88080B - Wallace, Robert & JM

I
kL MA .] DREDGE & FILL N9 88080 A i0C D
GENERAL PERMIT T_D -1 ` 5qq Previous permit ,i///a
Date previous permit issued ,vA •
L 1 ew ("Modification ❑Complete Reissue ❑Partial Reissue
As authorized by the State of North Carolina,Department of Environmental Quality and the Coast Resources Commission in an area of environmental concern pursuant to:
15A NCAC 0 / r r-a V U ❑Rules attached. General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant Name /r`�t,r/ tP ' '.1 ./t"/ Y Authorized Agent �j./-G 1 £ ,//at i
Address /2//r/ lr`/�oc/�h Project Location(County): J
city, /r/� .. -' State MD ZIP 4.-P?0C d
_ Street Address/State Road/Lot#(s) /a7 A re://c7 „57
Phone#(1F/ ) .507 - O;J p
Email 45'2 j.c4,, 6� s S'./tic,n, Subdivision /V/-4
j J �l City (JG _r.,.fi t_ / /ZIP .•279 6O
Affected ❑cw �W I_1 r r„ ❑ES ❑PTS Adj.Wtr.Body i4 v t6�-rt C ./Y c! 4 nan/unk)
AEC(s): ElOEA ElIHA ❑UW ❑SPIMA ❑PWS Closest Maj.Wtr.Body / /c j' (:‘,1,1 cl `J
ORW:yes/no PNA:yes/no
Typeof Project/Activity /- (..., f G�r t1 'r Cam" C,). 6,, c (."1/0•U✓•��arY1 .27 L✓fir V</ ,-) L.i.1/4
/6'X/6' //tr r+ (Scale:) .J0 )
Shoreline Length dkriligla .— /VO '
Access Length //co X G /
Pier(dock)length 'Z7)' 6 i6 L rr,x
Fixed Platform(s) /('X/4' '� -
—7 t/c/ i , %of
Floating Platform(s) 0 e-t 7-11
Total Platform area .348 r S11 N
Groin length/if a r,
Bulkhead/Riprap length j,/t l✓L
��
Avg distance offshore Y
Breakwater/Sill 4 4/�L
Max distance/length ��.— f„L_T Jk /, f 7�ar� 14
Basin,channel (� r
Cubic yards ! 1L,
1
Boat ramp ! � . L
Boathouse/Boatlift 1-
Beach Bulldozing
Other 3� P
Y
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no �,�,
A building permit/zoning permit may be required by: H�ele—
Permit Conditions (c e 0 J// /42 e() '' I TAR/PAM/NEUSE/BUFFER(circle one)
/y w. cr iL - !.2 3-I n See note on back regarding River Basin rules
f 1� :•__— e/ / / k n See additional notes/conditions on back
t1 r�o.csl ter �I"�c,i.'e-t1D
I AM AWARE OF STATUTES,CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) i
I`. { k/ 1 ,. (7 / V -e of ` _S-L�ED re ��„` ,l�
Agent r Applicant PRINTED Name -Permit 'ce PRINTED Name
C/J�I t it r,L ...,se-c'
Signature"Please read compliance statement on back of permit" Signature
Application Fee( Check B/Money Order Issui g Date xpiration Date

ADJACENT/
N.C. DIVISION OF COASTAL MANAGEMENT RIVER FORM
RIPARIAN PROPERTY OWNER NOTIFICATIO
CERT4.
-FED MAIL RETURN RECEIPT RE VESTED or HAND DELIVERY
t:
(Top portion to be completed by owner or their agent) ;._:<j
Name of Property `=' y
Owner:•
G�
1 �� ��,
Address of Property1 «'
e.
Mailing Address of Owner 1 07 1 t V.t tet,O>✓� l St�i7t$ IN-CD "'�
f• _
Owner's email:�4�� a,t owne s Phone# -301 -801 -0 73 (�
Agent's Name: �t-lC'� g-�` Agent Phone#: d 4 q2.1 - 0 M l
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Prope OW r
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
ion
descri t or drawrnd, with dimensions. must be oro.•deo with this letter.
100 NOT have objections to this propose I DO have objections to this proposal.
' If you have objections to what is being proposed, you must notify the N.C.
tal
Management(DCM)in writing within 10 days of receipt of this notice. CorrespondenceDivision of shouCoald
be
mailed to 943 Washington Square Mall, Washington, NC 27889. DCM representativesc should be
contacted at(252)946-6481. No response is considered the same as no o • ionf youcan also be
•notified by Certified Mail. objection if have been
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'frcm 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 sip`
the appropnate blank below.)
f DO wish to waive someiall of the 15'setback 1
OR- Signature of Adjacent Riparian Property, Owner
I do not wish to waive the 15'setback requirement(initial the blank)
Signature of Adjacent Riparian Property Owner: X r
•
Typed/Printed name of ARPO:
Av►
Mailing::: z
s ARPO's Qk r w` o-- -
q �6 .Z RPD's Phone#: ZOZ" ct cZ t."04" j r
i i 6 0,.,,:.,
Date: 6
'waiver is valid for up to one year from A
RPO's Signature*
Revised July�021
,i:
"ct

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner RequestingPermit: ci \ t/VL. `Q e
Mailing Address: ( 0' 1 k)
Phone Number: (° � r 3� (70-3)
Email Address: ,a5 5L.() ( )
I certify that I have authorized TN ,V K Y > ,
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: q)
at my property located at �l n
s
in County.
l furthermore certify that I 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:
laf0UkaN(19
Signature
S. A-t.C_Pc.0
Print or Type Name
aft
Title
Oc 9O2
Date
This certification is valid through 03 / '30 / ��