86561A_Perry-Webber, Janine_20220621

❑CAMA ❑ DREDGE & FILL �� N° 86561 Aj; B C
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.dgq.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 (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 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
(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" Signature
Application Feels) Check #/Money Order Issuing Date Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 6 It a` �)-
Name of Property Owner Applying for Permit:
`:Yf� tj PER Uu
Mailing Address:
I certify that I have authorized (agent) 0 y / '! �-SS (' to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) /V L' VU Q L)L-K H El4 D -
at (my property located at) t o I W An-�F- #Ego ✓y .0
This certification is valid thru (date) 1 D ` / —
Property Owner Signature
4-a0-2A
Date
gE
GEV eg
JUN2AV11

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner:
Address of Property: 10 9 � j"-w ��
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Agent's phone #:
Mailing Address:
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 have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 401 S.
GrMn St., Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901. No response Is considered the same as no objection if you have been notified by Certified Mail
WAIVER SECTION
I understand that a 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 f '
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
J U % 2 1 2022
I do not wish to waive the 15' setback requirement.
M_EC
(Property Owner Information)
SigWature
Print or Type Name
Py 6 ox t-� i F
Mailing Address
Cjty/State ip
(Adjacent Property Owner Information)
Signature* ./
eAa rk#e / 40 j, l I'
Print or Type Name
%d 7 le- /ie ro,, -�)r.
Maiilling Address // I
elu
CitylStatelZip
?5--7 -4,J 7-64-.q q 3 -w A o 7-?3tf-
Telephone Numberl EmaH Address Telephone Number/Emajl Address
440Z-2:
Date Date*
*Valid for one calendar year after signature* Revised Jan. 2017

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
Name of Property Owner:
Address of Property:
Agent's Name #:
Agent's phone #:
q"a4.- "y u'"`ate N' L'2,, 1 119,_,q
(Lot or Street #, Street or Road, City & County)
Mailing Address:
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 have no objections to this proposal. I have objections to this proposal.
Nyou have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 401 S.
Grdfln St, Ste 300, Elizabeth City, NC, 27909. DCM representatives can also be contacted at (252) 264-
3901. No response Is considered the same as no objection if you have been notlffed by Certified Mail
WAIVER SECTION
I understand that a 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 : r-P VE D
me. (If you wish to waive the setback, you must initial the appropriate blank below.) I
I do wish to waive the 15' setback requirement. J U H 2 1 2022
I do not wish to waive the 15' setback requirement.
^M-EC
(Property Owner Information)
Si tore
�J-A�') NitA 1
Print or Type Name
PO 134 1 ag1
Mailing Address
City/State ip
7 - 17 -� -- Cc -/-A
Telephone Number/Email Address
_ ,mot
(Adjac Pr nor Information)
Stgnature *
Print or Type Name
Mailing Address
V� C 2 q Z�
City/State/Zip
-1 --11 �--3c)
Telephone Number/Email Address
Date Date*
*Valid for one calendar year after signature' Revised Jan. 2017
,f C0 V-n

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Currituck County GIS
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