87500D-WARD

�o�°�`°""k QCAMA ❑ DREDGE & FILL �,, e,�' N9 87500 ABC :'D
Previous permit
GENERAL PERMIT -_ -`�'
� Date previous permit issued
PNew ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State
,00ff(North Carolina, D(epa�rtment of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC r ' . ! � �✓ ❑ Rules attached. 0 General Permit Rules available at the following link: www.deq.nc.Yov/CAMArules
Applicant Name p >> ✓«-c aci
Address 03 ( ,OdAL r2. kA kk t11
City State YZIP la c) a ` 1
Phone # L
Authorized Agent --
Project Location (County): =''r ^sti'� C U.-
Street Address/State Road/Lot #(s) (n Z
J
Email CSAC, Subdivision
City r�1C r,�. \- (I
'i 2+CPS ZIP 2`A LE�
Affected cW MEW PTA ❑ ES ❑ PTS Adj. Wtr. Body ` `c (na nk)
AEC(s): g OEA IHA EUW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body
ORW: yes/rio„„! PNA: yes lb
Type of Project/ Activity N 1
Shoreline Length
Access Length
Pier (dock) length t.9y
Fixed Platform(s)
Floating Platform(s) XIw
Finger pier(s)
Total Platform area %L
Groin length/# — -
Bulkhead/ Riprap length --+----- ---- -- }
Avg distance offshore
Breakwater/Sill
i
Max distance/ length ,
Basin, channel _ -
Cubic yards __--
Boat ramp rr
Boathouse43oatliftl f 3 =f
Beach Bulldozing V
Othekk1i C P o,� N;
� "'t � I
10 2_ -t-,A
SAV observed: yes M
r r .Aur
Moratorium: n/a yes o ►,�
Site Photos: yes _ _ �+!�- .�_.- .__ ..._ - _ _ -- - --
Riparian Waiver Attached: ��.�o
A building permit/zoning =imaybe required by:Permit Conditions (C . ` RA aK
Agent or Applicant PRINTED Name
(Scale:)) TS )
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
VIEWED.COMPLIANCE STATEMENT. (Please Initial)
%(t +r'� is � 7 � �'( "•- .
t offrerffmINTfID Name"
Signature **Ple se read compliance statement on back of permit**
Application Feels) Check #/Money Order
Signature /
Issuing Mate E irati n 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:
1-1 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

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N.C. DjvjSjON OF COASTAL MANAGE-MENT
ADJACENT RIPARIAN PROPF—RTY OWNER NOTIFICATIONMAIVER FORM
C �r-RETURN
R �UE �TEQ or t-4ANDO—LEERY
(Top portion to be, completed by owner or their agent)
s 1,jme of Property 0%vnef'. I.
Address of property: 'L;" Al-cet -162�1112%101
Mali'ng Addre%S of OWner L-JlP - �i -nc —o-
owner'o efou!il:
Agent'S Name'
, 11 , - '4' , , f
'6 1z
Aje nt Phone C.-It
J21 1 , c- 114- �-', Q, -
Age 111's Email:
A DJACEN-TM PARIAH PROPERTY OWNER,' S CERTIFICATION
TM—Iomlodkn—to WS201plet Owner)
I hereby certify th-,1
4j c;,Avj properly ndjacant to the Db(we refercneed proMlY. The individual *J)Plying kw 0115
permit, hiDs desQihed to "10, a$ sj-#uVjn on the attached dfavAng, 0� (levelopment IM11 --kfa 13FDPLISIng-A
-.-1 ha. nrmuitif-A With NO letter.
1 L)o N'OT f1,1YF,- objections tit MIS PrOPOSOL i DO have objedAns 10 thig PICPD-Sal,
—40r� of c5iist"71
being proposiv , you jintiat ]C111h the' M-C' Divis
If you tratYia 0 ec fis to what "t Maw
Management (DCM) ievdting w0f9in 10 days Of fccefPt Of th't notito. CorrespondenceShouid ba
mailed W 127 CarrJ;rT.,v[.0jrjVj0 E. Wilm;ngton, XC 28405-3045. DOW representatives CD17 SISO be
coniaciod&I (ajo) 7,06-7215. No response Ls considered tho"me 0S 00 cbjQc0on.ff you have been
notified by Certified Afall f,
WAIVER SECTION
I understand Mat any propOSK!Pit',", dOck, rnoormg pilings, boat ramp, bf-eterViiler. b0aftUsc, lift, or
groom jnce oj,16,.from my are.q of riptirion Grc�,,k," unless "Wed by me.,
JJJU-�Jj: be Set 1091Ck 3 m1o.1mum &g.
(Ns does nr,4 apply to bulktxeads or (Mr0l) revetments). (it you wish to waive the setbqoa, yoU must St
tkfe appropriate Win% beivnv.)
1,DO -yoAsh lomfive Soift-MIll Of t1113 15, setback .4
-0 Fmperty omw
OR -
I do not wish to Vr N'13 0`10 1V se;,bock requirement (irf&tw�'aI lbe blarik)­
Sqj ropawner ---------
n-,,�tjj,e ci Adjacent Riparian 1ptrty
TypedlPrintedn3me of ARPO:-U:K'46�c --R "
- --
---
Mailing Address of ARPO: n/ �7
W-*RPO's Phorw#:
IP V
-wAlveriswilid for up to *no year fro.m ARPO's Signiatura*
Reviseci July 202.1
f
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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND p�RY
(Top portion to be cornpl led by owner or their agent)
Narre of P iy Owner ' `� I.. ! as�,�i` l
Address of PmPe4,
5 r: fia `e: t : R?I � � e��ct, ad Ir 4 G~��jlw Q�� �i'i . jai ��3 d ; fi •-.v5 .� �..�4
mailing Address of 0-41x-r
0.vm `s e!tn2i1: tlw.nef s Pbones
{
Ageni's Nam. li-:t t. C. � ', Agent Phone#:
Ai
nt's Email:
. �....-
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
�Bott�m pi n to b� completed by the Adjacent Proae 0Wngr
hereby certify that I own prapeq adjacent to the abave referenced properly, Tber imgviduat appiy-;ncg for this
permit has described to Me. as &hown o+i the attached drawirsg, the deveklprnea they are voposmg, A
desc rip3i+cxa or do%incl ariAh dimen§ic7rs, rnUct_ire prog ded with this 4tttef
}' ,1,DO PLOT have o+b*bOns to this proposal I Do have ot�ect'ons to 'his proposal:
tf you have objections to what is balingProposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of recoipt of this notice. Corresporndia nce should b a
mailed to 127 Cardinal Drive Ext, Wilmington, NC 28405-3845. OCH represontatives can also b&
contacted at [phone] No response is considered tho same as no abjection if you have .been
notified by Certified Mail.
WAIVER SECTION
I understand thal any proposed pier. dock. mooring Olings, teat ramp, 'breakwater. boathouse, lift, or
groin must be set back a rnirlimum distance of 15- from my area of riparian acu�ss unless waived by me
(thus does not appty to bulkheads or riprap :revetments). (if you wish to waive the setback, you must skin
the appropriate blank bela►i.)
100 %ish to waive a)efall Of the 15' setba�',
Signature orA*cent Riparian Property Owner
-OR-
I do Pot wish to waive the 15' setback requirement (initial lire blank')
Signature of Adjacent Ripa6an Prop" Owner: -
�!
TypedlPnted aarne of ARPO. ''- 1` 457 .-
r"l
Mailing Address cd ARPO:
ARPO's email: ; r,ac ��;r.n;, vim+', 6' ARPO's Phone#:3-6
Daitr: y *wa var Is valid' for up to one ya;ir front ARPO's Signatures'
Revised July 2021
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Date Recelved-
Date Deposited
Check From Name
Name or Permh Holder
Vender
Check number
Check
mount
Permit NumbeNComments
Recel t or RerundlRealloeeted
Celumnf
Column2
Cdumn3
Co1umn4
Co/umn5
Co4umn6
Column7
Column0
Column9
11/21/2022
11/22/2022
Gregory Holden
Roach
United Bank
5592
$ 200.00
GP #87597D
BB rct. 17915
11/21/2022
11/22/2022
B and B Marine Construction
Flemin 8 House, LLC
Wells Faro
2008
$ 400.00
GP #858021)
JD rct. 17861
11/21/2022
11/22/2022
CD Jewell
same
USAA Federal Savings Bank
1290
$ 200.00
GP #85384D
JD rct. 18737
11/21/2022
11/22/2022
Lighthouse Marine Construction Inc
Hilker
Coastal Bank and Trust
4474
$ 600.00
GP #87602D
JD rct. 18736
11/21/2022
11/22/2022
AMW Docks and Marine Constructior
Ward
Truist
8011
$ 200.00
GP #87500D
BB rct. 18691
11/21/2022
11/22/2022
Gregory Holden
Allred
United Bank
1 5690
$ 400.00
1 GP #85813D
PA rct. 17749

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