [phone]. No response Is considered the some as no ob]WV*n H you have been notilled by
CertNied 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 a arien access unless waived by me
�►1\ (this does not apply to bulkheads or riprap revetments). (If u wi give the setback, you must elan
the appropriate blank below.)
J I DO wish to waive somelall of the 15' setback
-0R-
Signature ofAdjacent Riparian Property Owner
I do not wish to waive the 16 setback requirement (Initial blank)
C \�� Signature of Adjacent Riparian Property Owner: �'��� v
y r L d �f {� 01�Y \ Typed/Piinted name of ARPO: // a i' G v1 aa
Meiling Address of ARPO: �f4IAARPO's
eARPO's small: J fir) Phone#: k-1 7 Sf
Date: �2 ✓ •waMer is valid for up to one year from ARPO's Signature"
Revised July 2021
c,, ygl.o

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property owner:
Mailing Address of Owner.
Owners email: jtlson5mi-hlRehannel1711Wee Phone#'' —! o'l %rl
Agent's Name: EnQ] J+ L�ari n C 0,a),4ro646gAgent Phone#:17- 4q 5
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(�ctttcm portion to be completed by ttte Adle"nt Properiv O 1I2Ij
I hereby certify that 1 own property adjaoentto the above referenced property. The individual applying
Permit has described to me, as shown on the attached drawing, the development they are propoa
descrfoIto or drewirw with dime Tana m s 6e o Aded with this letter.
NOT have objections to this proposal, I DO have objections to this propose
alyou have objections to what is behrg proposed, you must hotly the N.C. ivlslon of C
Management (DChQ In writing within 10 days of receipt of this notice. Correspondence sha
mailed to 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be cot
at [phone]. No response is considered the some as no objection If you have been noti
Certh9ed Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift,
groin must be set back a minimum distance of 15' from my area of riparian access unless waived b
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you MiLs
the appropriate blank below.)
I DO wish to waive some/all of the I & setback
Signature of Ad/acertt R/paNan -OR- Property Owner
I do not wish to waive the 15 setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:: , I ;
Cp1V�Q- h Typed/Printed name of ARPO: �.�✓� F��
,sec Mailing Address of ARPO: - ? L3 L'
L 1 Y <
u t IC_ he fYS
ARPO's email: _t )tl� C'vr 77 ;Lf. ARPO's Phone#: !/` ) ` �j�? Cr
Date: _ t�i `�"> :)-� �- "waiver Is valid for up to one year from ARPO's Signature'
Revised Jt