86612A_Lee, Linda_20220701

tAQk "NI ElCAMA ❑ DREDGE & FILL
41 GENERAL PERMIT
N° 86612 A, B C D
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
I SA NCAC 1 ` , :
-( i i-
❑ Rules attached.
❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name L , !, J o.
Authorized Agent 14 CAi !" .r r
Address TJ
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P
Project Location (County): - O. rQ-
City ;. �1 `0
b - 1 State
ZIP
Street Address/State Road/Lot #(s)
Phone # (2 5
Email 'i
s-
Subdivision
City ZIP 7 j
Affected ❑ CW
❑ EW
❑ PTA
❑ ES ❑ PTS
Adj. Wtr. Body (nakan%�ink)
AEC(s): ❑ OEA
❑ IHA
❑ UW
❑ SPIMA ❑ PWs
Closest Mal. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
7
4-(Scale:'r'.
Shoreline Length 442 !
Access Length
Pier(dock) length / f (�
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
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAVobserved:
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:
Permit Conditions
❑ 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
i
AgenY'or Applicant PRINTED Name
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #/Money Order
Permit Officer's PRINTED Name
s.
Signature-7
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Issuing Date Expiration Date

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4715 S Roanoke WAY
Owners: Mazuka, Karen -Primary
Tax District: Nags Head
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Nags Head NC, 27959
Owner
Subdivision: Old Nags Head Cove Sec D
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Parcel: 009096000
Lot BLKSec: Lot: 45 Blk: Sec: D
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Pin: 989116935578
Building Value: S244,700
Property Use: Residential
as—ded deeds, plats.
Land Value: S219,000
Building Type: Beach Contemporary
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Misc Value: S7,900
Year Built: 1980
caked For"ifratian
Total Value: $471,600
of the infarmation
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ANCHOR DETAIL ;.5;;- 65
y z Date W—H ULKHE'A D y - -- _ Harrington cons#
06-10-2022 -. 405 w lakeside st
J m� Linda RTtee Lee Nags Head NC
4711 s Roanoke way Nags Head NC

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:
Linda RTtee Lee
4711 S Roanoke way nags head NC 279-
70 Chownina Dr Hampton VA 23664
Owner's email: [e-mail]
Owner's Phone#: [phone]
Agent's Name: Sean Harrington Agent Phone#: [phone]
Agent's_••_ •• ••2 til•••_ ••-
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
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
-OR-
i
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:_ Et
Typed/Printed name of ARPO:
Mailing Address of ARPO: I ' Ck- h c; J
1"u.re,h , tihr%. iV%0,-Zbka U
ARPO's email: ZL 1 rv-\ ARPO's Phone#: U
Date: l0 o *waiver is valid for up to one year from ARPO's Signatures
Revised July 2021

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A*%nMaPrOPO(V 4711 S Roanoke way nags head NC 279-
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Rewmed Jar 2021

Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
e' r) % 4
q
-agent"/ Contractor *Av'
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 4
771 lr* Coal -Ctn4C*-4/'
at my property located at >L N e4A
in 404 rf County. ( AG —77
I furthermore certify that I am authorized to grant, and do in fact grant permission to rl
Division of Coastal Management staff, the �ocal Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
Print or Type Name
Title
Date
This certification is valid through
Revised Mar. 2016

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