84467C - Annas, Donald

1*olcoasrg1 �❑CAMA ❑ DREDGE & FILL NO.-84467 A B C D
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 t le is X, ,I j t
City State , ZIP
Phone # ( )
Email
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
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
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #/Money Order
Permit Officer's PRINTED Name
Signature
Issuing Date Expiration Date

y*°1(OILS I kNCAMA DREDGE & FILL NO. 8446 A B C D
z = ❑ El Previous 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
Affected ❑ CW
AEC(s): ❑ OEA
ORW: yes/no
State ZIP
❑EW ❑PTA
❑ IHA ❑ UW
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
❑ ES
❑ SPIMA
❑ PTS
❑ PWS
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Adj. Wtr. Body
Closest Maj. Wtr. Body
P
(nat/man/unk)
(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
Signature **Please read compliance statement on back of permit** a
Application Fee(s) Check #/Money Order
Permit Officer's PRINTED Name
Signature
Issuing Date Expiration Date

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: Donald W Annas Jr.
Address of Property:
2698 Lennoxville Rd., Beaufort, NC 28516
Mailing Address of Owner: 2698 Lennoxville Rd., Beaufort, NC 28516
Owner's email: [e-mail] Owner's Phone#: [phone]
Agent's Name: n/a
Agent's Email: n/a
Agent Phone#: n/a
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the AdLacent 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.
LI 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.) 1-17
I DO wish to waive some/all of the 15' setback
-OR-
Signature of Adjacent Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO: C) � I (j � l
is
ARPO's email: WAik,G(�?YN6428,^ I A k/, A t f ARPO's Phone#:
Date: *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
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I hereby certify that I own property adjacent to ir\v+�f� In% A nnat f .I r' s
(Name of Property Owner)
property located at r1 K �/Z lit
(Address, Lot, Blo k, Ro d, etc.)
on A tor , in f'4 Vow , N.C.
(Waterbody) (City/Town and/or County)
Initial The applicant has described to me, as shown below, the development proposed at the above
Here on location.
one of
=� 1 have no objection to this proposal.
these I have objections to this proposal.
lines
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
fit' )vi
,
1
WAIVER SECTION
I understand that a 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
Initial me. (If you wish to waive the setback, you must initial the appropriate blank below.)
Here on I do wish to waive the 15' setback requirement.
one of
these I do not wish to waive the 15' setback requirement.
lines
(Property Owner Information)-ADJ7tc.F_NT P erty Owner Information)
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PA860164R&viafle rd Print or Type Name
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Te ep one um ,e email address Telephone Number/email address
- 8/12/2022 R — I - -�?j
Date Date *
(Revised Aug. 2014)
*Valid for one calendar year after signature'

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Q6r% 0. -Q;I A.,- A,,,%f,s
property located at Lw� ,yi ��a7e of,Prope�ty Owner)
/���,� ,{�✓ G
Kiy::L,(Address, Lot, Block,r4l
etc.)
on ik , In f?.eZ , N.C.
(Waterbody) (City/Town and/or County)
Initial The applicant has described to me, as shown below, the development proposed at the above
Hereon locatio
one, of.'.,
have no objection to this proposal.
these, : I have objections to this proposal.
lines
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
41t" ct' 4
WAIVER SECTION
I understand that a 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
Initial
me. (If you wish to waive the setback, you must Initial the appropriate blank below.)
Here v ie— I do wish to waive the 15' setback requirement.
one off
these I do not wish to waive the 15' setback requirement.
lines
(Pro er Information)
Sr na ure
trt AnnAs Tr -
Print or Type Name 2,G9? 1.4n oxyilk RA
Mailing Ayldress p
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CitylStatelZi h h K n
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Telephone Number/email address
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Date
*Valid for one calendar year after signature*
(Adjacent Property
er Information)
Print or pe ame
ing A ddres r
CiLMStatelzig
Telephone Numberl email address
F-16
Date '
(Revised Aug. 2014)

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