86671A - Davenport, Anissa

edt°` � CAMA ❑ DREDGE & FILL
GENERAL PERMIT
Ida 86671 B C D
�. 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 Comrrurwn in an area of errAronmental concern pursuant to:
t
SA NCAC I H , 1 2CK) I 1 Rules attached. ® General Permit Rules available at the following link. www deal ncsov/SAi+WUJes
Applicant Nanv An iS Ci T' Authorized Agent
Add C`r O i Q c FAProiect Location (County): gear +m
city Gw-e&"A .State MC —zip--;,) YST_ _ Street Address/state Road/Lct s(s) __lap � 9
Phone #f (ZS L) %;I -� '1501 10 C( � . �� r J D�v-_CA,,
Email CR t1 k S z. 1- ckQ ve ^ pp r4-@ % Subdnrs+on GYYur` S & G
city Cetex-+air. -,-,Zip
1\cci�Qv. tl t d Q,�- _ (t nart/unk)
Affected M M NEW NM ❑ ES [_] Pas A4. Mr. body
AEC(&): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA t ❑ PWS CIO�t t'al, Mr. Body p+r✓(�4C a �an�
ORW: yes/(R) PNA: yes/ n7�71 Aq1•�eo1 � %hi;' L-
Type of Project/ Activity - � 4r, ` N, rr, wl c f x go, ++ ' e,,J to,+Q,
oar•.oi kr`S)ra'V cki2' x iZ' 106a+l (Scale: I" 3S }
Shoreline Length QS 4
Access Length ;
Pier (dock) length -5 -4
Fixed Platform(s) p�4 / K� '(M► i i
Floating Platform($)
Finger pier(s) f
S
H
Total Platform area r7�C1? S
Groin length/a ;.
Bulkhead/ Riprap length i
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
r
Boat ramp.
Boathous Boat i Z-t
Beach Bulldozing
Other
SAV observed: yes ®�
Moratorium: yes no _. w4
Site Photos: no ' -- — —;i t t _ i ' ._._ .
Riparian Waiver Attached: yes ' QI�__=�
A building permitlzoning permit may be required by:
Permit Conditions
❑ TAR/PAMUNEUS"UFFER (d le 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 PROIECT AND REVIEWED COMPLIANCE SIATEMENT. (Please Initial)
or
"Please read compliance statement on back of permit"
S1817.7r
Application Fee(s) Check #/Money Order
Permit *,rs PRINTED Na
A
Si natu
h4 /Zz 11l1-1 tZz
Issuing Date Expiration Date

LEFT Side Dock 5'x 50' (250sgft) Right Side
Platform 20' x 20'(400sgft)
255—!
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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: GCS/
S
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Address of Property:
t S ?c-c(4l S R eGC k
109
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L le C6 � n
N
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D Mailing Address of Owner: D _ S Ct Cca C _ -kU 4
6,ee
o vr l (� /VC
Z795
Owner's email:
Agent's Name:
Agent's Email:
C7►rAI `+ Cost _
Owner's Phone#: Z� Z 0 Z-`7S b %
Agent Phone#:
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. A
description or drawina. with dimensions. must be Drovided 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 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 blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property Owner
l�Ga
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: G ; f,�— RRU J R `
Mailing Address of ARPO: / D 7 Pf-p 12u F r-_ A-C_ VN
ARPO's email:
ARPO's Phone#: 25 .2.-_-1,t `) - S'?6 C1
Date: "1 I 13 Z *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 NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Da ne�
Name of Property Owner:V �h i- t-t� �Sa t_ )6(Vdt'l
Address of Property:16qJ P, r(VSC l `Cf (_e,) C
Mailing Address of Owner. L W _S+qCCA4-o CE r-ce n U ( [ 1e %vC 2-795S
Owner's email: ` Aye-LkPor- Owner's Phone#: 2 5 2 —902` -7S b
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. A
description or drawing, with dimensions, must be provided with this letter.
V�I 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 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 blank below.)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email:
ARPO's Phone#:_
Date: - ` - l5 `av2 ,waiver is valid for up to one year from ARPO's Signature"
Revised July 2021

LEFT Side Dock 5'x 70' (350sgft) Right Side
Platform 20' x 20'(400sgft)
Boatlift
E
0
A U G 2 5 2022