86552A_Gervais, James & Brenda_20220525

*'CO#5r4,1 ❑CAMA ❑ DREDGE & FILL N° 86552 A", B C D
s� \ Previous permit
GENERAL PERMIT
3 r 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 > E I i I ❑ Rules attached. ❑ General Permit Rules available at the following link: www.dgg.nc.Qov/CAMArules
Applicant Name r A <'
Address' -�
City State ZIP
Phone # ()
Email
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
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
Shoreline Length
Access Length
Pier (dock) length
Fixed Platforms)
Floating Platform(s)
t
Finger pier(s) /
1
Total Platform area
Groin length/#
ulkhead -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
i
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
(Scale: )
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) ; r„
Agent or Applicant PRINT£b'Name Permit Officer's PRINTED Name
Signature"Please read compliance statement on back of permit" Signature
Application Fee(s) Check #/Money Order Issuing Date Expiration Date

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:
Address of Property:
Mailing Address of Owner: 77! 4 t�,e l IS -r<,- In-, id Rd Luf'f'/► xA.- . tom' t i
Owner's email:tis K, In 'G{t��t`'�hone#:C!% ��
Agent's Name:
Agents Email:
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
descriptionawina. 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
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 Ar
Signature of Adjacent Riparian Pro ner
-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:
Mailing Address of ARPO:
ARPO's email: 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 MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner:
Address of Property:
Mailing Address of Owner:
I ;.
Owner's email: Vn1. 12. G yac) A4,u+ 1. ,owner's Phone#: Z 5,7, 413 T ;XCr�t'
Agent's Name:
Agents Email:
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
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
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 f�
-OR-
Signa ure nt Rip of Adjacen 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:
Mailing Address of ARPO:
ARPO's email: ARPO's Phone#:
Date: *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

an.Zed Tlebacv R,Od
2' X 518" Galy
F'x4' Deadheads
_SAVING
i
a
Z
to
n
,n
L
Mud Line
n
In
;!
REPLACE LEFT BULKHEAD Wj
NEW WALL 1 FT TALLER THAN E)l
50 FT FRONTAGE - 6 FT END W)
2 FT OUT FROM EXISTING WA
VINYL PILING WALL - EXTERNAL F
4"x6" OUTER WALER BOAR[
2"x8" INNER WALER BOARC
666x6"x12' PILINGS (8' for Piling/4' DE
(1 0) 12'x5/8" Tieback Rods
Bolts & Lugs
Existing Bowed Out Wall
New Wall 2 FT Beyond Existing End Post
2.5 - 3.0 FT CURRENT WALL HEIGHT TO MUD LINE
<--------- Canal End 20OFT (Right Side) COINJOCK BAY (Left Side) ------->

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