87781D - MATTHEWS

�`""'u+r ❑CAMA ❑ DREDGE & FIL N9 87781am, A B C D
3� J
4. GENERAL PERMIT �15 l Previous permit
C dJ Date previ us per it iss ed
❑New ❑ Modification ❑ Complete Reissue ❑ Partial R Issue J�
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an tr.of en ntaall concern pursuant to:
15A NCAC (t -' '-i
❑ Rules attached. ❑General Pernik Rules available at the following lin : www.deq.nc.2ov/CAMArules
7
Applicant Name 4�j l ( i- -# f / ',, Ir/
r-
Address iJ 4zf t d { L
City State "`F ZIP F
Phone # (_ )
Email
Affected ❑ CW ❑ EW ❑ PTA
AEC(s): ❑ OEA ❑ IHA ❑ UW
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-" �'" �J
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes
Moratorium: n/a yes
Site Photos: yes
Riparian Waiver Attached: yes
A building permit/zoning permit ma
ES ❑ PTS
❑ SPIMA n PWS
1
Permit Conditions il
Authorized Agent
Project Location (County):
/k � lwkj.'
Street Address/State Road/Lot #(s) t ` /A ' "' `
Subdivision
City
Adj. Wtr. Body (nat/man/unk)
Closest Maj. Wtr. Body
(Scale:Wj ,
U 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.,
Signature "Please read compliance statement on back of permit"
Application Feels) 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 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:
F� 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/ 1-888-4RCOAST 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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: b/ '441 !� ql+h e Q s
Mailing Address:
NC-
p� o
Phone Number: �-( 10) g 7 L, a g 4
Email Address:
I certify that I have authorized
c_) Y-Yla 1` 1-h.'e LoS
�).Jg.e :VLeyl'n
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
`/ com
necessary for the following proposed development: &AA �%>
at my property located at
A09 lqf kl�sOn floint
in Pe r)ct{ County.
1 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.
Property Owner Information:
Signature
( +� Alhe wS
Print or Type Name
Title
Date
This certification is valid through / /

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER 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:
4a-7Y old
lPt�
t- 116o, d
`f2I tII
Owner's email: C) V►'Itt twS c�ao��O®cll0 er's Phone#: v
Agent's Name:
Agent's Email:
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
5W00(ft -y,Nc
4- J C 2 V4
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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
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 28405-3845. 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
understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minirrium 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
Signat re of A yacent parian Property Owner
KeTza
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:
ARPO's Phone#: T1 Jo4— A6,1071—
*waiver, is valid for up to one year from ARPO's Signature*
Revised July 2021

TIPS FOR ADJACENT RIPARIAN OWNER NOTIFICATION & WAIVER FORMS
CAMA Regulations require notice of proposed development to the Adjacent Riparian Property Owners (15A
NCAC 7J.0204(b)(5)). Proof of actual notice (a sign -off by the owner on this form) or certified mail return
receipts (showing delivery of notice) are needed.
The purpose of this notice is to make adjacent riparian property owners aware of the proposed development
so that they have an opportunity to provide comments (or potentially object to) the proposed development,
and to give DCM an opportunity to consider these comments/objections before a permit decision is made.
"Permission" of adjacent property owners is not necessarily required for DCM to issue a permit; however,
permission must be obtained for certain types of proposed developments if they fall within a 15' setback area
along the riparian access area of the adjacent property, as determined solely by DCM. It is in the applicant's
best interest to provide comprehensive and accurate notice so that any concerns or objections can be
resolved early in the permit review process. In addition, if the adjacent riparian property owner appeals the
permit decision, insufficient notice could be a basis for granting such an appeal.
Who is an Adjacent Riparian Property Owner?
What is Adjacent? (Note: DCM reads this broadly to ensure comment by potentially impacted neighbors)
• A property that shares a boundary line with the site of proposed development; AND
• A property that fronts a natural or manmade waterbody that is connected to coastal waters and
can support some form of navigation, even a kayak or canoe, including a common canal system
or a manmade basin.
• Easement holders? Yes, if the easement could be impacted by the proposed development.
• Streets/Roads? Only if the street/road could be impacted by the proposed development. This
might include street -ends which might be used for parking and beach access.
• Holders of recognized submerged lands claims/shellfish franchises.
What is Riparian?
Do the boundaries of the adjacent property legally intersect with the water at mean high tide? If there is a
question about whether an adjacent property is considered "riparian," please reach out to DCM Staff -
especially on the oceanfront beach where there may be undeveloped parcels on the beach or in the water.
Who/What is a Property Owner?
For private individuals (or families), send notice to the address listed on the tax card. If the property is owned
by an Inc. or LLC, please send notice to the person listed as the registered agent on the NC Secretary of
State's Corporations Look Up site: https://www.sosnc.gov/search/index/corp. For Condominiums or
neighborhoods with an owners' association (HOA/POA), send notice to the association (which is usually a
corporation, for which you send notice to its registered agent).
What is Notice, and how do I ensure it is received?
• You can meet with your adjacent property owner, provide a description or drawing of the
proposed development, and ask them to sign this form and return it to DCM; OR
• You can hand -deliver this form and a description or drawing, and ask your neighbor to return it to
DCM (consider providing them with a stamped envelope); OR
• You can mail this form by USPS Certified Mail, return receipt requested (the Green Card). If you
choose this option, you must provide either the signed & returned green card OR track the
certified mail package number on USPS.GOV's online tracking system, and provide the tracking
print-out as proof of delivery to DCM
If you have any questions about this process, please reach out to DCM Staff and DCM Legal Counsel
and we will work to answer your questions.
Revised July 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: A-II14, 0,6
Address of Property:
Mailing Address of Owner:
t(G>h so" r'orh+
©(d us 4Zt
Owner's email:0) Mu f h Pw s p1` A 0 02'leis 'onM nes Phone#:
Agent's Name: Agent Phon
Agent's Email:
,e t0-S
014
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
Ca.V Ne
Iv C A 7.5_�6
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.
NZ 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 28405-3845. 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
-O R-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:��0�[�
Typed/Printed name of ARPOEYVIPCG. S�10\61e_
Mailing Address ofARPO:V15115 5m� NC 50 NC
ARPO'semail:Af"C)Ka,S"o1�Y(cpCkma.1.C—ARPO'sPhone#: qko-34o-4-)ko7
Date: 5jaa *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

TIPS FOR ADJACENT RIPARIAN OWNER NOTIFICATION & WAIVER FORMS
CAMA Regulations require notice of proposed development to the Adjacent Riparian Property Owners (15A
NCAC 7J.0204(b)(5)). Proof of actual notice (a sign -off by the owner on this form) or certified mail return
receipts (showing delivery of notice) are needed.
The purpose of this notice is to make adjacent riparian property owners aware of the proposed development
so that they have an opportunity to provide comments (or potentially object to) the proposed development,
and to give DCM an opportunity to consider these comments/objections before a permit decision is made.
"Permission" of adjacent property owners is not necessarily required for DCM to issue a permit; however,
permission must be obtained for certain types of proposed developments if they fall within a 15' setback area
along the riparian access area of the adjacent property, as determined solely by DCM. It is in the applicant's
best interest to provide comprehensive and accurate notice so that any concerns or objections can be
resolved early in the permit review process. In addition, if the adjacent riparian property owner appeals the
permit decision, insufficient notice could be a basis for granting such an appeal.
Who is an Adjacent Riparian Property Owner?
What is Adjacent? (Note: DCM reads this broadly to ensure comment by potentially impacted neighbors)
• A property that shares a boundary line with the site of proposed development; AND
• A property that fronts a natural or manmade waterbody that is connected to coastal waters and
can support some form of navigation, even a kayak or canoe, including a common canal system
or a manmade basin.
• Easement holders? Yes, if the easement could be impacted by the proposed development.
• Streets/Roads? Only if the street/road could be impacted by the proposed development. This
might include street -ends which might be used for parking and beach access.
• Holders of recognized submerged lands claims/shellfish franchises.
What is Riparian?
Do the boundaries of the adjacent property legally intersect with the water at mean high tide? If there is a
question about whether an adjacent property is considered "riparian," please reach out to DCM Staff -
especially on the oceanfront beach where there may be undeveloped parcels on the beach or in the water.
Who/What is a Property Owner?
For private individuals (or families), send notice to the address listed on the tax card. If the property is owned
by an Inc. or LLC, please send notice to the person listed as the registered agent on the NC Secretary of
State's Corporations Look Up site: https://www.sosnc.gov/search/index/corp. For Condominiums or
neighborhoods with an owners' association (HOA/POA), send notice to the association (which is usually a
corporation, for which you send notice to its registered agent).
What is Notice, and how do I ensure it is received?
• You can meet with your adjacent property owner, provide a description or drawing of the
proposed development, and ask them to sign this form and return it to DCM; OR
• You can hand -deliver this form and a description or drawing, and ask your neighbor to return it to
DCM (consider providing them with a stamped envelope); OR
• You can mail this form by USPS Certified Mail, return receipt requested (the Green Card). If you
choose this option, you must provide either the signed & returned green card OR track the
certified mail package number on USPS.GOV's online tracking system, and provide the tracking
print-out as proof of delivery to DCM
If you have any questions about this process, please reach out to DCM Staff and DCM Legal Counsel
and we will work to answer your questions.
Revised July 2021

Date Recehed
Dafe DelM IW
Check F—(Name)
Name of Pe It Holder
Vendor
Cheeknumher
Check
mount
Pomh NumheNCommenM
Receipt or Refund/Realloeated
Columnf
10/20/2022
Col-2
Columns
David Grice Money Order
Column4
Bryan Daniel High etals
COIU-5
United States Postal Service
Co1umn6
2.64E+10
Column7
$ 200.00
Column6
GP #87510D
Column9
BB rct. 18677
10/20/2022
10/20/2022
Lighthouse Marine Construction Inc
Delta Dock & Boat Lift
matthews
Thush anithan
Coastal Bank and Trust
First Citizens Bank
4433
9435
$ 400.00
$ 200.00
GP #87781 D
GP #87483D
JD rct. 17699
JD rct. 17698
10/20/2022
Southeastern Coastal Construction C
MT Vacation Properties, LLC
ISouth State Bank
126841
$ 400.00
GP #87457D
KB rct. 10374
10/20/2022
Carolina Bluewater Construction, Inc.
Kinton
IBB&T
25568
$ 200.00
GP #87509D
BB rct. 18676
10/20/2022
Land to Sea Construction, LLC
Frost
I First Citizens Bank
636
$ 200.00
GP #87675D
JD rct. 17771
10/20/2022
Richard Penny Construction, LLC
Jefferies
I NAVY FCU
5220
$ 400.00
GP #87448D
KB rct. 10372
10/20/2022
Bruce Marek PE
Bald Head Island Club
Wells Faro
2306
$ 100.00
Ma -or Renewal Fee #108-17 BrCo
JD rct. 17852