86625A - H V Cole Revocable Trust

Ito_4" ACCAMA :2,/DREDGE & FILL
GENERAL PERMIT
[_New ',—!Modification ❑ Complete Reissue F_j Partial Reissue
t 86625 (A') B C D
Previous permit
Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality and the Coas al Resources Commission in an area of environmental concern pursuant to:
I SA NCAC 7_ t i C7 �'✓ E] Rules attached. L General Permit Rules available at the following link: www,deq.nc.eoy�JCAMArvlgs
Applicant Name H u GQlq. Rt x jc�c 4 i[? .__T%_.......----..__._--
Address
City Ca + 4c6f A, 6-/ State ! C _......... _. ZIP .-a.7-CIdl ._._.._._
Phone # 4L(l
Email a V L-0 C-, - C.: C_ �d ; 'a ' . ; +✓ r_e Subdivision
City 1— ZIP D_41SC6
Affected �CW PEW �TA �ES ��PTS Adj.Wtr.Bocly ti„cil�`Ia_ % e>.(i �h� na an/unk)
AEC(s): ROEA ❑IHA []UW ElSPIMA 1:1PWS Closest Maj. Wtr.Body ('_ur,
ORW: yes4 PNA: yese
Authorized Agent r,,- 1 AS A -t_
C Project Location (County): ',r t, 4-, k, CC4Y
Street Address!State Road/Lot #(js) ?`94 " 50a 'C
1�rinf. s _.._._�d .�.--.7_ lei" I!
Type of Project/ Activity 13t_1 _J e
r (Scale;A)T,S 1
Shoreline Length
Access te.ngth _
Pier(dock)length
Fixed Platform(s).
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin ngth/it
Bulkhead/ iprap length
Avg istance offshore 1 t
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes s..rss'' J 40 � 1 e_ �C�(y(� "r ��,
Moratorium: Gn no P4
Site Photos: �no�
Riparian Waiver Attached: yes t.::y
A building permit/zoning permit may be required by: i..l t i 44. C k (�,{�,•+`�
Permit Conditions 0 + �Lt.r`*�R _..._.uisn t+ :1 6,4-
R,AJ
TARIPAM/NEUSEIBUFFER (circle one)
❑ See note on back regarding River Basin rules
See additional notes/conditions on back
1 AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please lnitiaq%X
Agent Si Iit�RINTED Name
SignbUfre —Please read compliance statement on back of permit"
qWJ . or)) a2)F,-)
Application Feels) Check k/Money Order
i
r tit fficer's PRINTE me '
Signature
F -��c - a- 2 o - .)-(4 -
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: a-y- co :mVMdQ� ' 1� f xi —
Mailing Address: t4• WX 1,492
Z-7 909
Phone Number: acb!�.
Email Address: GjVY1� CD(2_Q(I �WI��� COvy�
I certify that I have authorized fit! d �A.
Agent / Con ractor
to act on my behalf, for the purpose of applying for and obtaining�W
all CAMA permits
necessary for the following proposed development: 6%W-0yr IA44em
at my property located at 2q7 6 �AA Od Ad D�CPV1�- r70� �6-�` IG� e�V►,W%j)
in CD yclk County. • 00 dp(A
1 furthermore certify that 1 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:
)61 >�
Signature
Print or Type Name
Title
�--
Date
This certification is valid through I l

CE I\,1'
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
APR 1 2 2022 CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: i�
Address of Property: 2�� , F aay j� Am Al 6ceoI Q j
, NG
Mailing Address of Owner.
2790
Owners email: aml-Co)�,Owner's Phone#:
Agent's NamelD VUtO f 1 Agent Phone#-. (,W
Agent's Email: l�lti'� 11 1 E �b'KE-1
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property Owner)
I hereby certify that 1 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 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 (DCNQ in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. 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.)
1 DO wish to waive some/all of the 15' se acko
re of Adjacent Ri rorty Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner.
Typed/Printed nam
cozill g Address of
`�� mo ve
ARI�'O's emaii{
Dater *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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: Amy c e I�
Agent's Name:"'
Agent's Email:
Agent Phone#: �'72 ZZ • ZJ 'T
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
description 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.
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 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. 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
•m
do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owne,4P7' `,0
Typed/Printed name of ARPO: -�Jd7Ct tG Y� � V{/Y1 l�flll� i ,N{�%1 �� I /f� J�
Mailing Address of ARPO: 3 NG Z Y 1; r�
ARPO's e ail9�qx4k "/ / ARPO's Phone#���
Date 'waiver Is valid for up to one year from ARPO's Signature"
Revised July 2021

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