Tolmich, Tracy & Jester, Keith 88707C

1°``°"�'",1ffi�F]Nevv
N❑CAMA ❑ DREDGE & FILL ® 88707 A B C D
4�0
GENERAL PERMIT
ti Date previous permit issued
❑Modification ❑Complete Reissue ❑Partial Reissue Previous permit
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 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
(Scale:,
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
❑ 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

o1*°jCOA `41 ❑ CAMA ❑ DREDGE & FILL N9 88707 A B C D
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.eov/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
f
(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" Signature
Application Feels) Check #/Money Order Issuing Date Expiration Date

ENT AUTHORIZATION FOR CANA PERMIT A
ppLIGAYION
AG Cj
Permit:
Name of Property Owner Requesting
NJ
Mailing Address:
Phone Number:
n
Email Address: br'
tt
I certify that I have authorized
agent /Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development © `-x
be `&- -I 3C/
at my property located at
in ON40` J County.
l furthermore certify that I am authorized to grant,
Division of Coastal Management staff, the Local Pe
on the aforementioned lands in connection with e
permit application.
Property Owner
or Type Name
Title
9131
Date
This certification

/ N.C. DIVISION OF COASTAL MANAGEMENT
IVER
ADCERTIFIED MAILL! OWNER
RETURN RECEIPTREQI ESTED or
(Top(Topportion
t t`o b\e completed by owner or their agent)
l�
Name of Property Owner: e' 1�'�\
t, �l
Address of Property:
Mailing Address of Owner: gffSeYi cu'w VA
Owners email: 1+ Owners Phone#: k0
qe. Agent Phone#: q 10 " 5 `a `i -
Agent's Name: h 5y h i
Agent's Email:i YJr 4rt�� t i u Lv�'2
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be completed by the Adjacent Pr party Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying fa'tht
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.
(11-1— I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objection to writingwith't 0 days of receipt of this notice. Correspondence should be
Management (DCM) ' g
mailed to 400 Commerce Ave., Morehead City, NC 28557. DCM representativescpn also be contacted
m ailed o 400 o No response is considered the same ate no objection if you have: been notified by
Certified Mail. -
WAIVER SEC (t?N
I understand that any proposed pier, dock, mooring ptbng , Oat tamp, bre€�kwatee, boathouse, lift, of
me
groin must be set back a minimum distance of 15' from my area of riparian access unless you mu t M
(this does not apply to bulkheads or riprap revetments). (if you wish to waive the setback, y
the appropriate blank below.)
I DO wish to waive some/all of the 15sc:tbnc�bperty
_
Signature4Ajjac,�-,r-)i1Riparkqn
-OR-
i . s:.. , etbeck requirement (initial the blank)
an Property
gs,P
Phone#: �i�" 3 9 - 4 —1
up to one year from ARPO's Signature*
Revised July 202

N.C. DIVISION OF COASTAL MANAGEMENT AVE ER
ADJACENT RIPARIAN PROPER-C
TY OWNER NOTIFICATtpN D E
CERT FEED M�ETURN l� T REQUEST�� HAND
(Top p �
ortion to be completed by owner or their age
c • / a 1't Gt �C 1 -� G• LSE
Name of Properly Owner 12 ' 1 t3 q`_ j2_ ,
L
Address of PropertY 15 - ;i ---- _ d•'C ,,�
Mailing Address of Owner:
Owner's Pnone#:
Owner's email:
�t Agent Phone#. �1--- — "--
Agent's Name�—
Agent's Email
pWNFS,S cERTIFICA IO r)
ADJACENT RIPARIAN PROPERe�TYth acent Pro ert
(Bolt m ortion to be com I In for this
ro erty The individual aP plying
the development they are proposing A
adjacent to the above referenced property
I hereby certify that I own property ied
permit has escribeci to me, as shown on the attacv'ded with his letter.
d scri •o r drawing with dim_ " �n$1Ons must be I D0 have objections to this propoyaL
I DO NOT have objections to this proposal _ -
-- ou must notitY the 1+6.C. Rivi fc�n �f Coastal.
If you have obe
bjections to what Is being proposed, Y
VCM) In writing of eceipt DCM re presoptaitives can ciao be contacted
Management ( within i0 days of receipt of this notice. Correspondence should
mailed to 4f70 Commerce Ave., Morehead city, ou have been notified by
at riled) o 400 f)8. No response is considered the same as no obJeetiafn tf y
Certified Mail
WAIVER SECTION
rn� tY is
I understand that any proposed distance of dock, frorm mylarea ofriparianuntcsf.s waived b} lift, (r grain
must be set back a min If you wish to waive the settbacic, you It sl s1 the
does not apply to bulkheads or riprap revetments) (
appropriate blank below)
1 DU wish to Waive somelall I)f the
setback _
i= tdt PAdjacent H- 'Variarl PropQrfy Owner
15' setback req� ir6me initial tt r� mark}
I tic not Irish t� - Si natui e of Rrlja adri P;rspvrty �stti'r*er
Typed/Printed narne`; O;
.. t 4LI 1/
,'Mailing Address of
it;n-A 6� [J
vtiver is ~valid or Up one year from ARPO s Signature
Revised May 2021