86330A - Glean, Thomas

❑CAMA ❑ DREDGE & FILL , N° 86330 A B C D
Previous permit
Date L
GENERAL PERMIT
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:
I SA NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.degnc.Qov/CAMArules
Applicant Name _
Address
City
Phone # (_ )
Email
State
Authorized Agent
Project Location (County):
ZIP Street Address/State Road/Lot #(s) l �D
Subdivision
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): IDEA ❑ 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 j
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes ho
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
Permit Conditions
(Scale: 1 5 )
TAR/PAM/NEUSE/BUFFER (circle one)
1-1 See note on back regarding River Basin rules
ElSee 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
Signature "Please read compliance statement on back of permit"
Application Feels) Check #/Mone Order
Permit Officer's PRINTED Name
Signature
Issuing Date Expiration Date

J U N 8 8 2022 AG—M AUTHOR IZATM FOR CANA PEOW APPLICATION
Nam of Property Oww Reques" Pear&
• �..... .....
EmA Address Tc >/4< /; %� (/, Cc —
1 Denny that I trove authorized L� fC��'� /'n W'S✓� ! Zvi L-
Aa trt / CoNracWr
to act on my beteff, for the purpose of applying for and obta*g al camp► permits
neamm for the foWming proposed development X
at my pqwty bcad at 6i = l «7���'� � .e12r��"aa -
in Cufr'-hCk C nty.
P►>r!t or Type Mama
T�s
This cwftskin is valid ftough I

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM RECEIVED
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion,, to be completed by owner or their agent) APR 2 7 2022
Name of Property Owner: 1 ►' \OMr/k, "A
Address of Property:
Mailing Address of Owner: �c o
Owner's email: 9�"l� ��u;� m D r� t (_m0wner's Phone#: �1 ��� �10
Agent's Name:
Agent's Email:
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
M-EC
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.
JI 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
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: A 4c
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email: AMPL, .(o1),_ARPO's Phone#: 4f3y'q0 j-07r1�
Date: L� - 7 2Z2 *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: I ► 10MA'> ,,-- (_—'r-eei--%
Address of Property:
Mailing Address of Ownei
Owner's email: 99Qr'hirn195Gwc&r,'1nP'1J Owner's Phone#: 104-
Agent's Name:
Agent's Email:
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
ZA �Z3
3__*7 Z-
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
_;,4_ 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
-O R)- S RECEIVED
I do not wish to waive the 15' setback requirement (initial the blank) APR 0 8 2022
Signature of Adjacent Riparian Property Owner: �'
Typed/Printed name of ARPO: _ J r/ �i S
d <- e0 &.-)
DCM-EC
Mailing Address of ARPO:
ARPO's email: r�J���-C �1.�, r� 6aU ARPO's Phone#: %f
Date: 4� �Z G *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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APR 0 8 2022
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