Phan, San 88626C

aoF(PAST41Ilk-
-goX, CAMA El DREDGE & FILL
= GENERAL PERMIT
N9 88626
Previous permit
Date previous permit issued
A B (DID
_NNew [—]Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by th State
%4North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC /� ❑ Rules attached. eAl' General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Address ^ 3 Oa -
City State ZIP t
Phone #
Email
Affected ❑ CW _,NEW PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS
ORW: ye nn PNA: ye no
Type of Project/ Activity 2V020-2ca
Shoreline Length
Access Length s
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 Z
Max distance/ length _
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bull ing
Other 1
SAV observed: yes n
Moratorium: n/a yes no
Site Photos:
Riparian Waiver Attached: ye no
A building permit/zoning permit may be required by:
Permit Conditions if
Authorized Agent
Project Location (County): L QsA i--t7U -A F
Street Address/State Road/Lot #(s)
Subdivision
City ZIP
Adj. Wtr. Body
Closest Maj. Wtr. Body
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
ENT. (Please Initial)
Ag)t or Applic t PRINTED Name
Permit Officer's PRIN-T.El�lame
Si a ure **Plelspiead compliance statement on back of permit** Signatur p
Application Fee(s) Check # oney Order Issuin Date Exp

Name of Property Owner Requesting Permit .Vk A (PH A rJ f MA 2 � A M �
Mailing Address: / 9 Pee-cdiwW o n'4 yr
v ;Ac A*,dOA SA0 ") AJ C 2 8S/C
Phone Number: `/4 , 3 i/ S 1 z-5-
Email Address:
oM M
I certify that I have authorized Ayyy- W FRg
Agent / Contractrx
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
W 4/ 6'x Zo' 05�rrFv
'Vve-v S - 8" t Zo `
i6
EI
at my property located at /a'l / is ee"A -'0 a , l T) r I mot-
in C risocof County.
1 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
an the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
S-S` f
ssA Av Ol-IAnl _
Print or Type Name
O6-Iv(IL
Title
/7/�
Date
i
This certification is valid through 7 1
� a0��

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:
Agent's Name:
Agent's Email:
Owner's Phone#:
Agent
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be completed by the Adjacent Property Owner)
1 hereby certify that I own property adjacent to the above referenced property. The individual applying forthis
permit has described to me, as shown on the attached drawing, the development they are proposing. A
descri tion or drawing,with dimensions must be provided with this letter.
1 DO NOT have objections to this proposal. I DO have objections to this proposal.
it you nave objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (OCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 28557. 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) 7. t
Signature of Adjacent Riparian Property Owner: T i ) LAV/t-T C ll _
Typed/Printed name of ARPO: �: 1 t Z GG' C. V ti. 7 , j r cf
(�l ` ��/
Mailing Address of ARPO: 123 ei-� L �rr ���; N"� '.uJ✓� � 1 i �`�.. � l��r + "'�-
ARPO'semail:
qq(���i�P(Jo`i�� Cf, AR O Phone#:
Date: t J t= waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

WC. [MVISION 9F COASTAL MANAGEMENT
AfuACEINT RIPARIAN PROPERTY OWNER NOT'IFICATIONANAWER FORM
hM
.8XIED L :,AUURm 1l L L Et21I[s f? tir r _ p�?1&lyi:ii`r
(Top PGfEk)n to be cornpietod by orwme or their agent)
Nafm of fkoporty Owner
Addruea of PPnaprrrly
Pvtuilirng Aadro&stsr Owrer.
I7wmf'A QW4 : _ 3bkRur's t"f16%'irtfa
Agaata'a Ivlmna; A"rn1 rlrur}ne,e,.._
+Agsanro Frvi€ad: y—
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
IBOURIM 1=1100 to Ne ce>an hW. W 12Y Wit Adlaeanl PMRB,ijX29=E
R heroby cortiaythat I [rwrr propcft adtncd+it to llrn abovm rererenced properly The indivWYM opp}i+v r(r this
permit has dosufbed Eo me, as shown on the altaetied clamming, Iho dovdwnon1 they are peopolsrig. 6
p rrD oll,QrdaMhlj A. ytlLh3 tl t!?SY➢Li J errv9d fh CtmIT ILA!•
4o I CX) NOT thwerobivolons tolhia pfopma li r_ _.. I DOluve 0C,Kto%10 Ihm pugcraal
Ff yarr frees Qby cfhk+rs mar rotfr#f da dwrrrg weposad,rtyw musf no 1 LHVfmri4rr or CQasfa)
Monapemeemt ("At) to wrl009 Wthfn 10 days at receipt of this no*lu. CsrrespondwKs shoufd bo
msiled'to 400 Commerce A vv.., JWQrehaad Clfy..HC M57. DCU mWps®nfalfr@a Can after bo crwit"rari
of (23)j 808.2M. No response is consl$arvO rho saam as nu ob* rleari if you hawa been notified by
CottffMd OW&A
WAIVER SECTH3N
t undorn6rnd INH any Pa lWAdd else, dock. "lowtrwP p+a aK n', "at rump, breakwati r. boof oi"Ai_ 1,7m. &
groin nsust be set back aI asdnimunn dlitarslco o f IJ rionn my .imm of riparan occono unless wwwod by nwo
(this does not apply to bulkheads nr rsPnaP 00WO PnIst. (If you wriiitu 10 waive the solback. you 1!!!t
Me apprW. ate bunk below.)
100 wrlsh la wotyu wrillNaail of the W mfelbwk
Sgnrtfaty Owncr
,013-
I d'a n*I wish to wuhrd the I b' smback requirement (init 11 tho Nap%)
signature of Adjaomt Rlprlrirlrl pmoprlrty affmr.., �__...
is
TypWrintsdnaMeofARPA,
Milling Addrori of ARP0, _ �14 Se±.
ARPO's dimslL pP,)L F , ee , ('f . ARPO'i Phofwr►:
Valvar Is VS11d for uptoono Ifssrfrom AR,PU'S SlgnstuW
ReWsed May 2021

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W1917C, INC.
AME MPE
NI N O P AWORf 70AP
MEW 6EEIJ, MC 26662
252-665-qN'8
PHAN RESIDENCE
121 BEECHWOOD DRIVE, PINE KNOLL SHORES
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SITE PLANS
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RECEIVED
SEP 26 2022
0CM-MHD CITY
COASTAL MANAGEMENT
••a- - FoRm
.. .. 1 .lU. .. . FIL. . . .
Nam of Pre "Owner. 5,O') /.VOA)
Address of Property: /Z/ gffUJWODV �V,,r `JNF ,t!i"OlL Spt,40 Nc
Ma&q Address of Owner So,f 6
Owrwr's emai: SQAP - �i �VGhtv- Ownees Phonet. 061- 3 91 - 5B25
Agent Phonet 252- &1S- VS�7?
Agents Ernat
1 hereby aaliytbet 1 awn propertyavfjsoertbgo above referenced property. The kairift of applykrghsrflris
per,. has desgih 4 eo me, as shown on the atacihed drawing, the development their are popoeip A
100 NOT bare oNeetiore In Ihts pgmsat 100 have ebjecions b Ihis proposal
m roe Gave oyecalaas to new b AW4 prppom" you wart na p Me AtG. ukdAlas of commm
tDCAI16ConupoedaamaIMMbe
m 6 1110 0000 wrwaroulva,M' 11 Cxy,NC2MW.DCIra'resalnta0aesaamataobacawOcbd
strAwso6.2ifgf NorespousslsaonsI'm e, fwsamaasnactil So/yoebaeebaann0~6y
Caralg Ab a
WAMER SECTION
I w4ustwA flat any proposed Dim dock, mooring pups. boat ramp, breeloralar, bodhoum kR or
groin nuM be set back a rrirroaarr dicimm a of 16 ham my area of riparian aeoeas utea, anrI l by me
(dw does not appry b buWwada or ripap nnobnerft). (if you wah to w*je do saback, you ewj Wm
the appropia/a blank below.)
100 wish to waive semeW of the 19 adbadk e�-7A . 11 ,.L- \ . _
-OR-
1 do not wish to wake the 1S aelbeek nwp*vnrert (rW tre [blank) — —
TypedmrletedmwwofARPO: - 111 9 Addraaa of ARpo- 3 74-� t km P KL�'RC—c�BS �aL
Ortsc 7 f J�a is vdid for up b om year(kow Ammin t�atmre'
fbviead May 2M