86624A_Lewis, Vernon & Lisa_20220622

etA*O"ETCAMA ❑ DREDGE & FILL �� N9 86624 A B C D
a rk � GENERAL PERMIT Previous 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:
15A NCAC a I j -T / / ❑ Rules attached. General Permit Rules available at the following link: www.dgq.nc.gov/CAMArules
Applicant Name
Address
City State ZIP
Phone # ( )
Email
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City ZIP �� 2 9
PTA DES 1-1PTS Adj. Wtr. Body (Hallman/unk)
Affected El CW ❑ EW ❑'
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body C'
ORW: yes/no PNA: yes/no.
Type of Project/ Activity IF
Shoreline Length
Access Length
Pier (dock) length xv i ' _ i
Fixed Platform(s) t
Floating Platform(s)
Finger pier(s)
Total Platform -area
"'•
Groin length/#
!
Bulkhead/ Riprap length
Av9--distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
!
i.
Boat ramp
I
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: k
Permit Conditions _� •' -` "
(Scale: )
,- r
❑ 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)' �'t}
4/
Agent or Applicant PRINTED Nam_ a Perngit Officer's PRINTED Name .-
Signature "Please read compliance statement on back of permit" Signature
Application Fee(s) ' Check #/Money Order Issuing Date Expiration Date

AWAGLIII Kll'AKIAN NKUPLKI Y UYYNtK NUIIhII;AiItJWVVAIVLK t-UKM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be%Completed by owner or their a ent)
Name of Property Owner l� ' "S Sol (�1
Address of Property: 1 1 jZ(7 �r. �j
Mailing Address of Owner. _ �0 l� ` ✓� �js �. Z��2 t
owner's email_ Lt' e-�,d
r's Phone#:5
Agent's Name: S� i)'l. + `K-� Agent Ptwe#: - .� �lo� 6 2)
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Ad -ace ll r r y ownerl
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 devebpment 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.
N 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.
WAVER 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 sometall of the 15' setback
-OR-
Signature of A jacen R dan Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner.
Typed/Printed name of ARPO:
Mailing Address of ARPO: 0 FDL ll YAt7 l n, ,V o
ARPO's email: ]�( �� '9Z3a ,IU/i ?n? i PO's Phone#: (rl<
Date: a--wahrer 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 RE UESTED or NAND DELIVERY
(Top portion to be completed by owner or their art
Name of Property Owner: t L (1� S S c� (�(S
Address of Property: 1 ZC� ti -y V (C.- DYl Ko .LU /C L
Mailing Address
Owner's email:
of Owner. L Zo U�S'JGCK �f(V--e 2-4
Leezr,dl szleW;se�rn��.cm,
w:�:&4- gs�•3-4
ner's Phone#:
Agent's Name: SUsh �%�t ` �-� Agent Phone#: a
Agent's Email: S QSA, \Q c-> w) bLi 1 e L.i
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent 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 somelall of the 15' setba
-0R-
Signafure of Adjacent Riparlan Props
z&----
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property
Typed/Printed name of ARPO:Jb•�7, rY &.r1 �
Mailing Address ofARPO:] l'Z-! re�e6 e- e— Ae ZL
ARPO's email-- D , be ARPO's Phone#: 75 �' a �
(
_ S_ r J
Date: _ 'waiver Is valid for up year from ARPO's Signature'
Revised July 2021

f-
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---6Y /-rD - J

FLOORPLAN SKETCH
Borrower: Lee and Lisa Lewis File No.: Lift
Property Address:120 E Canvasback Dr Case No.:
City' Currituck State: NC Zip: 27929
20.0'
26.0'
Pier o
0
r-
20.0' 4.0' 26.0'
Bulkhead o 0 0 0 0
v �t v o
4.0'
One Story
Lift
Open Walls
AREA CALCULATIONS SUMMARY ( AREA CALCULATIONS BREAKDOWN
Descrlption Factor Net Size Perimeter Net Totals Name Base x Height x Width = Area

FLOORPLAN SKETCH
Borrower: Lee & Lisa Lewis File No.: Bulkhead & Pier/Lift
Property Address:120 E Canvasback Case No,: NIA
r ihr I".—i+.,n4 State: NC Zip: 27929
Off 10.0'
z
SkeD&.- by ApexS4etc

FLOORPLAN SKETCH
Borrower: Lee & Lisa Lewis
Fie No.: Bulkhead & Pier/Lift
Property Address' 120 E Canvasback
Case No.: N/A
-
CiIY Currituck
State: NC
Zip' 27929
Lender: N/A
Yµ )
r
4.0
to.a
10'x �
3 tt O
�7
5
Pier
.aka
Distance to Prop. Line
34.5'
SAY /,
- 11
Distance to Prop. Line
45 5'
14.a
New Bulkhead
b Pier
New Bulkhead
42.5'
Zi
11 AY
Old Bulkhead
85.0'
Old Bulkhead
bFill
FOW b b
o
Ramp o ci
12.0
i
QG uRld
��
Sk!:c� Dr apexSketcn

Currituck County GIS Data Viewer
Currituck County GIS
Phone: [phone]
E-mail: [e-mail]
This map should be used for general reference purposes only. Currituck County assumes no legal liability for the information
shown on this map.

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