86668A - Jennings, Sean & Danielle

UCAMA ❑ DREDGE & FILL N9 86668 B C D
Previous permit v
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:
1 SA NCAC Y f) - t ) L-' �> ❑ Rules attached. ❑ General Permit Rules available at the following link: www.dgq,nc.Qov/CAMArules
Applicant Name S(- ..-, r 1),& n , l I it 7C r. r
Address 14 3 Su d S h , c 6 v4-,
City (�. , r : .. c K State N L. ZIP
Phone # (-JL+j C 30- �I X O tr
Email Sic re yva re^) ,yA.. CyYr
Authorized Agent " •P r- r 1-, j3 , t V I S
Project Location (County): C. r r.. i c k
Street Address/State Road/Lot #(s) t-i 3 Soar �� �•
Subdivision C v r
City , I. 1< ZIP —I 07
Affected ❑ CW EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body i,Z yr % fnat/Jnan/unk)
AEC(s): ❑ OEA IHA UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body 0
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length I a
Access Length
,e ock) length `5'Lti X `,
-_ tlf)61
"xed�latform(s) Ili X I O
Floating Platform(s)
Finger pier(s)
Total Platform area IOU "t i
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards %
Boat ramp
Boathousef Biiatlift Ili 'X
Bear.4sulldoz+ng
'"Other
i'
1_
SAV observed: yes ho f
Moratorium: n/a yes no
Site Photos: yes no `(
Riparian Waiver Attached: yes
A building permit/zoning permit may be required by:
Permit Conditions
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJ
.y
Agent or Applicant PRINTED Name
Signature "Please read compliance statement on back of permit"
Application Feels) Check #/Money Order
S i-c �9S , n i u w� }-•' -
(Scale: PT S
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F,
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,
TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
ECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Permit Officer's PRINTED Name
Signature
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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit
Mailing Address:
Phone Number:
Email Address: 5� ec►n� r r,-t,��g . , ti _
I certify that I have authorized
Agent i Contractor
to act on my behalf. for the purpose of applying for and obtaining all CAbtA permits
necessary for the following proposed development:..;
it, xlr: ISSN � - i J�-��s �^ -C u04,ry 't- 4"
at 74y pro a )ocated ape
in .tk County.
I furthermore certify that / am authorized to grant, and do in fact grant permission to
Division; of Coastal tvtanagement staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Properly Owner Information_
Signature
Print or Type blame
Title
Cate
This certification is valid through

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER 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 �.„�.. �,,,' x�,_ Owner's Phone#''i
Agent's Name ,- _ , _ : _�, Agent Phone#•
Agent's Email
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed 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 described to me as shown on the attached drawing, the development they are proposing. R
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.
tf you have obiections to whei 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 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 biank below.)
I DO wish to waive some/all of the 15' setback
-OR-
Signature of Adjtent Riparian Property C?wner
I do not wish to waive the 15' setback requirement (k tiai the blank)
Signature of Adjacent Riparian Property Owner. �-
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email: ARPO's Phone#:
Date: 'waiver is valid for up to one year from ARPO's Signature'
Revised July 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAiVER FORM
DERTIFIED MAIL - RETURN RECEIPT REQV5$TED or HAND DELIVERY
(Top portion to be completed by �owner or their agent)
Name of Property Owner: i5erfrl ►✓GtYtr $ tf f (/yam IN CS �t
Address of Property. �o.3hUc i�ri,y.F�i r,/ii t IC %?�tZ�
Mailing Address of Owner: __4 �'o u,-gl AI C,,.
Owner's email: enn; rs^��,.,fi�r#s,,� t)wner's Phone# -- �'j'7 - G, `?r-ZO(c
1 Gun
Agent's Name: , ,,i�h��ctS Ager>r Phonelt_? -�a5 zt_
Agent's Email
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom ooftion to be completed by the Adjacent Property Owner;
' hereby certify that I own property adiacent 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
descnn6on or drawinc. with dimensions, must beprovided with this letter.
r, j —
�, 100 NOT have objections is this proposal. _ 100 have objections to this proposal.
Ft, you have objections to what is being proposed, you must natity 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. Grrtfrn St., Ste, 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at f252) 264-3901. 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
ithis 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 sometall of the 15' setback y
54niture o
-OR- f Adl cent Riparian Property Owner
i do not wish to waive the 16 setback requirement (initial the blanki f
Signature of Adjacent Riparian Property Owner:
TypedlPrinted name of ARPO:
Malting Address of ARPO:
ARPO's email: ARPO's Phone#:
Date: 'waiver Is valid for up to one year from ARPO's Signature'
Revised July 2021

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