Gaskins, Beverly 84219C

❑CAMA ❑ DREDGE & FILL O` 84219 A B c D
3 Previous permit
s GENERAL PERMIT
Date previous permit issued
❑ New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of North Carolina, De�paar'tment of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC' f' var�� j �.'-0"'� ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name,
Address
-'..
(
City
fl r
State
Phone # ( )
Email
Authorized Agent
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 Maj. Wtr. Body
ORW: yes/no PNA: yes/no
e
Type of Project/ Activity
(Scale: )
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
i
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 ruLim, cu uy.
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
Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit"
Application Fee(s)
Signature
Check #/Money Order Issuing Date
Expiration Date

COMM. ❑CAMA ❑ DREDGE & FILL INTO 84219 A B C o
a 3 Previous permit
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 _
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
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 nc
Moratorium: n/a yes nc
Site Photos: yes nc
Riparian Waiver Attached: yes nc
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
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
Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit"
Application Fee(s)
Signature
Check #/Money Order Issuing Date
Expiration Date

Property Owner Requesting E✓n 7 rL i�1S PAM� i�� fxfjs'IJA(G,
Name of rop rty q g Permit. � -l.Y
Mailing Address: Z 1 1 (� P PE4 -,Z �- L_L L,.1
rAEtj jai L 2 � 35�
Phone Number: 2 Z9 - ? -/ (,i
Email Address: ---) m c�, n n � n 4 Oc
' rn c\- < < C—Of -t)
I certify that I have authorized r�T"� r2E C'�� `�zv ►5
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: (rQ S-T A t (-- P 6a4-) T
LIFT C�� I�� non SuP(�ovzTi�C� S�uCTus at my property located at 2 I f)e -acL L- ,,A i�I Cw �)iEtL
County.
1 furthermore certify that l 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:
Signature
Print or Typh Name
Title
3) ZO Z2
Date
!' This certification is valid through
s
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RE(1`71VED
jUN ® 3 ?Q '
DGM-ICI A-j

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETQRN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: '1'�EV 2 -D �"� r'► Al{ SILM
AHrirPcc of PrnnPrty, L (' ctL-P'. ZtECl.-- Lr J ice- (V L-7 `JL 2,
Mailing Address of Owner: Z- ( t ( f ei, 1 � c_ L►,. , �--� �. `�=�-►.I
Owner's email: ```d�vner's Phone#:
Agent's Name: Carteret Marine Services
Agent's Email: [e-mail]
Agent Phone#: [phone]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the AgJacent 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 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 dprap 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 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: �� �P C ���,1
Mailing Address of ARPO:
\4-\V, V\,Q-A- , , "
ARPO's email: \ S-k0�PO's Phone#: —2
c—
Date: I Ld 1 -U *waiver is valid for up to one year from ARPO's Signature"
C �s S&.
Revised May 2021
i �::1V
,JUN 0 3 2022
D C M—N1HD (tITY

(Top portion to be completed by owner or their agent)
Name of Property Owner: ;Ev
/�,,-)AIfoC-1
Address of Property: ,? � ` R ccE, ,. -z-E —
--,---
Z PPS' h1 �LLL , �-- t-k---rL ►j N)c Mailing Address of Owner: r-1 , � � r
Owner's email. P'­')"1),% I rl 9 ' C`dO/ner's Phone#:
Agent's Name: Carteret Marine Services
Agent's Email: [e-mail]
Agent Phone#: [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.
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 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 , A./ ,, i
-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: en r< C S r ►`
Mailing Address of ARPO:
14
ARPO's email: email: r�' 'd - op—ARPO's Phone#: -2 roZ '(o .2,
Date: 2v,2� -z- *waiver Is valid for up to one year from ARPO's Signature*
Revised May 2021
UN 03 M

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