McCabe, Terry 88517C

°F`°�'"1 O❑ �CAMA DREDGE & FILL g.� A B c D
Previous permit
i 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:
5A NCAC a r ( ❑Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name Authorized Agent
Address Project Location (County):
City State ZIP Street Address/State Road/Lot #(s)
Phone # (_ )
Email
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)
Total Platform area
Groin length/# i
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 ("""F
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
-r
(Scale•.' ref)
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
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

,�°jCO 41 OCAMA ❑ DREDGE & FILL N9 88517 A B C D
o
GENERAL PERMIT Previous permit
Date previous permit issued
OTINew ❑ 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
Affected ❑ CW
AEC(s): ❑ OEA
ORW: yes/no
State ZIP
❑EW ❑PTA
❑ IHA ❑ UW
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
ES ❑ PTS
❑ SPIMA ❑ PWS
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City _ ZIP
Adj. Wtr. Body (nat/man/unk)
Closest Maj. Wtr. Body
(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 Fee(s) Check #/Money Order Issuing Date Expiration Date

m , G. DIVISS ION OF COASTAL MANAGEMENT
AMEN T AUTHORIZAINON FORM
Date %i/ �261V Z�
Name of Properly Owner Applying for Permit:
-T-e, or) tI [A c c n
Failing .address:
LjErjxAb IA
I certify that I have authorized (agent) b 41 \y to act on my
behalf, for the purpose of applying for and obtaining all CAFA. Permits necessary to��
f E 0, �_a� 5A ,n�ti iC. Cep f(3,0 t E-c r(-IC,k..
install or construct (activity).1C ') ! l AZ
at (m-y property located at) � Ll�)t 1t1 C<< 1 11 ttP CXt
This certification is valid thru (date)
e-
Z2
Owner Signature Date

ADJACENT RIPARIAN PROPERTY OWNER S TATEMENT
nereby certif-v 't-hat 1 own Property adjacenz-1to
Njame of Property Owner!
(Address, Lo Block Road, etc.*
in
INVaterbody', (City'Town and/or County
The appllc8t h2s describ,,-2--d "I.-o rneas shovir- below, i"ru devekopmez-�t c-ro-onsed
z 1 jec.t:on' - this pro.00sa�.
have to 'h"�S
DE —SCRIPTION ANDIOR DRNOVING OF PROPOSED DEv ELOPPUPIEN
Ynd id or a-ftach a Silp dlran ,,, VW Mang,
S'
<
Iff A, I VEM, S EC -1 10 N
.lilt erstand tat a pier, ciock, moorinig pilfings., I re-akftla- r: o,
bck a minimum distain-e N.` I._' PIeF-. of tro-an2n ail-cess L.Inlzess
ny" E�
t v4sh wa:vc--. setbac�,. vo4� must initial pproor. te blanv bek vv-
K
do vv`s�- to v,,a'Ve the 15, s,:�thac' reauiremen,
f� e
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1, 4
P --m n-L.
L—c a
Lbackreq li
Property O-Tvner Informationi
;
Ma. 0 R
�-!qhing Addr---s-s
0

I hereby certify that I own property adjacent to e C P `1t� s
(Name of Property Owner)
property located at j cad -C7t(i a .t k1 P)eac'k a nad
�Ad ress, Lot, Block, Road, etc_)
on i\3 _t s-e.. z ti i) t^ in 11 t l �_ _ , N.C.
(Waterbody) (City/Town anchor County)
The applicant has described to me, as shown below, the development proposed at the above
location.
X I have no objection to this proposal.
l have objections to this proposal.
_ DESCRIPTION AND/OR DRAWING OF PROPOSED DEVEHLOPMENT
(individual proposing development must iiii in description below or attach a site drawing)
-47
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S
-
4 1
WAIVER SECTION
:rstand 'gat a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
a mini m distance of 15' from my area of riparian access unless waived by me. (if you
:qua; the setback, you must initial the appropriate'blank below.)
i do wish to waive the 15' setback requirement.
v i do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property owner Inforrnation)
C
Sign tore Signature
M h,9 -
Print or T pe Name ¢ Print or Type Namme
�. ('r Mark Griffin
M ilingAddres Mailing Address
V' e,16" (. N - 465 Daugherty Rd
ii
Citylstatelzip Citylstatelzip Dover, NC 28526
Telephone Number Telephone Number
,,l / 4 1 ,ADa� 252-268-0657
Date Date 5 July 2022
(Revised 611812012)