88788C - Mitchell, Derek

❑CAMA ❑DREDGE & FILL N9 88788 A `B ;D
Previt GENERAL PERM17. Date r iouspermit
all.
Date previous permit issued
J New ❑Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the S ia,�lee of N�1ash /C''rarolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuam to:
I SA NCAC I / 7 , 1 t-ny ❑ Rules attached. ❑ General Permit Rules available at the following link: wwwdea.nc.aov/CAMArules
Applicant Name
f1 +
Authorized Age�- D
rrc �.✓�2%
n h-
/
Address
-
Project Location (County):
City '' /
Stare rs. ZIP f �'
Street Address/State Road/Lot #(s)
c
Phone #(+�( �.� '� ^
—
%
Email
Subdivision
City
ZIP
Affected ❑ CW
❑ EW ❑ PTA ❑ ES ❑ pTS
Adj. Wtr. Body
�nar/hwdunk)
i(
AEC(s): ❑ OEA
� IHA uW ❑ SPIMA PINS
Closest Mai. Wtr Body / V�/S
1
e /�, r V i .
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 romp
Beach Bulldozing
Other
SAV observed: yes no "
Moratorium: n/a yes (f no
Site Photos: no
Riparian Waiver Attached: ++yam,-- no
A building permit/zoning permit may be required by:
Permit Conditions
(Scale/_"/or)
❑ 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
r� de11geyYor Applicant PRINTE"ame Permit Officer's PRINTED Name)
Signature " Plegs, [ eacl compliance statement on back of permit-* /y Signature
Application Feels) Check#/Money Order Issuing Dafe
(Please Initial) (
�l6 �21
E)6iratiofi Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit conditions. Any violation of these terms may
subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for
compliance. The applicant certifies by signing this permit that: 1) prior to undertaking any activities authorized by this
permit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the
local land use plan and all local ordinances, and 2) a written statement from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules 1-1 Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules
for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the
NC Division of Water Resources. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave Morehead City, NC 28557
252-808-2808/ 1-888-4RCOAST Fax: [phone]
(Serves: Carteret, Craven — south of the Neuse River, Onslow
Counties)
Elizabeth City District
401 S. Griffin St. Ste. 300
Elizabeth City, NC 27909
252-264-3901
(Serves: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford,
Pasquotank and Perquimans Counties)
Washington District
943 Washington Square Mall Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Craven — north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover and Fender Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

❑CAMA ❑ DREDGE & FILL N9 88788 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:
I SA NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArvles
Applicant Name _
Address
City
Phone # (_ )
Email
State ZIP
Affected ❑CW ❑EW ❑PTA
AEC(s): ❑ OEA ❑ IHA ❑ UW
ORW: yes/no PNA: yes/no
Type of Project/ Activity
❑ ES ❑ PTS
❑SPIMA ❑PWS
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Adj. Wtr. Body
Closest Maj. Won Body
(Scale�-�/O
- 7-
Access Length
}- L
Pier (dock) length-
'..
I
Fixed Platform(s).
Floating Platformis)
.(}
Finger pier(s)
Total Platform area
'
Groin length/#
_
Bulkhead/Riprap length
i
Avg distance offshore -
_. -. _-_ �__ _ _..._ —
_. __
__ -.
(._ -_ _ __.._
_�._ ..... _
Breakwater/Sill
I�.
Max distance/length
_
Basin, channel
Cubic yards
Boat ramp -
,----
�,I
Boathouse/ Boatlift j
1
Beach Bulldozing
t
Other -i-_
l
SAV observed: yes no
i
Moratorium: n/a yes no
Site Photos: yes no
Rinarian Waiver Attached: ves 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 Feels) Check#/Money Order Issuing Date
Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit conditions. Any violation of these terms may
subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for
compliance. The applicant certifies by signing this permit that: 1) prior to undertaking any activities authorized by this
permit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the
local land use plan and all local ordinances, and 2) a written statement from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules
for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the
NC Division of Water Resources. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave Morehead City, NC 28557
252-808-2808/ 1-888-4RCOA5T Fax: [phone]
(Serves: Carteret, Craven — south of the Neuse River, Onslow
Counties)
Elizabeth City District
401 S. Griffin St. Ste. 300
Elizabeth City, NC 27909
252-264-3901
(Serves: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford,
Pasquotank and Perquimans Counties)
Washington District
943 Washington Square Mall Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Craven — north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover and Pander Counties)
http:Hportal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

s:
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Derek Mitchell
Mailing Address:
Phone Number:
4503 Tenella Rd
Trent Woods. NC
252-324-9007
Email Address: [e-mail]
I certify that I have authorized Coastal Boat Lift Repair, LLC
Agent! Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at 4503 Tenella Rd Trent Woods, NC
I furthermore certify that 1 am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
8 I Z G 1:Z -L�
Date
This certification is valid through 1 I
RECEIVED
DCM-MHD CITY

or
F*, k ' -
IF
Y
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENTERRIPARIAN
MAIRLIARETURN R CEIPT REQUESTED or HAND DEOWNER LIVERY
FORM
VER
(Top portion to be completed by owner or their agent)
Name of Property Owner: Derek Mitchell
Address of Property: 4503 Tenella Rd Trent Woods, NC
Mailing Address of Owner: 4503 TENELLA RD TRENT WOODS, NC 26562
@9
Owner's email: [e-mail] owner's Phone#: [phone]
Agent's Name: Coastal Boat Lift Repair, LLC Agent
Agent's Email: [e-mail]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacentto 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
descri ti n or drawing, with dimensions must be provided with this letter.
i � 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 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 dprap revetments). (If you wish to waive the setbacVS(you must sign
the appropriate blank below.) I
I DO wish to waive some/all of the 15'setback
vroperty Ownet
-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:
Mailing Address of ARPO: u Cos T cv-J )Q7 o-t c
ARPO's4j
email: }ra�S,rt"de�wcl�s�as ,a ARPO'sPhone#: Z('Z Clit -'2
(�
Date: I I 1 a I al- -waiver Is valid for up to one year from ARPO's Signature*
Revised July 2021

AL
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 Owner: Derek Mitchell
Address of Property: 4503 Tenella Rd Trent Woods, NC
Mailing Address of Owner: 4503 TENELLA RD TRENT WOODS, NC 28562
Owners email: [e-mail] Owner's Phone#: [phone]
Agent's Name: Coastal Boat Lift Repair, LLC Agent Phone#: [phone]
Agent's Email: [e-mail]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that 1 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 nonry the m.�. urvrarorr, yr
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.)
I DO wish to waive some/all of the 15' ggtback �C
Signature of Adjace ipari Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
XSignature of Adjacent Riparian Property Owner: p
Typed/Printed name ofARPO: 1uvo f>U E- g)alf
Mailing Address ofARPO: 'fed• A\-,Nt w00&Jy)C, 2a9pa
ARPO's email:
ARPO's Phone#:
Date: l 1 )-�J a a 'waiver is valid for up to one year from ARPO's Signature'
Revised July 2021

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