88906C - Dos Palms LLC Co Howard Hink

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�®.CAMA [I DREDGE & i�=1LL N 9 8 A `P(:--`J /�
D
GENERAL PERMP Date us previous
Date previous permit issued
[YNew ❑ 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:
15A NCAC �� —__! L J ❑ Rules attached. General Permit Rules available at the following link: www.deo nc.Rov/CAMArules
Applicant Name p65
Address "1 {ol( �� __ —
11
City -I _�SSttate Jl Ji ZIP _ t620r2
Phone # (w) M(. __-f-.161
V- Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Email Subdivision f --
City -[�hl� y��j zip 0V5AP— '�
Affected ❑ CW EW 6PTA [1 ES ❑ PTS Adj. Wtr. Body �Kt! i , f�) JO/unk)
AEC(s): ❑ OEA [� IHA UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body l/
ORW: yes Q PNA: yes/e
Type of Project/ Activity�,�vNFi
Shoreline Length
Access Length �I---- t \N
t / �{I+
Pier (dock) length
Fixed Platform(s)
Floating Pla)tform(s o' 7
4/x 15
Finger pier(s)
Total Platform area 2 S S
Groin length/#
Bulkhead/ Riprap length /
Avg distance offshore
Breakwater/Sill _ r'
Max distance/ length
Basin, channel
Cubic yards
Boat ramp,/
Boathouse/ Boatlift
Beach Bullddo�ortting
Other _ �CjUPS M /-
-- ---------- -- (Scale: f';2b )
I pQ�
u5' MXY Wµ �l _
New To �t
Vt
SAVobserved: yes
Moratorium:
Moratorium: n/a yes
Site Photos: yes no
Riparian Waiver Attached: �I no Q �.�
A building permit/zoning permit may be required by: -(A f71�X� t 'V,
Permit Conditions d/its 0V St'WL)m �✓KlH („[�07 ►% % '�-M �� , TN6
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT
Agent or Applicant PRINT D Name
Signature "Please read compliance statement on back of permit"
Application Feels) nOckMoney Order
0�lYie -,( ix-
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
STATEMENT. (Please Initial)
Signature
Issuing date I Expiratin 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. D � s P" � ,,,, S 1, L c , �4/s C�,, -:P a- S ,v / o i L
Address of Property: J 7 D S^ -t -e o-,Ay` rlN
Mailing Address of Owner: L( C1 t ► e l� � �� ✓Z I� c-< , e � e 2 7 6 G
Owner's email: w ®c, jmcc , I Owner's Phone#: J!F-P Qy 19-
. co r►�
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.
I DO NOT have objections to this proposal. DE 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 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 U. 'RECEIVED
-OR-
re Signatuf Adjace t Riparian r perty Owner (ARPO)
Tr NOV �� P1 ?r?C
I do not wish to waive the 15' setback requirement (initial the blank) (3K
OCa"M-MHD CITY
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO`: 1 1 r\� 1
Mailing Address of ARPO: l J `C r �` • r
ARPO's email:('C•C ARPO's Phone#:
Date: 1 1��Z�i 'waiver is valid for up to one year from ARPO's Signature*
Revised May 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
l v� A J )u
L L L
Address of Property: I ") C .S 4- / 7 .G �i2 C:IXA S r
�� n �SL
Mailing Address of Owner: � �7 D � '�— I -�� � I .f' c � 'C ..� � � Z/J
4� D
Owner's email: VN O Cs> L e i A k OWper's Phone#: 12f
MCr r t • co & --k
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.
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 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 (ARPO)
-OR- RECEIVE®
I do not wish to waive the 15' setback requirement (initial the blank) _1Nov 3 0 2022
i
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: IN I11E LtAe
DCM-MHD CITY
Mailing Address of ARPO: , 2 (; A Ej?p�3''— 4�_7
ARPO's email: C1flr EIVIr itt e e-e-s 417• (0 ARPO's Phone#: k9 t-3 2'
Date: ' e- 1 70Z_ *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

RF-CEIVED
NOV 3 0 ZOR
()r,QhPAAHD CITY
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