MGD Properties LLC 88630C

❑DREDGE & FILL > N° 88630 A Be D
�ENERAL Previous permit
PERMIT
� Date previous permit issued
ew ❑Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the States of N h Ca lina, artment of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
SA NCAC ��' a K_ ❑Rules attached. General Permit Rules available at the following link: www deq nc.gov/CAMArules
Applicant
Phone #
Email
Authorized
Project Location (County): v L
Street Address/State Road/Lot #(s)
City
r
Affected ❑ cW „_WW A ❑ ES ❑ PTS Adj. Wtr. Body not/ an/unk)
AEC(s): ❑OEA ❑IHA UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body
ORW: y-4127PNA: ye o
Type of Project/ Activity
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s).,—.,L--.
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/M
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards ,(
Boat ramp —
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: 4yesnoMoratorium: n/a Site Photos:
Riparian Waiver Attached:
A building permit/zoning permit may be required by
Permit Conditions
Name
M &D
FMA S-ffel&
Permit Officer's
�O 'Vjn
TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
❑ See additional notes/conditions on back
Initial)
Sligptture'*Pleasp,read compliance statement on back of permit"•M6�
77 �
App Kcation Fee(s) Chec q/ oney Order

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Y�V°,�/���1 / � Pw
L— -- 6/I J
Mailing Address: I�v &;?i )-0" l 71 VI't�;hOro , 1V
2 -W
Phone Number:
Email Address:
I certify that I have authorized
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at b
in `,ar4tl�& aCounty.
l 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 Information:
Signature \
w;tl r�1,(6
Print or Type Name
Title
/_�)/-) 0 )-
Date
This certification is valid through

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER 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: (✓LUoW..AQ5w C/Jr s,
Agent's Name:
Agent's Email:
Phone#: 33 6
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacentto the above referenced property. The individual applying for this
permit has descgbed'to me, as shown on the attached drawing, the development they are proposing. 9
I DO NOT have objections to this proposal. I DO have objections to this proposal.
if you nave objections to what is being proposes, you must notify rife rv.c. wvision Or tioastar
Management (DCM) In writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 28557. DCMrepresentatives 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 revelments). (if you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive somelall of the 15' setback
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the biank)�
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:/ /
Mailing Address of ARPO:
ARP O'semail 7`&,0-7c-3ri,5--yW-1ARPW&Phorfe#: lo', V
n
Date: *waiver is valid for up to one year from ARPO's Signature*
M.'4e d May- 8021

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: W/luk)61--
Agent's Name:
Agent's Email:
j6wner's Phone#: 3;6 , '1 / w O
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be completed by the Adjacent Property Owner)
20
I hereby certify that I own property adjacentto 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. 100 have objections to this proposal.
If you have objections to what is being proposea, you must notrry the N.U. uivisron or coasrai
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 28587 DCMrepresentatives 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
Signaffg6 ofAdjacep Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (Initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: �(� fl� -Al '1`
Mailing Address of ARPO:
ARPO's email:
Date:
ARPO's Phone#;
*waiver Is valid for up to one year from ARPO's Signature*
Re vlsad May 2021

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