87328C - Viduna, David & Teri

�o`O"S'"1 9 87328 A B C D
CAMA [IDREDGE & FILL ❑
�O
z =GENERAL PERMIT 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:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name '
Address
City State
Phone # ( )
Email
Affected ❑ CW
AEC(s): ❑ OEA
ORW: yes/no
❑EW ❑PTA
❑ IHA ❑ UW
PNA: yes/no
Type of Project/ Activity
Shoreline Leng
Access Length
Pier (dock) len,
Fixed Platform
Floating Platfo
Finger pier(s) _
Total Platform
Groin length/#
Bulkhead/ Ripr
Avg distance o
Breakwater/Sil
Max distance/
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Bc
Beach Bulldozi
Other
SAV observed:
Moratorium:
Site Photos:
Riparian Waive
A building pert,,,.,
Permit Conditions
Authorized Agent
Project Location (County):
_ ZIP Street Address/State Road/Lot #(s)
❑ ES ❑ PTS
❑ SPIMA ❑ PWS
Subdivision
City
Adj. Wtr. Body
Closest Maj. Wtr. Body
(Scale;`::_ )
❑ 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"
Application Feels) Check #/Money Order
Signature
Issuing Date Expiration Date

o1°j`°"`TN& ❑ CAMA ❑ DREDGE & FILL N9 87328 A B C D
h
y-0i
GENERAL PERMIT 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:
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
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
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
(Scale: )
❑ 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"
Application Fee(s) Check #/Money Order
Signature
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address: C> �g
a T l ar,ML - 3-ec�lclC a? -5s 1 Z
Phone Number: �� `? �S� �-1`��5 �8 l Q IS " (�-3
Email Address:
I certify that I have authorized N '
Agent / Pntractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 1106L, Ad,!tl` � o 4
at my property located at 5DS 1\- 1�► �` I
in (�, County.
I 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:
Print or Type Name
Div �&RZ
Title
'_I ZZ_
Date
This certification is valid through 3—.-1 �� I
✓�4
MOIL*, W'Fj
MAR 3 ® Z02'Z
D 0 M - M hID CITY

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: Te9Z ► V,► v e-r 5 � t d \,,,Nc— v
Address of Property:
Mailing Address of Owner: a5 qA `13G caa���� 2 m nn N �� (_1 I�
�_--Owners email: db��l e u Owner's Phone#:l '7R 1-4 3 LL$
Agent's Name: e 2iJ2
Agent Phone#: _-� (��O
_ ,
Agent's Email:
LPAM-Aw
y v
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property Owner)
-/1 lcjur%� ().—
S V C0 1y L� 1`fs tJ 1 l C11V'� f C lJ �C�L� 1 �/
2-9Si.Z
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 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.)
S S� I DO wish to waive some/all of the 15' setbpjk
i
nature of Adja t Riparian Prope y 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: 5c�-r',,41-0- C4-20 rv-N bA \ S-S ►')
Mailing Address of ARPO: ti-b lv N , K,, , n 4o n A Y
ARPO's email: S i C-b -C, CLC k� -l0 ma. ', ARPO's Phone#: 2-5 a ` 92d -j 20 i
CV w-\
Date: 3 S l), *waiver is valid for up to one yearfrorn ARPO's Signature*", €'. -,g
Revised May 2021
MAR 3 ® 2022
DCM-MHD CITY

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONM/AIVER FORM
CERT(F(ED lViAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: 1
Address of Property: s c'
p rty
\1 1 d L% V-Xti-'
S i c sJ AV'
C, 2-85i Z--
Mailing Address of Owner: a5 A q-- BCJ (cr2krc,,e_ C,2 L"-'-M t c
Owner's email: tkb�4Z1s etJAkU;.L4-,AOwner's Phone#:�l?,3 � 3�
�I Agent's Name: P(,, ,ij Agent Phone#: %� Z_Lt Z-2-
� l' L�/9
Agent's Email: C1 `G� '" e~ C Gw—
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Pro a 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
description or drawing with dimensions must be provided with this letter.
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 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.) /, J
S � r o 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)
Signature of Adjacent Riparian Property Owner:
Ben E Winstead III
T'I,e t,t, Typed/Printed name of ARPO:
Mailing Address of ARPO: 51ON Kinston Ave Atlantic Beach, NC 28512
ARPO's email:
[e-mail] ARPO's Phone#: [phone]
Date: 3/05/2022 *waiver is valid for up to one yearfrom ARPO's SignatufW17CEIVED
Revised May 2021
MAI1 !') `) 2022
DUA- HD CITY

DCIu9pMHD CITY