Piner, Karen 88509C

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❑CAMA ElDREDGE & FILL N� A B C D
J.=GENERAL PERMIT Previous permit
ok 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): l
City( ' , '� State' ZIP Street Address/State Road/Lot #(s) f!
Phone #
Email 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
r4✓"''s "i r�
Shoreline Length
Access Length ---- .......
Pier (dock) length
Fixed Platform(s) r. f
...................... _,.............
Floating Platform(s)
Finger pier(s)
3
Total Platform area j
Groin length/#
Bulkhead/ Riprap length-...-..-.........__.._.__...._M
...._......___...___
Avg distance offshore.........................................................................
Breakwater/Sill"
1
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 required by:
Permit Conditions
;9
.
(Scalefk­"
' ❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
t
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

5E`°�T'� ❑CAMA ElDREDGE & FILL 1�` gSS�� A B c D
GPrevious permit
GENERAL PERMIT T
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
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body
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)
Finger pier(s)
Total Platform area
Groin length/#
-
•-•
Bulkhead/ Riprap length.....
_.._...._..._.
_...
Avg distance offshore
i.....:......................................
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
...........
_....�
..................
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
r..
;
SAV observed: yes
no
Moratorium: n/a yes
no
Site Photos: yes
no
f
Riparian Waiver Attached: yes
no
A building permit/zoning permit may be required by:
Permit Conditions
ZIP
man/unk)
(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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number: (/,,qA 1 cO b`4rl b b
Email Address:p'�—�v��(�� 0, C
i���.
certify that I have authorized arJ %> -r ���� �t.�� ``f�� `'�!�_r c i >��
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
LX (.
necessary for the following proposed development: `_D6 6 �e'o(au Y'h6") r
at m property located at ��� ' _�� - A"'1 U e)j^ e 1�<% � �� �ef�
Yp p Y r � rj�
in Crl(14(_,vJ County.
I 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 Type Name
Title
Date
This certification is valid through

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:
h /A d Z03 Mo&-e- Lo-4,e-
Mailing Address of Owner: liz PeAdl, A�Lan�/C. ,mac `` I
Owner's email: Owner's Phone#: q / ,OK)
2S6-12
Agent's Name: 1 g t �� ©l. gent Phone#: l -2-e � Z � 2-
�. �'� " � �
Agent's Email: tie a Yet
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Igft.om go[ ion to be comRIe�by the Adja-cent 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 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
Certirled 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.)
a is o
I DO wish to waive some/all of the 15' setback
Signature of Adjacent loarian Propedy Owner
_OR -
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
v
TypediPrinted name of ARPO: C. '� i—YZ - - .,*,
n ►�
Mailing Address of ARPO: ��- /L74
� �`/�✓
ARPO's email:/��� I' ��//ARPO's Phonei#:-_,�
Date: �::ZZZ�-;--dver is valid for up to one year from ARPO's Signature*
Revised July 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER 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:
cl r,3Ai Q
Mailing Address of Owner: l _ �'r�1 11, �L-ox 2
Owner's email: Owner's Phone#:
Agent's Name: ` f �� Ot"ed,,�c4c, (clyu/�Agent Phone#: 2 7 TZ 412-
Agent's Email: 4 Ac i , , c tIn
,�2, 0 3 Mo&,e, L&ile-
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
descriotibn 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'
Sig
MRdo not wish to waive the 15' setback
nt Riparian Property Owner
ment (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO: ici
ARPO's email:
ARPO's Phone#:�
Date: (0 3 `s L7 Z- *waiver is valid for up to one year from ARPO's Signature*
evised
July 2021