84634C - Todd, Mark

I*°Ft°"Rg11 FICAMA ❑ DREDGE & FILL 9 84634 A g c D
kX Previous permit
i 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 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 Authorized Agent
Address
City State 1 y
ZIP
Phone # ( )
Email
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length d
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
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 reyuiieu uy.
Permit Conditions
(Scale• ;!�---,.,-; i )
TAR/PAM/NEUSE/BUFFER (circle one)
ElSee 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.
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature **Please read compliance statement on back of permit** . Signature
(Please Initial)
Application Fee(s)
Check #/Money Order Issuing Date
Expiration Date

0 �°FCOAR4, ,. ❑CAMA ❑ DREDGE & FILL Na 84634 A B C D
T Previous permit
i 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 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 Authorized Agent
Address Project Location (County):
City State ZIP Street Address/State Road/Lot #(s)
Phone # ( )
Email
Affected ❑ CW ❑ EW ❑ PTA
AEC(s): ❑ OEA ❑ IHA ❑ UW
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length.
Access Length
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
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
Subdivision
City ZIP
ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
(Scale: )
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 Fee(s)
Check #/Money Order Issuing Date
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Jody Gravelin & Mark Todd
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
1397 County Highway 4
Otego, NY 13825
[phone]
[e-mail]
Riverfront Docks, LLC
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
Install hog slat dock and platform
at my property located at 124 Great Neck Road Havelock, NC 28532
in Craven 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:
Mark & Jody Todd
Sign tur
Print or Type Name
Owner
Title
Date
This certification is valid through 4 / 4 / 2023

pIVISION OF COASTAL MANAGEMENT
NI N 0TPROPERTY OWNER NOTIFICATION/WAIVER FORM
CEf.TIl=1l_D �
ADJACENT RIpARIrnU N ECCIPT REC�UESTE6
��1, � cr FIl1ND DELIVERY
(Top p,,,(ion to be completed by owner or their agent)
Nana of Property Owner: Jody Gravolin & Mark Todd
Address of Properly: 124 Great Neck Road Havelock, NC 28532
Mailing Address of Owner: _ 1397 County Highway 4 Olego, NY 13825
Owner's email; jgravelin a,sidneycsd.org Owner's Phonell: [phone]
Agent's Name: John Gudaitis Riverfront Docks Agent Phenol/:_('lam 675-8210
Agent's Email: [e-mail]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be comeleted by the Adiacenl 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.
l/ 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 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 revelments). (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
leeL'?a
I do not wish to waive the 15' setback requirement (initial ti►e blank)
Signature of Adjacent Riparian Properly Owner:
Kenneth Grimm
Typed/Printed name of ARpO;
Mailing Address o110 Great Ncck Road I lavelock, NC 28532
(ARPp;
ARPO's email: k�rlr`a c,gRtail.Gom ------
ARP Phone#: (252) '�Gg 1267
Date: waiver valid for up to ono year fro1 n, RPO's Signature'
r%Q.Jl 1N Or 15 A
ptwised &4ay 2021
isCamScanner

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: Jody Gravelin & Mark Todd
Address of Property: 124 Great Neck Road Havelock, NC 28532
Mailing Address of Owner: 1397 County
Owner's email: [e-mail]
ighway 4 Otego, NY 13825
Owner's Phone#:
[phone]
Agent's Name: John Gudaitis, Riverfront Docks Agent Phone#: [phone]
Agent's Email: [e-mail]
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.
-"/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 of Coastal
Management (DCM) in writing within 90 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
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 Adja nt iparian Property r
-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: Ebbie Howard
Mailing Address of ARPO:
312 Madam Moores Lane New Bern, NC 28562
ARPO's email: Phone#: [phone]e22" 7'& 2 ,-
Date: 9_-Z- 2.e_72 *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

N EUSE RIVER
21' x 9' Platform
E
Lmm
Mark & Jody Todd
124 Great Neck Road
Havelock, NC 28532
IVERFRONT
.DOCKS
3614 Old Cherry Point Road
New Bern, NC 28560
[phone]
RiverfrontDocks.com
,for future
boat lift)
50' x 5'
Walkway