84700C - Queens Point HOA

"(Weir CAMA ❑ DREDGE & FILL NQ 84700 A B O D
" Previous permit
GENERAL PERMIT Date previous permit issuedN
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 t �.� = ❑Rules attached. � General Permit Rules available at the following link: vmffiwdea nc eov! ales
City -A
Phone #
Email
Authorized
Project Location (County): t.,
ZIP-9 Street Address/State Road/Lot #($) �'>> • v ��.
Subdivision
City ✓� ZIP _
� Ad . Wtr. Body naVto n/unk)
Affected ❑CW .,-W TA ES ❑PTS i y
N
AEC(s): ❑OEA ❑INA UW ❑SPIMA ❑PWS Closest Maj. WtrBdy
ORW: ye(np PNA: /
s
Type of Project/ Activity
Shoreline Length
Access Length
Pier (dock) length V
Fixed Platforms)
Floating Platform( C" r
Finger pler(s) - 's
Total Platform area
/wJ
Breakwater/Sill R V
Max distance/ lengt
Basin, channel`
Cubicyards
Boat
r
Beach Bulldozing
Other
yes no
yes no
ye no
Riparian Waiver Attached. es n
A building permit/zoning ermit may be equired y:
Permit Con itions
Groin length/g
Bulkhead/ Riprap length
Avg distance offshore
Boat ramp
Boathouse So
SAV observed:
Moratorium: n/a
Site Photos:
rt or Appl [PAINTED Name Permit
De Seem
a�e " le�read compliance statement on back of permit"
31,__, 5 Sight
pli<atit/oo Feels) Check q/Money Order Issr ng
W
o �<A
IEl
TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
See additional notes/conditions on back

'AcWtA, CAMA ElDREDGE & FILL NY 84700 A B Q D
`
`� - Previous permit
GENERAL PERMIT Date previous permit issued
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by- tyhe State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC Q / H'�f .t,,.cl / ❑ Rules attached. X General Permit Rules available at the following link: www.deq.nc.eov/CAMArules
Applicant Name _ Authorized Agent
LGEWAI J'7AIIIIIIIIIIN
Affected ❑ CW �EW JPTA ❑ ES ❑ PTS
AEC(s): ❑,� OEA ❑IHA❑SPIMA ❑PWS
ORW: vetnh PNA:
Type of Project/ Activity
Shoreline Length
Total Platform area
Groin length/q
Bulkhead/ Riprap lent
Avg distance offshore
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse Bo
Beach Bulldozing
Other ��
SAV observed: yes ' no
Moratorium: n/a yes no
Site Photos: yes no
Rioarian Waiver Attached: es np
OF
or Annllcafnt PRINTED Name
Project Location (County): _ L
Street Address/State Road/Lot #(s)
Subdivision
City ZIP
Adj. Wtr, Body na m n/unk)
Closest Maj. Wtr. Body
Permit
❑ TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
See additional notes/conditions on back
Slianature "Pleread compliance statement on back of permit" 3t//�9—
plication Feels) Check #/Money Order

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: 5+e VC fJ tJ . W
Address of Property: lb k G-Lk,-eV, 5�b'ccC i �3<W7Qr m eN,)Q a35(c1)
Mailing Address of Owner:
Agent's Name:
Agent's Email:
Owner's Phone#: Z S2—(p?0 - 2 s r7
Agent Phone#:
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.
,L4 W I DO NOT have objections to this proposal. I DO have objections to this proposal.
ff 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 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
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 Owner:
Typed/Printed name of ARPO: "rsa °��V/v wayiui/
Mailing Address of nARPO/�: 173y rr-oiv7 .S1/'te ; Ale61 Be�'N Al � Z5 U
ARPO'semail: Dr�ilc{,1-IsleSrrla%/ trK ARPO'sPhone#:
Date: i S ,?U 22 *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

HCDEH
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Heveq Eaves Perdue, Govemor James H. Gregson, Director Dee Freeman, Secretary
Date ! t�
Name of Property Owner Applying for Permit:
r
Mailing
//Address:
I certify that I have authorized (agent) 1c sv ��,"on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) (�A �t`c �C�LA- � ` _ _,, _ r —.
at (my property located at) � ,s ��yG_ s.AR _��s i ��r� rC� T"
cqt3F�4p(-)
This certification is valid thru (date)
Property Owner Signature Date
y it
�,t"f � 5 �_' ,a,R� C.., : ^, 7Y i � ✓,. it ! . J
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] Internet: www.nwmtatmanagement.net
An Equal Oppr rffytAirumatimArAwEmplover>50'%R"cledl10%Put ConsumerPaper

AMCENT RIPARIAN FILOPERTY OWNER STATEMENT h
1 hereby certify that I own property adjacent to JJ AJgS t`i-b;f& &Si- �buYlE✓S• S�4i d '§�
(Name of Property Owner)
property located at Qx ti r� Y-N `��%+
(Address, Sfock, oad, aft.)
on o e_;,t._. In ti1� N.C.
(Waterbody) (Cltyfl'o" anr� unty)
The applicant has described to me, as shown below, the development proposed at the above
IoceU n.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(Indlvldual pro�poving(development must flit In description below or attach a site drawing)
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set hack a minimum distance of 15' from my area of riparian access unless waived by
me. (if you wifh to waive the setback, you must Initial the appropriate blank below.)
A) do wish to waive the 15' setback requiremeaL
I do not wish to waive the 15' setback requirement.
(Property Owner information) (Adjacpnt Prop Owner Information)
(Ra*W Aug. 2014)
'Valid for one calendar year after signature

A�fACENT RIPARIAN PROPEL[ OWNER STATEMENT
I hereby certify that I own property adjacent to S9(IJ QQii CL1iYl��tSk eZ a�{ _ t e>x.��.R"scn
(Name of Propert Owner)
property located at SC.1., 4' V v,
(Address, Lot, Block, Road, aft.)
on _� y w• ; �_. inS5 " N.C.
(INater)ody) (C)ty)Town andlor County)
The applicant has described to me, as shown below, the development proposed at the above
location.
✓ I have no objection to this proposal.
i have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must 1111 In description below or attach a Site dtewing)
WAIHER A90-9-N
I understand that a 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. (If you wish to waive the setback, you must Initial the appropriate blank below.)
Date
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 1W setback requirement.
(Adjacent Property Owner Information)
Telephone Numbarremall address
Pete@
"Valid for one calendar year sitar signabtre° (Revised Aug. 2014)

/{ A,;SOc,i W
ow I hereby CWW 2W 1 n pmperty BADGent to ' u ee S tM- Gast FJWw� = _.. 's
PropenProperly Of Qw
(NarrM �
Y IOCa29d at� l ; '1.
r (4ddrem. Lot "c. RkM Road, atc.)
on a \�� d GF �' in ` ,;. .r,. a C ' N.C.
(Yllawbedy) (CIWTOwa WWW ODunly)
The applicant has deecribad to me, as shown below, the development proposed at the above
location.
ir/ _ I have no oWcdon to this proposal.
. as - � .. . . - , :+ . , , � ;:. • �.. ,, ra.'a - { 1
� I do not wish Do waive the 9 6 mclukament.
7fM
(Adjecent PropmW Owner Information)
T Number%ame/Jaddmm
Dale*
'Valid for one calandar year afta tgrdit as (Revf Aug- 2014)

ADJACENT RIPARIAN PRO,�ERTY OWNER STATEMENT
I hereby certify that I own property adjacent to l 1 l of s
(Name of Property ner)
property located at-"
(Address, Lot, Block, Road, etc.)
on - .,K'.`� J ewe ' in }� �ti N.C.
(Waierb'ody) (City/Town andlor County)
The applicant has described to me, as Shown below, the development proposed at the above
location.
i 1 W I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANDlOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
S.� PcC�i"G
WAIVER SECTION
I understand that a 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. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement
1-\-'Al_ I do not wish to waive the 15' setback requirement
(property corner information)
Date _
:<AM
(Adjacent PropeYty Owner Information)
�.i S/( �fNN Yi nf NiC�
Print or Type 13ame
?Sy zrrr"f 51-rr<74
Marling Adress
N'r✓ nrA/ IZte 2854[i
CWstate/ZiP — - —� -
+c+ap+rone rvurnberlemait address
*Valid for one calendar year after signature* (Reviued Rug. 2014)

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