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.*g$ggn Kcerua tr oneocE & FILLiIEcENEpqL PERMIT
?-=Ifiruew lModification lComplete Reissue lPartial Reissue
N9 8441e
Previous permit
A e@
Date previous permit issue4
D
As authorized by the State of North Carolina, Depanment of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I5A NCAC [-l Rules attached. ffi Cenemt Permit Rules a\railable at the following link: www.deq.nc.gov/CAMArules
Applicant Name
xa,",, 6nZ / f)l t 'q 4 SA
state AJL ze ? funl?
Authorized Agent
Proiect Location (County):
Street Address/State Road/Lot #(s)
0_l .
DEV6
City
Phone #
Email SuMivision
City -14?.4P
Affected
AEC(s):
!cw
!oer
ht*&toEr*
ffi'l-I lsPrMA I ews Ctosest Maj. Wtr. Body
Ertt Adi' Wtr' BodY
Irxe @{ btn.,\
PNA:
Type of Proiectl Activity
Shoreline Len6h
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
W:',Yj*dOA- -, a itlS_ 7€ep
NS
^JIa
t/)'
*nt
4tiweJ
(Scale:
u6 latlOD +1
F
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ le
o/c+
u( z/e
I
(ot tb/ta lbd
Basin, channel
Cubic yards
Boat ramp
Boathouse/
Beach Bulldozing
Other
SAV observed:
Moratorium: n/a
Site Photos:
Riparian Waiver Attached
Perm Conditions,
i:: RU**$MN brg fi\w
dr4Z
Fr1}
SorS
A building permit/zoning permit may be required by:
tU'(0
Agent or
Fee(s)Check #/Money Order lssuing
COMPLIANCE STATEMENT.
Expiration Date
I AM AWARE OF CRC RULES AND APPTY TO THIS PROJECT AND (Please lnitial)
Applicant PRINTED Name
**Please read compliance statement on back ofa
! rnVrnmlr.rEUsE/BUFFER (circte one)
! S"" note on back regarding River Basin rules
! S"" additional notes/conditions on back
(
Statement of Compliance and Consistency
This permit is sub.iect to compliance with this application and permit conditions. Any violation of these terms may
subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for
compliance. The applicant certifies by signing this permit that: 1) prior to undertaking any acfivities authorized by this
permit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the
local land use plan and all local ordinances, and 2) a written statement from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(s).
The State of North Carolina and the Divislon of Coastal Management, in issuing this permit under the best available
information and beliel certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules Neuse River Basin Buffer Rules
lf indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules
for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the
NC Division of Water Resources. lf you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
please ensure all d€bris assoclated with the removal or construction of the permltted development is contained within the authorized
proJect area and dlsposed of in an appropriate upland locetion.
Dlvlslon of Coastal Manaqement Offfces
Morehead Clty Headquarters Washlngton District
4OO Commerce Ave Morehead City, NC 28557 943 Washington Square MallWashington, NC 27889
252-808-2808/ 1-888-4RcoAsT Fax: 252-247-3330 252-946-6487
(Serves: Carteret, Craven - south of the Neuse River, Onslow Fax].252-948-0478
Counties) (Serves: Eeaufort, Craven - north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
EllEbeth City Olstrlct
401S. Griffin St. Ste. 300
Elizabeth City, NC 27909
252-254-3901
(Serves: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford,
Pasquotank and Perquimans Counties)
Wilmintton District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
9to-796-72L5
Fax; 910-395-3964
(Serves: Brunswick, New Hanover and Pender Counties)
Revised 6/01/2o21http://porta l. ncdenr.org/web/cm/dcm-home
AGENT AUTHORIZATIOTTI FOR CATIA PERIIIT APPLICATION
NameofProperryOwnerReqnestingPermil 0 ln,t,l,, finrl,rr' | fl^J<
Mailing Address:
Phone Number:
Email Address:
I ceftify that I have authorized
3<L- t"l,tt-tlt: ?aL Eg 9ltsd
3 s
,
:i qrl t
Ahr ,fuls @- (l,nr L-r . ,tel
/"
Clun u
at my property located at bo/l/t /<an ^Jo
l?.7 {en )3fi2>
ini u'le,d-Countv.
I furthermore certify that I am authoized to grant, and do in fact grant pormission to
Division of Coastal Management statr, the Local Permit Ofrcer and their agents to enter
on the alorementioned lands in connection with evaluating information rebbd to this
permit application.
Property 0wner lnlormation :
Signature
5
Print or Tyoe Name
oilLor,
Ti e
--At-tL--t. Jotl.
Date
TnE ceruncauon ls valn mrougn / ,
' Agent / Contrac{or
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: hu ,ld,n., ,t r.i.cK
e / ( J.*--
ADJACENT RIPARIAN PROPERTY OWNER STATEMEI{T
I hereby certifo that I own property adjacent to ...: , ,
property located at
(Name of Property Owner)
(Address, Lot, Block, Road, etc.)cn .:tn N.C.(Wat6rbody) (Clty/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAYYING OF PROPOSED DEVELOPMENT
(lmliviclual proposing fuvelopment must fill in descrtp$on below or attach a site drawing)
'3,:rq /du',iz i/.C
$a
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15'from my area of riparian access unless waived by me. (lf you
wish to waive the setback, you must initial the appropriate blank below.)
fi- t;'7, , I do wish to waive the 't 5' setback requirement.
i do not wish to waive the 15' setback requirement.
(Property Owner lnformation)
"'wl7 tl,/\t cc i" f, tv
(Adiacent Property Ourner lnformation)
t or Type Name
t/V
Prin or N;;;7'
A
I 1/"'r'! C
2
o f
Mailing Addrcssl) ;LtGsdt d2 4 Al e I sCrl
Ciu/State/Zlp-'3i'Z:ZZq-l-<qq t ootz Jr 1-??1- )333 ctrt
Telephorn Number
6- ?.2072Telephone Numberf. 'ct?- A=-
Dote
),(
Date
(Revised 6/142U 2)
N.C. OIV}SION OF COASTAI- T'ANAGEIIENT
AOJACET{T RIPARI,AT{ PROPER,TY OWIYER llONfl CANO'{,WAIVER FORM
Y
(top portion to be compbted by orner or treir agent)
Name of Prcperty Omer cl .. N0 Erl 6
Agenfs Name: _Agent Phon€#'_--
Ag6nts Emall:
-oR-
Signatutg of Adja@nt Rtparian Ptopafty Owner
AD.'ACEI{T RIPARIAI{ PROPERTY OU'NER€ CERI|FICATION
r hereby certify tMt r ou,n property adjacant ro the aborre r€f€r.ncad prop.rty. The indrvrduar applying bf thisp€rmit has de.cribed to rne, as shcruvn on the atbctred ora*ins, fi;lreviroemenr thav ail i riipEiing. A0escriouon or 0rawino . wrm oEnenslops. must be omvided *i;'fiL-tddr.
-
I DO NOT have obJarions b this proposal. _ I DO heve obiectbns to lhis proposat_
i yol'tnye -a'b@n av*til E Rig plrlet;;ai, yo,, ntr@rrxMd:6Wi;;?fffifrt,tal,iryn7lt_pdq h wfi,g wtthht ro-&$ t_n&St ot itr-'ffi{r.. cotrJ W/rE rce shwkt bon!!!{_p -t9o-PPretta Ava, yo,*,tg ci,., ttC nSt. oCtirep6e,,,d,/as ;n or"o l" c'6ffiriimfff:. n" nqpo,rce is car,',an d u. oi. i i'fui i w, b; br; ;ffi.;y
I underetand rn* env propos€d pier,.docrqffiitir-!6&li":t €mp, b*ar$rEler, boathouse, rift, or srornmust be set bact a minimum dt6tanc€ of tg. fom iri aria'ot ,ip"*n'iil". un,os trraivod by me (this
13::-p-t ?ppty rg grroaads or riprap ,evermenrs). ([ryou GhirGw-],e .o".X-,
.iil;;i;;;
d;appropriate bbnk below.)
I DO wish b waive somelalt of the lO, setback
I do not wish to watue the lE setback requirement (initial th
"
Ot *1 ,M=
Signature of Adjacant Ripaden propsft), Owner: --I*'
TypodrPrlnbd nams otARpO: 6 T)-a
ttalling Addr?s6 of ARPO:rra.i$ So \c BI ,.U La J6ZtsL
ARpos emaih @fg.!19$_1a!!Lf!! ARpob phone*: Llt bI: !/Ja
O"C. QIIZV rwalver ts vatid for up to ona y..r ftom aRpo,s sign.rurer
I
Addrcss of popertf
Mailing Addr.e8 of Ormet: .. o . 4a -... - 6 3 fa6l{ ,.) *rlAgiaa a pa LeLll
a*net" emait Axrirot soora a c42@ff#f l*"* g3c-oaw.f rta - c ettS?G -?r4-15s
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