87462D CREWS

❑CAMA ❑ DREDGE & FILL (! C /9�f�'f N° 87462 A B C o
GENERAL PERMIT Previous permit
�� �� Date revious permit issued
❑ New ❑ Modification [:]Complete Reissue Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commissi n in an area of environmental concern pursuant to:
I SA NCAC
Applicant Name i '
Address 5A .
City Vl ' ;`.. State d ZIP
Phone #
Email ` . (.cM
❑ Rules attached. ❑ General Permit Rules available at the following link: www.dgg.nc.Yov/CAMArules
Authorized Agent i,-; j i-' \
Project Location (County): 7)\
Street Address/State Road/Lot #(s) k (� '
Subdivision
City ZIP
Affected E1CW ❑ EW ❑ PTA ❑ ES ❑ pTS Adj. Wtr. Body / k. (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body AA Uk-.�U-
ORW: yes/no PNA: yes/no
Type of Project/ Activity
1 (Scale:M 5 )
Shoreline Length _
Access Length
Pier (dock) length
Fixed Platform(s) _
Floating Platform(
Finger pier(s) _
Total Platform are
Groin length/# _
Bulkhead/ Riprap
Avg distance offish
Breakwater/Sill _
Max distance/ lens
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatli
Beach Bulldozing _
Other
SAV observed:
Moratorium: n/
Site Photos:
Riparian Waiver Al
A building permit/zoning permit may be required by: 1 \ <� k ��e( ti.( h !
Permit Conditions )(Ail YIQA `fir-1 "Y
❑ 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)
�J
Agent or Applicant PRINTED Nan
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #/Money Order
Permit Officer's PRINTED Name
Signature
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 primihIal 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 Pender Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

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)
Name of Property Owner:
Address of Property:
Mailing Address of Owner: SNmZ
Owner'semail:COwner'sPhone#: Cm7
Agent's Name:
Agent's Email:
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 drawing, with dimensions, must be provided with this letter.
o 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 127 Cardinal Drive EXT, Wilmington, NC 28405. 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 hprap 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 (A P
"W
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property
Typed/Printed name of ARPO: Vl k�rULa �/� ,� p r
Mailing Address of ARPO: E 1 f 10 ►1 ra e j4- O ceo o Tsle- 14,Un /! C
ARPO's email /) 1- 4- U c cur IN 11 F-, [In ARPO's Phone#: - l 1 v
Date: Z`) Z© ZZ *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to k N-9—vi S 's
(Name of Property Owner)
property located at �` moc �p� S�
(Address, Lot, Block, Road, etc.)
on Cp:NP� , in OcQ-(w N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
—_ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
1 understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to waive
the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)\\ } (Adj Property Owner Inf ation)
Signatur ! IC IDICC-lS Signature
ct
Print or Type Name Print or Type Name
?1,\ M�,V,�coe S 33 nit) iroe S�
Mailing Address Mrceayl—Fsle
ing Address
c7Ce� 15i� - c F� l001 gekc�, N C 6�1
City/State2ip City/State2i
910 40 q / 0 - &220-2(-rlZ
Telephone Number Telep one Number
!�iIZ1/2oZL
Date Date
(Revised 611812012)

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Date Reeelvad
Date Deooalted
Cheek Fran Name
Name nlParmk Holder
Vendor
Check number
Check
ount
Permit Number/Comments
R—Inta Refund/Reallocated
Columnl
Column]
Cdumn3
Calu-4
Column5
Column6
Column!
ColumnB
Column9
9/29/2022
Sea Dog Marine Construction
Bonnett
First Bank
1926
$ 200.00
GP #87469D
BB rct. 17903
9/29/2022
Joel Klass
RWJ Investments LLC
BB&T
667
$ 400.00
GP #87476D
BB rct. 17901
9/29/2022
Tommy Adams
same
Bank of America
110
$ 200.00
GP #87642D
BH rct. 17721
9/29/2022
Barry Crews
same
Members Credit Union
5556
$ 200.00
GP #87462D
KB rct. 10366
9/29/2022
Christopher Lovell
Douglas,
First Citizens Bank
102
$ 600.00
GP #85958D
PA rct. 17736
9/29/2022
James Williamson
same
Truist
4752
$ 200.00
GP #87431 D
PA rct. 17734
9/29/2022
Pippin Marine Construction LLC
Harold and Prince
Wells Faro
��6117
$ 400.00
GP #87461 D
KB rct. 17805
9/29/2022
Southern NC Marine LLC
Gerow
First Bank
1548
$ 200.00
GP #87486D
JD rct. 17695
9/29/2022
Steven Farmer
Holt
Truist
5533
$ 200.00
GP #87493D
KB rct. 10367