86654A_Forrer, Candace_20220726

it 1'` X CAMA 0DREDGE & FILL
R
GENESAL PERMIT
KNew ElMadifcatian 171 Complete Reissue Partial Reissue
N9 8 654 (3 6 C D
Pr permit
Date previous permit issued
As attthonzed by the $nft of Nate+ Cxotra, Deparwvtvt of E rJU QUj4X ai she coaual kesow s Coffv" s+on " it am Mx m pursuant to
SA NCAC . _. R [] Ru cs u -,. I Pw rA &An vamwe x the "o-ft Laic.
Apolira+t N"
Address II
Ads)- F OEA
ORW yes
Type of Project/ Activity
EMMA
s
fS _ PTS
SPf#AA PM
k I%l` x a
I - ,.1
r
i
• ix • it s.
,A • rs
AA. YVI-- BodY
Ckasest rty, wo, Body
X'(?� t A t C�:ar� i� f? �r�S��i) `k 1�`fj,flscale: tt (,},
Shcreime length +/
Access lergth �,fl•# - I` s ° £
f
z
Peer (dock) ttr�o �A.L_...xij
r� j
Fixed Ptatform(s)
£
` +
Float tv Platform{s}
`v4 �► {-t'`e+� 'sly tt� L
�y� �,,4.
�i -
Total Plattarmarsak -
Gran lersEt *
�..
Bulkhead/ Rim te»rh ..-.�_...__.._.._..,.. ` � £
Avg distance offshore}
efeakw3w/Sill
Max distance/ kevh I
x-
$asen,
Cubic yards
t
Boat ramp
Boathou BoatLft
t
r
other
� t
sAv observed ye 0 by, l (
Morato m: n%a y, s two
Site Photos; ,� nm �-•<){'
Ripanan Wahw AttaOed- TV` no
A buitdlrili permit/zonmg permit may be roqutred by,
Perm* Condtwm
TMMA NEUSI~ UIi ff* kcxcae ores}
E] See note on back ,ytrda * Rif A as.n sWc
ElSee#616cewaf im to
t ALA AWARE OF STATt lT7 S Gt C RVUS AND CXiNOti M TFfItT APPLY TO THIS PROJECT AND ItfY WED U#Aa $TAtifkfW i,Fw e =f }
RINIEONartze Permrt PRDITEDatrKtrc �.
5gtnatartt *'Please read WmOW" statement ors tracer of permit" `
Scgrta6care
Application ft*fif Check #/Nlu +p Or f l asuittE t`�te
E*raaw. Dow
(q

M,C, yt$ok Of COASTAL 44AA AG&MENT AVER FORM
ADJACENT R1PARtAfu/ PMOPlRT'1r O"WWR NOT€ ICATtC!!1lIM6s
Top podon to be comps b'Y a cx lr*t
'ty
s -. --
A a
�i i►iR+p}��t°xrr �p�R'f CiteT��j'ior+
Al,�iA't'ttMR • �-...�fRrrestly Dsa>nt��j
Irwv� OWL't` FI o $ 'C' mvety+ � :-'tt"�" "k aix pefft"t"s4 t'ic+"CK~� WA'Y
s rwa. as ate am
! c)t> A
txay+f � pope"-"
D co
MD 4W $, � ,f. $tx lr C. 27 # np Y*tr is u
.. No � � tc^ is tfls prr; r ,asp
WAkvEtt w PA" , oreakonts,s ate
€ *. c *' t of r t sc� i tE1�
vam must A a rt t ta?YR
4'bukhoadt c?, t"r' -.. r 3. ita Y04 *tot 10
RAW" Of
Koo
x� gyp,
* vat
ft,,f yeas k w
Ramod My 1

57'n ¢D.nER. No. 917 R t t E
U,Svieer's Computatlon pad
i
11
41

t+ �
4
Perquimans GIS
N
Id.
1/10/2022, 10:37:21 AM 1:
0 0.01 0.01 0.03 Ill
Address Points perquimans_nc_lot perquimans-_nc__acres Green: Green I—' ' 1 ' '` ,
0 0.01 0.02 0.04 km
perquimans_nc_easement Imagery 2020 State of North Carolina DOT, State of North Carolina DOT. Esri. HERE, Oarmin,
Centerlines Blue: Blue INCREMENT P,USl3S,EPA
perquimans_nc_misc perquimans_nc_dims Red: Red ®Imagery2016
r��j'nc Ca► -Iooc . F�fryr PerqumansoIs
S u i ZcCr✓ ` I ( w f' Cti M For tax purposes only Not a bgal document or survey Perqulrnens nor State of NC assume any liability resulting hrxn use a this map
�W.
7 7C 1 q 1A-p-,K�'- l t N 4

I ;
Untitled Map
Write a description for your map. - "?
f t
•
Legend
111 W Camp Perry Rd
0, ,`' ,44 o ^ 7
r r'�
lk
49
JIM
r ,
'' .•i , - a.�nyy
-r
. ,
goof
it
t.
f • l j , ..,
4'
�i
fix;

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL RETI IRN RECJiPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner of their agent)
Name of Property 0wrier R«„ P4C. ~ -'
Address of property --A \ \�
Mailing Address of Owner,
��,\ %�A a
Owner's email ir.t3�
�, ��'� �'�# t,�. ��Q�- Owner's Ph©re#
Agent's Name
Agent's Email,
Agent Phone#
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property Owneri
I hereby ce; 0fly that I own property adjacent to the above referenced property, The individual applying for :►pis
permit has described to me as shown on the attached draw+ng. the development they are proposing A
description or drawing with dimensions must be provided with this lette,
I DO NOT have objections to this proposal. l DC have objections to this proposa
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 it 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 minimums 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 sett",ack you; gust Sion
the appropriate blank below.)
I DO wish to waive somelall of the 15` setback
ature f A,11a6ent panan property Owner _
I do not wish to waive the 15' setback requirement (initial the blank)
A U 6 3 - 2022
Signature of Adjacent Riparian Property Gwner(iD
Typed/Printed name of ARPO: IMfk"'[St&, „8 ���+��
Mailing Address of ARPO• IIb_1%,J ,_CArAA ("`�.I;LP-`/ t'.
ARPO's email: ARPO's Phone#: Jto
D a t giver is valid for up to one year from ARPO's Signature'
Revised July 2021