Harris, L. Worth 88744C

N❑CAMA ❑ DREDGE & FILL
4 GENERAL PERMIT
❑v'�evv ❑Modification ❑Complete Reissue ❑Partial Reissue
N9 88744 A B C D
Previous permit
Date previous permit issued
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:
15A NCAC
n N. I 'o
❑ Rules attached.
dGeneral Permit Rules available at the following link: wwwdeq nc.gov/CAMArules
Applicant Name
VJot•4"IA }4n (',(1
Authorized Agent
Address JfnQ �YrJhh�'
S'+-
Project Location (County.): 1`f ls•�---F fdi----�'f lc,if e.l <`f�
City RG¢, lGei"
State !`j(—
ZIP 28 S14o
Street Address/State Road/Lot#(s) vt'I
Phone # ('"r, -) ho I
- 113 1,9
Email ;,. ,,,ell h. Pha
e,1 G{,Men l i ,;
v,
Subdivision
City ZIP
Affected ❑ CW
[9'€W [A PTA
❑ ES ❑ PTS
Adj. Wtr. Body t�f, 5 (_.7 fC'_};,, . (nat/ na /unk)
AEC(s): ❑OEA
❑IHA ❑UW
❑SPIMA ❑PINS
ClosestMaj. Wtr.Body !��JOf"•'f�t I�,tVe(
ORW: yes/no
PNA: yes/` I
Type of Project/ Activity
(scale:` ::L
Shoreline Length /O
Access Length
T
Pier (dock) length
Fixed Platform(s)
I
Floating Platforms)
L—
Ir
Finger pier(s)
�_
•
Total Platform area
._
_
4
Groin length/# ..�
_`
l)
—j.—,_
f
Bulkhead/Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/length
i_
Basin, channel
C ..,
��
l
Cubic yards 1� r_sl
S
r-
Boat ramp !�
Boathouse/ Boatlift �•''
_
i-
`
+�
_
k
TF,
Td
(
_
Beach Bulldozing
Other
T
I
SAV observed: yes no
-7k.
d
+
Moratorium: n/a yes no
Moratorium:
�'
-
.
--
Site Photos: yes no
Riparian Waiver Attached: r,Ve's',, no
c
-
i
—
-
I -
----
P
-
--
—
-
—
—
-
—
_u
A building perm it/zoning permit may be required by: n('r ! l•r/✓/Q'i t UN/1"a
\lA i �.k n �1n r J OYttl o(/'SrIP �•`nRbi«( la(Gti�J✓,
❑ 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. (Pleaselnitial)
W c�V✓ic !,I II
Agent or Applicant PRINTED Name Permit Officer's P INTED Name
Signature -*Please read compliance statement on backof permit" Signature
-Dt4
Application Feels) Check ft/Money Order Issuing Date'
Expiration Date

#[JNew
❑CAMA ElDREDGE & FILL N9 88744 A B C.D
GENERAL PERMIT Previous permit
Date previous permit issued ❑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:
r'
15A NCAC ❑ Rules attached. 0 General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Address
City
Phone # (_ )
Email
Authorized Agent
Project Location (County): /,1-�-- -r-r-^<�'�----•F' i /,:'("
Street Address/State Road/Lot #(s) i
Subdivision
City
Affected ❑ CW ® EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body �_ .: (nat(4-,/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wen Body t.... i'c
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scaler
p
Access Length
I_
Pier (dock) length s
�
"�
(t
`�
�
!
-_
Fixed Platform(s) 1"
t
't
Floating Platform(s)
I
i
Y,c
Finger piers)
i
('�
Total Platform area
a
!
_
_
_
Groin length/Jt .=
i-
_;Z
Bulkhead/Riprap length%
Avg distance offshore
-_
T
-___
-.i_.
._..._
__
-
-
-
-
-
-
r
_
_
r
Breakwater/Sill
Max distance/length
tF
--;
'Basin, channel r.f_7 Y L1
Y-
�
r_
T�
-
r c-
.
rrJ
Cubicyards 12, `i r-.J
)
.�
_
_
-_
_
Boat ramp •
._'�-
j_.
I
J.-
1
-
t
-
_v
<,+nr---
J
_ - II
(
i
Boathouse/ Boatiift .�
Beach Bulldozing
Other
SAV observed: r�
yes no
Moratorium:
f-
n/a yes no
Site Photos: yes no
I^k
Riparian Waiver Attached: Yes . no
f
A building permi)�zoning permit may be required by: (_ rw14'/
r—
Permit Conditions" 1 Y04n,t
❑ 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 backof permit** Signature
Application Fee(s) Check JI/Money Order Issuing Date Expiration Date

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: L w , 6r4 Aa ✓r (1
Address of Property: _ )&03 Fv,—+ S-� IJco- �o' NC
Mailing Address of Owner: /001 I a✓vc-) /VC
Owner's email: "",owners Phone#: 91,7 eol 933`
Agent's Name: AIA Agent Phone#: NA
Agent's Email: IVA
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adlacent 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.
AL100 NOT have objections to this proposal. I DO have objections to this proposal.
n you nave 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
malledto 400 Commerce Ave., Morehead City, NC 28557. DCMrepresentatives 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 revetme9ts) (If� wish to�lve t setback, you must slan
the appropriate blank below.) / J „ �
1 DO wish to waive sometall of the 15'
-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-
ARPO's email: 61,a 7✓1
Date:/U 'waiver Is valid for up to one year from ARPO's Signature'
Revised May 2021

U3\� C\oQ
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: L , W 6YA 1�a ✓✓ j
Address of Property: ) gU LL F,, } S )c H 1 A1L
Mailing Address of Owner: o1 �tQ✓vt $ (Q, AlL
Owner'semail%iur n•�4rr.')�S»o.l-�o. Owner's Phone#: 911 Rol 133L
Agent's Name: A/A Agent Phone#: NA
Agent's Email: A4
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.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
n you nave objections to what is being proposed, you must notify the N.C. Division o1 Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
malledto 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/ail of the 1 6' setback r�
-OR-
Signature of Adja 1 Riparian Prope ty 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: ��((2`/ i x ARR
Mailing Address of ARPO: IC.
ARPO's email: Vt9Yhgkrb 43 AryOtAtG ARPO's Phone#: _G'J /6 682 1&O'L
sd f
Date: 10 ZLZ `waiver is valid for up to one year from ARPO's Signature'
Revised May 2021

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