86396A_Pollard, Mark_20220525 (2)

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❑CAMA ❑ DREDGE & FILL 6 c D
-� Ii- C R1 C 12 A 1 D =12 RA T Previous permit
As authorized by the Same-af- J arolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC 4 ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name G r" 1 1 \G f Authorized Agent
Address ` ? �_ * �a ° Project Location (County):
City State 1 t ZIP Street Address/State Road/Lot #(s)
Phone # (_)
Email 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
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 Ino
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:' )
h r.•
❑ 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

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit conditions. Any violation of these terms may
subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for
compliance. The applicant certifies by signing this permit that: 1) prior to undertaking any activities authorized by this
permit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the
local land use plan and all local ordinances, and 2) a written statement from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
1-1 Tar - Pamlico River Basin Buffer Rules F-1 Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules
for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the
NC Division of Water Resources. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST Fax: [phone]
(Serves: Carteret, Craven — south of the Neuse River, Onslow
Counties)
Elizabeth City District
401 S. Griffin St. Ste. 300
Elizabeth City, NC 27909
252-264-3901
(Serves: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford,
Pasquotank and Perquimans Counties)
Washington District
943 Washington Square Mall Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Craven — north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover and Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

RECEIVED
AGMT AUTIjCqUZATM FOR CAYA Peaff APPL CATIOM MAY 0 9 2022
Name of Property Owner Ring Perms M
Rk / W DCM-EC
Mailing Address:
Phone Number:
i certify that i have audmized
`I35--3r?S�
La
to act on my behalf, for the purpose of applying for and ob ff*V ar CJ1MA pemnft
Rulhdicvd
at my property iocated at ye ��,e 6 r ,
in OLtr , -d- county.
I furft:rrrrore certify that I am authorized to gram and do in fact grant peon to
Division of Coastal Management staff, fhe Local Permit Officer and f mw agents to, utter
on the aforementioned lands in connection with evaluating infor► ohm related to this
permit appikaffon-
Property Owner InIb nation:
%/� -� '4'
PMW or Type Name
Tft
II t 0 G _
Date
This cwff=Am is valid through I _I �?-- 1 2- -)—

LLri--.`ii''
N.C. DIVISION OF COASTAL MANAGEMENT
MAY 0 9 2022
ADJACENT RIPARIAN PROPERTY OWNER NOTWICATIONlWAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Toffs �iortion to be completed 1by owner or their agent)
Name of Property Owner. ! ' A R
Address of Property: ? 3 ln..�► i f ��/G/►
Mailing Address of Owner. 5 pf" &-
Owner's emaE �//9 Owner's Phone# S� - [ 3s 3 s�
'
Agent's Name: L a elen g� & Jejt L Agent Phone#:
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
Bottom portion to be completed by the Adiacent Property 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 lying proposed you must nobly the N.C. Division of Coastal
Management (DCAQ 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 obfection if you have been
notified by CarWiled Marl
WAIVER SECTION
I understand that any proposed per, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' fnxn 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
Isila
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner.
TypediPrinted name of ARPO: ,
Mailing Address of ARPO: C., I D q J� = he , I , 4 0- 19,, L ��l - VA
J
ARPO's email: N / ARPO's Phonett. ''Y— (� ' ( �g
Date: ")-- 2 S " a ' 'waiver is valid for up to one year from ARPO's S f
Revised July 2021

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R VED
MAY 0 9 2022
N.C. DIVIMN OF COASTAL. MANAGEMENT
ADJACENT RIPARIAN PRopERTY OWNER NOTMATiONIWAiYER FORM
+:;ERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERy-DCM-EC
(Top portion to be Completed by owner or their agent)
Nam of Property Owner: / n 4 R k PO i I CAI-d
Address of Property: (,;) ? "l c yezy'q Vj
Maifing Address of owner: 541nZ
Owner's emaiit 41A owner$ P wnt: 3,Sa
Agent's Name: L uadm /ncr,� ,^e . /IL /lgsnt
Agent's Emar3 (!rUt°hrQ
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
,Bottom portion to be completed by the AdhIgMat Property Owned
i hereby oerNy that 1 own property agent to the above referenced property. The indivKknd appWQ for this
penrd has descrted to me, as shown on the alladeed drawing, the develop mt they are Proposing- A
descri0w or drawino with dirnenskm must be Provided with iris leis.
l DO NOT have o*c Wns to this proposal. I DO have objections to this proposal.
if you have abjecdons to what is h- %g proposers you Brost nodFy the IM Dhnsion of Coastal
Uwa"nwd (DC" in writing wiffm 10 days of mc&W of this no6ce: Corne*endence sf w be
mooed to 401 S: GrONn St., Ste. 300, Erwabefti City, NCs 21909E DCN JeOweseatatives can also be
contntedat(2542644M No rye is cones the sam as no objection ff you have been
notrf®d by Csr~ Ma&
WAIVER SECTION
t undersUml Drat any pqPosed Pier, dodo, mooring Pam• boat rang, breakwater, boathouse, tiff, or
groin must be set beck a n* m xn mince of 1S from my area of riparian access unless waived by me
(this does not apply to buliftads or roap revetrmnts} (If You wish to waive the setback, you must sign
the appropriate Ie[rlt below.)
1 DO wish to waive somelalf of the IS setback
S*gnafum ofAaface&PmpedyOwner
-OR-
I do not wish to waive the 15! setback requilrement (ini W Ere tick)
Signature of Add# Riparian PropeMr Owner-
TypedlPrkded none of ARPO-- C Arl i , U yl` 1 CllYlMA
Mailing Address of ARPo: '\ \ (,e (, ant i- AAc m Ac- - CALr'ri4%11'A- f�
ARPO's email: ARPfYs Phone* 2 S-) - qSt; - () S (�L
Date: `i - - z �L— 'waiver Is valid for up to one year fiwn ARPO's Sign8bW
Revised Jrdy 2021

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CEIVED
MAY 0 9 2022
DCM-EC

Currituck County GIS Data Viewer
Currituck County GIS
Phone: [phone]
E-mail: [e-mail]
Addresses
Communities
Aydlett
Barco
Coktjock
coroY
CurrQuck
Gibbs Woods
Grandy
t �+
Harbftw
Jarvsburg
Knot ts Island
Maps
Moyock
Point Harbor
Poplar Branch
Powells Pokrt
Shawboro
Sligo
Watermy
County Boundary
— state
—county
Streets
Wright Memorial Bridge
Major Streets
— AnerlaLPrinc pal
Arteriel_Major
— collector_Major
Parcel Land Hooks
Parcels
Currituck County
Aerial Photography (202(
ERad: Band_?
WGreen:Band_2
EBkie: Bad 3
rhis map should be used for general reference purposes only. Currituck County assumes no legal liability for the information
shown on this map.

Nmne �Mroperty Owner: rn412/-,- foiru.,e/
Address of Property_ t a 3 14 exar b l'
Mafrrg Address of owner. 514ir► e-
oNmer's errraik Owws Phorn �� i35 " 3 7 S�
Agwfs Maim LP&Iden lit I- Agent Mmelk 331- 3d�
Agent's Frrrat
flMo m pof n to b@ tormieted by the Adracerd Pnom tY Owner)
t hereby cer* ttrat i own prnptety to the above r !brim tad property- The for UM
peI has desmibw to me: as sttk3wn at the a the developmerd ftleY are proposM A
desc3pfin or OMM with dons, must be Provided with ttm iettBz
I DO MOT have d*ctiom to this proposai- I DO #rave objections to this proposal.
if you have obfecoes to wha is t--IM pempose4 you must antfy the KG Derma rt of Coastal
�t (DC1Q 1r w, 0 9 wfflkk 10days of recQW of Oft MOM should be
marled tra 401 S. 60 Si, Sle. Soo, am abttfh � M 27'9M DGE represer� also be
corrtaeied aI 250,3 - No rasp a 1 0 is the same as no obfind n if you !rave beery
m) +ed by Cw~Mait
I crRderstand th d any pmposed pier, dock, moomV pings, boat rarnpr Wealmater, boal1house, WL or
groin must be set back a n*imtnn dibnoe of 1S room any area of riparian access unless waived by me
(ttm does not apply io buidreads or dprap rewefrnerrtj. (if you wish to vmm the setback. You mast smn
the appropriate War k below.)
I DO wish to wain soniefall of the 19 setback
afAa,Wnf ROanion Pmpedy Ownw
I do not wish to waive the 16 setback reMkornent (MM Om blank)
NOW."
s PIKE
l
.� ._ • � • r >f f• r ..I
ARPO's enfaik �� ARPVs '-I=�Qi j� �� [ � � Gt-t q�, G
*lrwiner is valid for up to one yew hoar AIRPO% Sllgrattete=
Revised Judy 2021

N.C. Dl1SION OF COASTAL MANAGEMENT
ADJACENT RWARIAN PROPERTY OWNER NOTiIFlCATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: 14 P r poll( 1.1G1
Address of Property. '61a'q 1✓ t
Mailing Address of Owner: x/►'1 p
Owner's email: /7�A Ownec's PhorreiF:
Agent's Name: L udin /%% r;ne _ 4i Agent Phone:
Agent's Ernailt [aC eon MlyI"' W G © /tG Jwvw . �. C ")4"
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
!Bottom portion to be cornDleted by the Adjacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
permit has descn ed 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 t~ikg proposed, you trust nosy the ALG Division of Coastal
Management (DCAQ in w rding widdn 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffith St, Sta_ 300, Elizabeth City, NC, 27909 DCM representatives can also be
contacted at [phone]. MD response is considered the saute as no objection W you have been
nothfned by Certified Ma#.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pifirhgs, boat ramp. breakwater, boathouse, lift, or
groan must be set back a nhinimum distance of 1s from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetnents). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive sometall of the is setback
Signahue of Adjacent Roarian Property Owner
1 do not wish to waive the 16 setbed[ requirement (initial the blank)
Signature of Admit Riparian Property Owner: ( ,i . UA46,21,Ask .
TypedlPnnted name of ARPO- 0-!AA JWLicr 7 U A\ I (1(YL9--i A.-
Mailing Address of ARPO: � � �F �i,�i ����61► 4�c �-�l f �1 4r&�
ARPO's emart: ARPO'3 Plwne* S7 t-155 . �• S (�2
Date: ` . - .Z - *waiver Is valid for up to one year from ARPWs Sire*
Revised Judy 2021

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