86325A_Guzman, Otmar & Viginia_20220405

30�0(OAS '41&❑CAMA El DREDGE & FILL N� 86325 B c D✓
s % Previous permit
3 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 State ZIP
Phone #
Email %r=Z r (cv
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
P
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/#
1 Bulkhead/, Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length _
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yesJIR
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.
Agent or Appligat"ORINTED Name Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit" Signature
Application Fee(s) Check #/Money Order Issuing Date
(Please Initial)
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 1-1 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 Fender Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

I 1
DIVISION OF COASTAL MANAGEMENT
AGENCY FO&M FOIZ PERMIT APPLICATIONS
I � � 5 L) ; �'�1 owner of the property located at:
(property owng G
(pr
�_,.aaYzs
(proper:- fM:. � �►rccc;
do hereby authorize
(nary -TY- _ act•,ng as agent)
to act as my agent for the purpose of ob in --a—v needed Area Management Act and/or
Dredge and Fill Act permits, that may be _-Dosed development at the above -
indicated property, which entails:
(describe proposed developmentror ,: nsch permits are being sought)
This agency authorization is limited to the specific activities described above, and will expire on:
iU 1.1r
(date onlvhich agency authorization expires)
l (signatur !aaze)
(printed name of owmer)
(title, if officer of core. owner or trustee for property)

C >0 AWAI WITk
�",�: f RP -ER fi 6

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: (� 1 LG m (A ►— U Z m 0 n
Address of Property:
Agent's Name #:
Agent's phone #:
(Lot or Street #, Street or
Mailing Address:
k
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 drawin the devel ent
they are proposing. x..
I have no objections to this proposal. I have objections to this proposal.
/f you have objections to what is being proposed, you must notify the Division of Coastal Management
(DC&V in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at htttp:!/www. nccoastaimanagement neJdveblcnafstaff- isting or by caning 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Cerdfied flit.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15' from my area of riparian access unless waived by me. (If
you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
i do not wish to waive the 15' setback requirement.
(Property Owner Information)
A-J. - le - zi
Si tore
Print or Type Name
i � Lip
Marling Address
:W11city/shfam
-75- p7-g07LO zma�
Telephone Number/ Email Address m5 a c oN
I-11�-�I
Date
(Riparian Property Owner, Inforrnati
Si re
Print or Type Name
Mailing Address
City/5ta ip
I b(!!!6��X<e
Telephone Email Address c,-7
q J �%�
Date
(Revised Aug. 2014)

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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: V 0410
Address of Property: 6 S b 1
(Lot or Street #, Street or Road, City A County)
Agent's Name #: Mailing Address:
Agents phone #:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permithasdescribed to me as shown on the attached drawin the development
they are proposing.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCAI) in writing within 10 days of receipt of this notice. Contact information for DCU offiloes is
available at htW-'1Avww. nccoastaimanaaement netlweblcm/staff-listina or by caNuV 1-888.4RCOAST.
No response is considered the same as no objection if you have been notrfred by Certified MWL
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15' from my area of riparian access unless waived by me. (if
you wish to waive- the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Riparian Property Owner Information)
Aj� 42 A, 4 )z' A
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Print or Type Name
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Mailing Address
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Telephone Number/Email Address
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Date
earn:
Print or Type Name
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Mailing Address
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City/Stat&Vp
90-3yo-� o�
Telephone Number/Email Address
Date
(Revised Aug. 2014)

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