86562A - 56127 Elizabeth Avenue, LLC

�CAMA ❑ DREDC k FILL rl 1� " iO. 86562 B C D
GENERAL PEr�M IT eous permit
Date previous permit issued
[(dew Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the,State of North Carolina. Department of Environmental Quality and the Coastal Resources Comndsslon in an area of environmental concern pursuant tot
I SA NCAC !l:i ,, / 210'a ❑ Rules attached. td General Permit Rules available at the following link: ywvhr dea.nc go 1CAMAruies
Applicant Name 5
iv/ 'Ll 61 T so. g
A ✓art ,, � C,,, Authorized Agent —"
Address M a_r V—
5 % S K r /, 3g 0 1,1
m C•f-4�, r1 Ito d
Project Location (County):
City � �-f`r C tate 1/ &
ZIP _ 4--y D(-p
Street Address/State Road/Lot #(s)
Phone # ( O�)
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IA�o�Th "41 t,
Email K
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Subdivision
City ZIP 2� q3.�
Affected ElcW
®EW ® PTA
❑ ES ❑ PTS
�i Wtr.Y �-' `� Q' r
AEC(s): ❑ OEA
INA ❑ UW
❑SPIMA ❑ PWS
t
Closest Maj, Wir, Body Pa.M l r t�t� ou it
ORW: yes/o
PNA: yes/9
hype of Project/ Activity <-L o i
A -Fb corn '
Shoreline length —
Access length
Pier (dock) length
Fixed Platform(s) r %rs
Vex
Floating Platform(s) .r
Finger piers)
Total Platform area u `
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore `
BreakwaterAIII
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
v ,
Other,' r
SAV observed: yes no
Moratorium: n/a s no
Site Photos: s no
Riparian Waiver Attached: no
A building permit/zoning permit may be rei
Permit Conditions
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by:
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❑ 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 A cant PRI N Permit Officer's PRINTED Name e
_1
S nature •Please read compliance statement on back of permit** Sig ure
,zn� 151 q�z
Application Feels) Check #/Money Order Issuing Date E�)radon Date

5612-7 E/,; a h e-A /five-
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MAY Z 0 2022
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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 Owner: MUr K Sisk I -T& 127 ��i �ct,�/
n �� LLC-
Address of Property:
Mailing Address of Owner: (BYO A/AYr" j<,�._ r-K"— e 'iC iC S 1.0W✓4
Owner's email: h?crrk@ Ce l feb-nc 4rac<%" Vwner's Phone#:
COWA
Agent's Name: AIIA Agent Phone#:
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be compered by the Adjacent Property Owner)
MAY 10 2022
2 2-�W
I hereby certify that 1 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 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
notNied by Cerdfied 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' setb k�,�
Signature of Adjacent Riparign Property Owner /
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner.
Typed/Printed name of ARPO: C �/Pt e � �(kj,51) d
Mailing Address of ARPO: 1�) /OS Seams" (� - /2a /e"rA, qc --) -7 (v/J
ARPO's email: r N'Oo P CX ryi / ARPO s Phone#:
Date: "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 NOTIFICATION/WAIVER FORM
CERTIFIED M61 • RETURN RECEIPT REQUESTED or HAND DELIVERY MAY 1 0 2022
(Top portion to be completed by owner or their agent)
Name of Property Owner.
Address of Property:
DCM-
Mailing Address of Owner. 12 90 AL Kr" 2d6t' d e*-,C k S Ear's . t/A 221
Owner's email: irictrk@ CAil a lo'nc fmd<' 9Dwner's Phone#:
cowl
Agent's Name: A11A Agent Phone#:
Agent's Email:
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. �4
description or drawing. with dimensions. must be provided with this letter.
x I DO NOT have objections to this proposal. l DO have objections to this proposal.
N 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. Gdyf/n St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response Is considered the same as no objection ff you have been
notlfled 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 dprap revetments). (if you wish to waive the setback, you must 9190
the appropriate blank below.)
100 wish to waive some/all of the 15' setb
Signature of Adjacent Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner.
Typed/Printed name of ARPO: _! /Z 4 6�4 " r
Mailing Address of ARPO: 3 c7rt r cos 12)r% lam. Cc ✓A,Z P,4 /78 J
ARPO's email:7��� frr r�aT0 tvS• ARPO's Phone#: '70--2G9-C13/(,0
Date: _�� /4ZZ6ZZ- "waiver Is valid for up to one year from ARPO's Signature"
Revised July 2021

This map is prepared
from data used for the
i
�l
inventory of the real
property for tax
Purposes . Primary
information sourcessc
recorded deeds, plat
a..
wills, and other primar
+-f
public _:the,
rds should
consulted for verificati
of the information
contained in this map.
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AGE & FILL
EPERMIT
JNew ❑Modification El Complete Reissue ❑Partial Reissue
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Previous permit #
Date previous permit issued
Yk aAU1 k,>
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC Rules attached.
Applicant Name (�Y"k't co Or""tom L L Project Location: County 1)6k r-(!-
�
Address ��a a to A C) (` r A"l of V1 a Street Address/ State Road/ Lot #(4s) tt]]�
1 �� <! a .
City �J�.�t,''i✓�l'�6�.('! State ALA ZIP �'•.yam ) 4� zek ATV('
Phone # ( is r i tj E-Mail t4j i 5 K 1 1b 0WPIAI,' I �05h Subdivision
Authorized Agent G1 4k +'l'it'1C6?. CiZIP
Phone #
Affected ❑ Cw K Ew �W PTA ❑ ES ❑ PTS (_ )
...... River Basin PC. 51? tk c� � � Cvv%.
OEA HHF ❑ I ❑ H ❑ UBA N/A
AEC(s): ❑ ElAdj. Wtr. Body `-�"� IIV'. � e (*ca �-�'?uty�G� (fiat man unkn
{{
❑ Pws:
Closest Maj. Wtr. Body
ORW: ves /, no} PNA yes / ro_)
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?gent or�pp icant Pri, ec) Name
(`fIj+�'(....s„,..ate
Signature PJ ase read compliance statement on back of permit"
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Permit Office 's Pr'nted Name
Signature
Fxniratinn Date

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