86680A - Foreman, Roscoe & Cathy

&❑CAMA ❑ DREDGE & FILL N9 86680 A B C D
GPrevious permit
GENERAL 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:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # (_ )
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale:
Shoreline Length
Access Length
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
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: 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 Initial)
Agent or Applicant PRINTED Name
Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit"
Signature
Application Fee(s) Check #/Money Order Issuing Date Expiration Date

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERED
I hereby certify that I own property adjacent to�'s
(Name of Property Owner)
property located at r' ve_-r-5 ho r'G IV
(Project Site: Address, Lot, Block, Road, etc.)
on a_6 Vb� Rt�1I in f- t- N.C.
(Waterbody) (City/Town and/ r County)
Agent's Name #:
Agent's phone #:
Mailing Address:
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
---------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
qfel��t2
RECEIVED,
J U L 13 2022
DCM-EC
If you have objections to what is being proposed, you must notify the 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 (252) 264-
3901. No response is considered the same as no objection if you have been notified by Certified Mail.
(Pro rty OWfier Inform tion)
Signature
R•_?a_i.�l �kM010 A
Print or Type Name
(Adjacent Property Owner Information)
&�����
�a ure'
Print or Type Name
t S 1 R Jer6 k&r-e__-" / S / / R1✓4r5ti6,r-e_9d.
Mailing Address Mailing Address
,6'ztla,�.9r-h ,A%G 279b9
City/State/Zip
;a2 -247 - Od 8 rt�nei✓+ f.GPpS.
Telephone Number/ Em it Address Jt{Z•✓!C.
7-12-Z2- vs
ZL-z,,,_,ka&AAG z7?09
Cit State/Zip
2�Z 3 -33s
lephone Number/ Email Address
Date Date
*Valid for one calendar year after signature"
Revised Jan. 2017

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERED
I hereby certify that I own property adjacent to R.PPtt frOr emQ.4- s
(Name of Property Owner)
property located at ��/� ���✓P�4 r'P_ Rd
(Project Site: Address, Lot, Block, Road, etc.)
on �,,5av G t ✓Gl in N.C.
(Waterbody) (Cityown and/or County)
Agent's Name #:
Agent's phone #:
Mailing Address:
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
---------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
Mr
l �0k. tm�f,
RECEMED
J U L 13 2022
DCM-EC,
If you have objections to what is being proposed, you must notify the 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 (252) 264-
3901. No response is considered the same as no objection if you have been notified by Certified Mail.
(ProperV Oyer InfoMation)
Signature
R. 7Ll Fo rer►�a,n
Print or Type Name
l S/5 4c',w-short- )a
Mailing Address
A/c 2 7q0 9
City/State/Zip
�95T U7-ZOO 5
Telep one Number/E ail Address /� /Z•��
(Adja�lcent Property Owner Information)
r .i A _
'Signature* n /
17�ate,c, (;,Nknp
Print or Type Name f
1521 ,yar5ho r-e-R
Mailing Address
'2
e X� e,�7709
City/State/Zip
2.54) zoz�y�zs'
elephone Number/Email Address
Date nateq
'Valid for one calendar year after signature" Revised Jan.2017

Pasquotank County NC
June 13, 2022 C�i`�� tit�.�c lye 1:564
0 0.01 0.01 0.02 mi
0 0.01 0.01 0.03 km
C Source Esn. Maxar, Earlhstar Geopraphics, and the GAS User
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