NG, Alex & Nancy 87395C

o1+0ECOAS41 ❑CAMA ❑ DREDGE & FILL N 87395 A B c
�ffit
GPrevious 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 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 Platform(s) _
Floating Platform(s)
Finger pier(s) '—'
Total Platform area
Groin length/# _
Bulkhead/ Riprap le
Avg distance offsho
Breakwater/Sill _
Max distance/ leng1
Basin, channel
Cubic yards
Boat ramp -
Boathouse/ Boatlift
Beach Bulldozing_
Other
SAV observed:
Moratorium: n/a
Site Photos:
Riparian Waiver Att
A building permit/z
Permit Conditions '+
T
(Scale:
sLJ TAR/PAM/NEUSt/13Ul-FtK (circle one)
1
t r
❑ 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) Check #/Money Order
Signature
Issuing Date Expiration Date

o�01`°"SJ41 ❑CAMA El DREDGE & FILLT g%�9S A B c D
Previous permit
m GENERAL PERMIT y � 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:
I SA 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 lE
Avg distance offsho
Breakwater/Sill _
Max distance/ lengi
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing _
Other
SAV observed:
Moratorium: n/a
Site Photos:
Riparian Waiver Att
(Scale: )
A building permit/zoning permit may be required by. ❑ TAR/PAM/NEUSE/BUFFER (circle one)
Permit Conditions
❑ 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

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
Owner's email: CN"V'tL,L(, Ck� n2�,ckmo�k I >�C`6'w'ners Phone#:
d 1 Agent Phone#:
Agent's Name*
Agent's Email:.
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed §y the Adjacent Property Owner)
-) lv� 1-- 1 `1
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
nr Arnwinn with dimensions. must be vrovided with this letter.
V 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
Signature of Adjacent Riparian Property owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner*
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fs
Typed/Printed name of ARPO: Jfk x
Mailing Address of ARPO: 5`1
r in or -.5 1�1
ARPO'S email: L>Sl r-1-1 �fy"ARPO's Phone#:
Date:
is valid for up to one year from ARPO's Signature*
A i).v' *waiver
Revised July 2021

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)
i
'
Name of Property Owner: l b V� ,n
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Address of Property:
Mailing Address of Owner: 1,--'9 4
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Owner's email: IX n
'J ner's Phone#:
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Agent Phone# -
Agent's Name:h' Cv�A, 64 R 2"2AY&C Aug
Agent's Email:
1 f2clz VY'�
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be corn Dated 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 with dimensions, must be provided with this le
I DO NOT have objections to this proposal. I DO have objections to this proposal.
it you have objections to what is being proposed, you must notify the N.G. vivision OT Lloasidl
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
Signature of Adjacent Riparian Property Owner
192
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: Ac-
Typed/Printed name of ARPO:
Mailing Address of ARPO:
(f,
ARPO's email: (;\V Ouv 9 YN 2S 1-0 2,w\ ARPO's Phone#: 3
J
Date: *waiver is valid for up to one year from ARPO's Signature*
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Revised July 2021