84409C - Kelly, Patti

f,IQAI"4( JXCAMA D DREDGE & FILL
GENERAL PERMIT
7New ❑ Modification ❑ Complete Reissue [:]Partial Reissue
N9 84409'A 8 (�) D
Previous permit "
Cate previous permit issued
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 h Y' k ' i20il _ ❑Rules attached. General Permit Rules available at the following link: r dea nc > ov/CAMArul
Applicant Name JP1 I IcffU-w"It _ Authorized Agent t M" K- t__ [vy�r.r�v+ tJl� vyt;t, l
Address _ - loul5et � ryry Project Location (County):.
CityN Stata ZIP 4 Street Address/State Road/Lot #(s}
Phone # 61L)
—Emailii`71 �Fi �yi�l - Swbdivision�.� _ 't q
City %MhL� kS�.L%f — --_ _ ,ZIP
Affected ❑ CW EW '0 PTA ❑ ES ❑ PTS Adj. Wtr. Body ,
AEC(s): ❑ OEA IHA ❑ uW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body --._
ORW: yes o PNA:
yes// Type of Project/ Activity
DQ(X(1V5L Gkrf'.[Llf�f (Scale:
Shoreline Length f .m.............
Access Length .-- -
Pier (dock) length
Fixed Platform(s), ______,—___
Floating Platform(s) ----
Finger pier(s)., _
Total Platform area U �fjF
Groin length/# ---
Bulkhead/
Riprap length
Avg distance offshore."
Breakwater/Sill ✓ �_ �__
Max distance/ length
Basin, channel -—
Cubic yards, ----
Boat ramp __—
��/ r����y�
ffB,;.1Id.;
oatliftl-L -�2kT____.____
ing
other >
SAV observed: yes
Moratorium: n/a Yes
Site Photos: yes
Riparian Waiver Attached: rw,7 o
A building permit/zoning permit may be required
tt to
Permit Conditions
_. l7n U _....... ......... - ----...__ __..x __..._.,_.._.. ......... ...... _ ..... ........................ ................. .._._. _.
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROP
AgentorApplicant PRINTED Name
Signature **Pleas�4ad compliance statement on back of permit** ,.^-5 s_ 2W m...._.._..__-_...._.� w-. ...- _........-.._........._.._ ._...._.....Uh- .. .
Application Fee(s)ec Money Order
AND
Date
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please initial) _._./........._._
Expiration Date

F`O"S'",& OCAMA ❑ DREDGE & FILL
9e
y GENERAL PERMIT
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
Na 84409 A B (�) o
Previous permit
Date previous permit issued
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 (t* two ❑ Rules attached. X General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Address/'j'jM1 !y Ca/V"0PL11 N I
City Ah,o(1T,2/\) State ZIP L24W�
Phone ## (%'L5
) t7l 53&
Email !i2 1(2l qt?o @ y44*AD• (hM
Authorized Agent LYH"It;KI✓I fyI'MilW(% 011`111-VIU(75J
Project Location (County):
Street Address/State Road/Lot #(s) o2
Subdivision q
City / ZIP l
Affected ❑ CW EW M PTA ❑ ES 1-1PTS Adj. Wtr. Body y 0 M �0U� (tfa"n/unk)
AEC(s): ❑ OEA r]IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body zo& u (� souw9 lJJ
ORW: yes/6) PNA: yes/6
Type of Project/ Activity �PD A- i W?-bl (00-M 1bDt,-ruFf TV A) L'xls ('(NG
D-=,Wc,c 1 k (L I ni (Scale: pl-(s )
Shoreline Length b51
Access Length --�
Pier (dock) length —�—
Fixed Platform(s)./
Floating Platform(s) ---
Finger pi
Total Platform areaTL Sf
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore --
Brea kwater/Si I I ---
Max distance/ length
Basin, channel.,' —
Cubic yards
Boat ramp '^
ouse oatlift KJ
Beacn Bulldozing �—
Other
SAV observed: yes
Moratorium: n/a yes
Site Photos: yes
Riparian Waiver Attached: es o
A building permit/zoning permit may be required
.fa IMP i Al lot) I
Permit Conditions) I/ I MLS P lA r L "f0t)MZ-u5C A g l)OeeD
806nj G7
I AM AWARE OF STATUTES. CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND
Agent or Applicant PRINTED Name
TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
❑ See additional notes/conditions on back
COMPLIANCE STATEMENT. (Please Initial)
Signature **Please read compliance statement on back of permit** ��� I T�u-re� 19�
(j ""I dtQ�
'5209
Application Fee(s) hec Money Order Issuing Date Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or NAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: Patti Kelly
Address of Property: 802 EMerald Drive, Emerald Isle, NC 28594
Mailing Address of Owner: 2781 N Quebec St, Arlington, VA 22207
Owner's email:
Agent's Name:
[e-mail] Owner's Phone#: [phone]
Carteret Marine Services AgentPhone#: 252 631-9435
Agent's Email: [e-mail]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to ba 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
deX.1
'or drawing, with dimensions must be Provided with this letter.
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)N"
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing AddressofAI,PO: o
ARPO's email: v ` AOL-1-J f 61 ���PO's Phone#:
Date: So Z% `waiver is valid for up to one year from ARPO's Signature`
Revised May 2021
RFCEIVED
JUN 2 8 ZOZZ
DCM-MHD CITY

AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: �fk�f t
Mailing Address: 2-7 ',�S i rJ . 6Z ,0c-,C
A-Y'i4L v �ix->t 7
S
Phone Number: 521 - 2-7 561 7
Email Address: 'dOLK 1 01 4-00 CI-)
I certify that I have authorized„ v�Jj!-1 h�a�(I,y ✓1 Cf?_,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at 3 0 7- e h`1e,r al e( & i J i Eyy7 ek-Id
in YCounty,
zJ�
I furthermore certify that I 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:
6
Signature
Print or Type Name
Title
6) - i �Z3 1 s Z
Date
� 5561 6
This certification is valid through ! ! RECEIVED
JUN 0 3 20('?)
DCM-MHD

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED ar HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: KaI [ ✓«C
Address of Property: �0 2 6,pner 1
Mailing Address of Owner: 2 %P/ o) -
F,
Owner's email: _ PA f Vi Owner's Phone#:
Agent's Name: Carteret Marine Servi S C. Agent Phone#: 252
Agent's Email: [e-mail]
f S lie, iocc�c
U-0-z;?-D6";z
631-9435
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
descl•Iption 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.
/f 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 Sig
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
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: a J f\ )one(
Mailing Address of ARPO: t 0 7 A Ll m .VN nn ✓ II // r►-]' Ir� n
ARPO's email: r, '64 A bt t50U+h ,net ARPO's Phone#: 6 dq l 053$
Date: _15/a5/a% *waiver is valid for up to one year from ARPO's SignatRpCEIIA -D
Revised May 2021
JUN 0 3 2021

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RECEIVED
JUN 0 3 2022
DCM-MAID CITY

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