86549A - Jethro, Phillip

❑CAMA ❑ DREDGE & FILL N9 86549 A' B C D
all4. GENERAL PERM 1 T Previous 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 Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Address
City
Phone # ( _
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
P
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 ' 'r I h c r ; - �,.0-� ,
(Scale:
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s) t
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
i,Bulkhead/Aiprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length r
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a`; yes no
Site Photos: yes no
Riparian Waiver Attached: yes no;
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
Signature "Please read compliance statement on back of permit"
Permit Officer's PRINTED Name
Signature
Application Feels) Check #/Money Order Issuing Date
Expiration Date

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: Phillip Jethro
Address of Property:
142 Williams Drive, Knotts Island, NC 27950
Mailing Address of Owner: 115 Ansell Lane, Knotts Island, NC 27950
Owner's email:
[e-mail] Owner's Phone#: [phone]
Agent's Name: Doug Dorman
Agent's Email:
[e-mail]
Agent Phone#: [phone]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Propertv 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 DO NOT have objections to this proposal. I DO have objections to this proposal.
` j P P 1 P P
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
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 15from 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
-O R-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner
Typed/Printed name of ARPO: William Kennedy
Mailing Address of ARPO: 1213 Lakeford Place, Chesapeake, VA 23322
ARPO's email: 76cacilZ-CK%• Iff ARPO's Phone#: 7 AA-.;Qcc
Date: 04/13/22
%waiver is valid for up to one year from ARPO's Signature*
Revised July 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:
Phillip Jethro
142 Williams Drive, Knotts Island, NC 27950
Mailing Address of Owner: 115 Ansell Lane, Knotts Island, NC 27950
Owner's email
[e-mail]
Owner's Phone#:
Agent's Name: Doug Dorman
Agent's Email: [e-mail]
757-635-6400
Agent Phone#: [phone]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent 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
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
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' setba
Sig ture of Adjacent Riparian Property Owner
-O R-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: Jo Ann Peterson
Mailing Address of ARPO: 4084 Harlow Street, Viriginia Beach, VA 23451
ARPO's email:
Date: 04/13/22
ARPO's Phone#:
`waiver is valid for up to one year from ARPO's Signature`
Revised July 2021

FED
TIE TO EIP
JN11 °02107'W
/ 37.06,
NOW OR FORMERLY
JO ANN M. PETERSON
8 JUDY M. LITTLE
D.B. 535. PG. 258
P.C. 2, SLD. 128
SIR - POINT
ON LINE �g
SHORELINE(TYP)
PIN: 0075000010E0000
D.B. 1487, PG. 455
(SECOND TRACT)
1.22 AC
RECOMBINED LOT
1.76 ACRES (DEEDED BOUNDARY)
a 96 ACRES (LANDWARD AREA)
PROPOSED
BULKHEAD ENDS
E)OS1ING CANAL
NOW OR FORMERLY
WILLIARD T. BOSTIC, JR., ETAL
O.B. 595, PG. 484
103
X 1.62
CK-102
LINES BY DEED
1�
N
CAMA GENERAL PERMIT FOR BULKHEAD
PHILLIP JETHRO
142 WILLIAMS DRIVE
KNOTTS ISLAND — CURRITUCK COUNTY — NORTH CAROLINA
50' 100' 150'
ATLANTIC ENVIRONMENTAL CONSULTANTS, LLC
RAPHIC SCALE 1"= 50' P.O. BOX .3266, VT17H,40,, N.C. 27949
(Z%261-7707, a mo// dougdoec®gmoi/. com
DATE REVISED: 04/13/22

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