86532A_Doyle, Michael; Jernigan, Joseph; White, Mathew_20220527

`°"'4 ❑CAMA ❑ DREDGE & FILL N° 86532 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:
I SA 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
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.
Agent or Applicaht PRINTED Name Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit" Signature
(Please Initial) t /
Application Fee(s)
Check #/Money Order Issuing Date
Expiration Date

AGENT jUTHORgAjic)N FgRWFOR PERMIT APPLICATIONS
_
1i"'[ 0 P, 0-V 1-1 Tr' -
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Name of Properly owner Applying for Permit.
S(PZ ffLT�d%tA1^',*jU INC, 2795
Mailing address' 4,, 4, Cy tp rMa M i rnl's4� , J,,/ A)C
Telephone Number:
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I certify that I have authorized . 1 (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all LAMA permits
necessary for the proposed development Of
at my property located at
This certifiation is valid through
(Prop,crt'
t'
v 0jke
;�tint or Type Name
1,ftle, co- ow;-Ieroi fnislee forpropetty
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Telephone Number
(date).
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AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
i . i 1�chae4 �. poy tee fir:
Name of Property Owner Applying for Permit: 3,/rla f+h�� LJh;tr —
Mailing address: / • ,sy.S�2 3 �'
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Telephone Number: a�asa a.-n 4
I certify that I have authorized _ _� (agent/contractor),
to act ur my behalf, for the purpose of app ying and obtaining all CAMA permits
necessary for the proposed development of
at my p,operty located at
This cr-,-rtrfi:;ation is valid through
(Property Owner Information)
�tgr►atc
'.)riot or Type Name
Titie. ,; . owner for trustee for property
Date
r clephone Number
(date).
C° E `� D
p©
0123V11

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
f. ;A,ckg040.Noylei 'Tr .
2. JosePk, R, J"c--rr,1 aniJr.
Name of Property Owner Applying for Permit: 3 /Yla..-f+hmo s Wh; }-
Mailing address �3 6
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Telephone Number: a.asa-3vs- �s ,2
I certify that I have authorized C- f!Lj (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of
at my property located at
This certification is valid through
(Property Owner Information)
ign7a/re
1A7
Print or Type Name
Title. co. owner or trustee for property
Date
RECEIVED
MAY 2 7 2022
DCM-EC
(date).
Telephone Number

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portior
i 'n•�h
J C-SC
Name of Property Owner. 114,7
Address of Property:
Mailing Address of Owner 3 J
Owner's email:
bye ompletted by owner or their agent)
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Owner's Phone* mac - k5-';
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.
! DO NOT have objections to this proposal. I DO have objections to this proposal.
ff 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 Owner:
Typed/Printed name of ARPO: r' 1�i i y1 t' L�l 5 ./� LJ k
Mailing Address of ARPO: `'i,�, N s
ARPO's email: ARPO's Phone#:
Date: *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021
RE C F'If VF n
MAY 2 3 2022

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top
T
Name of Property Owner. �, n
Address of Property:
Mailing Address of Owner.
Owner's email:
Agent's Name:
d by owner or their agent)
X,-,
f
meter a n� tJ�'1 'i91
Owner's Phone#.
Agent's Email:
m
Agent Phone#.
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be coinnieted 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.
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 mast notify the N.C. Division of Coastal
Management (DC" in writing wffliin 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Gdfffn St., Ste. 300, ,Elizabeth City; NC, 27909. DCU representatives can also be
contacted at [phone]. No response is considered the same as no objection If you have been
noted by CerttFed 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 sometali of the 15' setback ,tuf' -
n
Sigature of Adjacent Riparian Properly Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner.
RECEIVED
MAY 2 3 2022
Typed/Printed name of ARPO:
Mailing Address of ARPO: _ _-- -- - --__-- c m
ARPO's email:
ARPO's Phone#-.
*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
(Top portion to be gpmpleted by owner or their agent)
1, m.rhae-I p. lTry.
4.-Tosc--ph A, JCt �jCcn� af.
Name of Property Owner: 1 nv_ -r--r h�u} S . uJ -
Address of Property:
Mailing Address of Owner:
Owner's email:
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Owner's Phone#. �R; his �- Is- i
Agent's Name: Agent Phone#:
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property Owner)
NED
MAY27ZW
I hereby certify that I own property adjacent to the above referenced property. The individual applying forthis
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.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
ff 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 O�vner:�
Typed/Printed name of ARPO: _ �4
Mailing Address of ARPO: • Q C- _�S 1 `��C ���( N �-- a. 7 3-DS
ARPO's email. ' ARPO's Phone#:
Date: 1( (p Z 2 `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 HANDDELIVERY
(Top portion to bep3 m�leted by owner or their agent) &2 4661 a�Qf. IE e**aNr�t
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Name of Property Owner. 'Vic,
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Address of Property: ! i a W h!CSi ` �y ► 9
Mailing Address of Owner:
Owner's email: i, c12XVII cE(a v.I filt Owner's Phone# ie -
•Cover!
Agent's Name: Agent Phone#:
Agent's Email: _
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Ownerl
i hereby certify that I own property adjacent to the above referenced property. The individual applying forthis
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.
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 (DCAI) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St, Ste. 300, Elizabeth City, MC, 27309. 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 somelall of the 15' setback
Signature of Adjacent Riparian Property Owner
Eslfa
Typed/Printed name of ARPO: -L-1 �t` .Sio� P—
Mailing Address of ARPO} ba�q%taAIS>r�r � L a6-juZoiu N C , Z-7F3
ARPO's email: /, CEC VAt kV-lG9 tk:1�h..\ ARPO's Phone#: !• 7S7.7oS. n CialF
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Date:11 Mal 2.6 22 *waiver is valid for up to one year from ARPO's Signature*

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