86670A_Perry, Tammy_20220721

N86670
( k> K CAMA ❑ DREDGE & FILL Previous permit _ t issued
GENERAL PERMIT Date previous permit issued
[A New ❑ Modification []Complete Reissue j_] Partial Reissue to_
rtment of Emironmerrtal Quality and the Coastal Resources Commission in an area of environmental concern �nuattt
As authorized by the State of North Carolina. Depa nc v
�1 ❑ Rutes attached. [9 General Permit Rules available at the following link: www
l SA NCAC i rK � --'_._-
Aud prized Agent
cant Name _ L!m t (County):
3
%WPk .� x6r�'�► �Project Location
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AddressuC (
-__...-. '�� � Q Street AddresslState ftoadit.ot il►(s)
city fl State_ ____- zlP -- i {o
Phone # (W) 2_ _� =-�S `1(� t� i1
on
Etrall YYyY1\�iCL) .r._. fO E110r�.� :'gii CC CitySubdisi Co
olet'0.
W Qt1 t1/EiC' orran/unk)
Adj. Wtr. Body J
j w
Affected ❑ CW EW ®�A ❑ ES ❑ PWS Closest Maj. WQ.Y Ct S 6 u
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑
ORW: yes to PNA: yesQrn
{
Type of Project/ Activity S {
{Scale:) "3J )
Q. 5�4k
Shoreline length
r
/+t
Access Length
Pier(dock)length am-i -
/1 ''''yrAA . w '-�""`�--r•---r---�'... i
Fixed Platform(s)
_ � -may r_•, � .- t
r_
Floating Platform(s)
Fingerpier(s) r f. t.- k ( t , I'
� ( i i t � t f 7�! t t � � �IL ic•yt't `i � "-•—� y z � `-y t - = i
Total Platform area
t 24 t t
Groin length/it
Bulkhead/ Riprap length- r r
Avg distance offshore
Breakwater/Sill
Max distance/length ' i +
s {ii^V•
6a51t4 channel
f
{
Cubic yards
Boat ramp
8 }
Boathouse/Boatlift
Beach Bulldozing ,
�, y�...�._.._s.
other
It
SAV observed: yes
no
Moratorium:,,�y
Site Photos: no
Riparian Waiver Attached: yes {,
A building permtt/zoning permit may be required by: �-r` re- Co -
Permit Conditions._-__
❑ TARIPAMlNEUSEBUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditiom an back
t AM AWARE OF SrAMES CRC RULEot[) CONDITIONS THAT APPLYTO THIS PROIECr AND REVIEWED COMPLIANCE STATEM `NT. (Please Initial) rv,
or Applicant
Permit Offstr's,sRiNTEr Nam VJ-
Sign ure "Plea read complian atement on back of permit' Signature �y 7
i;l7-
Check #JMoney Order Issuing Date Expiration Date
Application Fee(s)

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be
Name of Property Owner,
Address of Property: _
Mailing Address of Owner:
Owner's a il:
Agent's Name:
Agent's Email:
owner or their agent)
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
jl� qa�
;AL
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.
t/ 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' setbac
`Signature of A scent Ripar(dn Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Ripari<
Typed/Printed name of ARI
Mailing Address of ARPO:
ARPO's emaiL•�>_-ti1i IcC •o, -1 ARPO's Phone#: Z-57-7,2q--
Date: /32-0 7 *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 NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property
Address of Property:
Mailing Address of Owner:
Owner's ema : b twner
Agent's Name:
Agent's Email:
1 ��fal�n N L
PC
Phone#:
1`
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent 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 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 (�
Sig
-OR-
nature o�entrty 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: 3, x Z7 Co �� ro.��,
�t�C—Z717--
ARPO's email: q tY'�Y-r w�,t . c o� ARPO's Phone#: 6 5 2, 2 \7-- 3'01
Date: 6 — ) 2 — ZZ-- *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

LEFT Side Dock 6'x 50' (250sgft) Right Side
Platform 20' x 20'(400sgft) 13'x13' Boatlift
101
Boatslip
n
Boatlift
1*1
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