86629A - Pilkins, David & Crystal

'ifA"� LXCAMA ❑ DREDGE & FILL Q B C D
Preous GENERAL PERMIT D tepre iouslpermmiit�6o �-2.a,.
[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 �Z H emi�2V ) _—__—_ FIRules attached. General Permit Rules available at the following link: www.deq.nc gov/CAMArules
Applicant Name Dg ti:.4 TRka, _
Address
��i�M,r�rT���
City ��fA� State ✓_k<___ zIP,J{
Phone # ( WJ) �8`1 - 336SS
Email 1
. r , , i..' 1
Authorized Agent t Jcax l-
Project Location (County): �L.�.^.�1LLL k-
Street Address/State Road/Lot #(s)—A2a� —
ll?_aa. 'PLO t 3-0
Subdivision -
city Cc>rwL(o,. zip 2�17-
Affected 0 CW DIEW j_"; PTA ES PTS Adj. Win Body ct�i.S�e�r�5at/Fnaru�nk)
AEC(s): ❑ QEA IHA u uW SPIMA PWS Closest Maj. Wtr. Body t�I Jr t� � 1fy"
ORW: yesALD PNA: yes)&
Type of Project/ Activity _�6,r� y iX 20r i ,de, �; U o- cf' x 2d w clG �l1ia.� >� •�.�
(Scale: /VT$ )
Shoreline Length
Access Length
Pier (dock) length i/ rx20 r
Fixed Platform(s) .` r • _i.
(h
Floating Platform(s)
1Q
Finger pier(s)
A
Total area C;
Groin length/A
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
T
Boathouse/ Boatlift
I
Beach Bulldozing
�
Other
Pr..+t�a►•Z c d 4'% J
d Q�L
SAV observed:k:,s Q1op.
/� yes rt�j
Moratorium: es no
Site Photos: no T,
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by: r,(,, f 1 ir+,, .. _
Permit Conditions LIB I T61e2sAt1.A Sf Z"-*Lor ,k141
TAR/PAM/NEUSEBUFFER (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 plic t PRINTE Na Perm)itnOf_icer'PP INTEND Na e
Si na I se read p' ce ater -nt on back of permit- Signature e�
on Feels) Check ri/Money Order Issuing Date Expiration Date
fLe, GP FSC6'3 t 14

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:u�Q. lC 4>)
Mailing Address:
Phone Number. %03 r 203
Email Address: _�E��S ►1� _�c�G>�
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all C�AMAA,p�ejrmits
necessary for the following proposed development:
2ziJ Z21Z 0Gej✓1 TCa/I-f►��t*^ i Z- `W4Y-7J,,;Ills
22tZ cc-toc-✓1 �� r
at my property located at ___-------_-271V i--.c-h��--
in r ounty.
I furthermore certify that I 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 Infnrmation:
'� Signature
X - )AV i �1) P Lim ►�S
Print or Type Name
Title
Date
This certification is valid through /_3 J /_'OZZZ

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER 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 �') (O � 1l T L; N�nK li A 2z r-7 f
Owner's email: �/ ; I" -,s r� rew, Owner's Phone#: �0.3 — -2�_J-�
Agent's Name: f I Vh,or,4> Agent Phone#: 25'7-- z)-7 -%s7 6
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adlacent 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 someiall of the 15' setback �'k
-OR-
Signature of Adja nt Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank)
x Signature of Adjacent Riparian Property Owner —"}�
I/ Typed/Printedname ofARPO: LAw�Z=t��ee I.a, �IEr4S s,
Mailing Address of ARPO: ly ¢ DJ
xARPO's email: ARPO's Phone#: Z..) o
x Date: �-d Zo L Z *waiver is valid for up to one year from ARPO's Signature"
Revised July 2021

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