86998A_Powell, William B_20230113

'a CAMA ❑ DREDGE & FILL N° 86998 A B C D
GENERAL PERMIT Previous permit
i Date previous permit issued
[] New ❑ 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 ❑ Rules attached. ❑ General Permit Rules available at the following link: www.dgq.nc.Yov/CAMArules
Applicant Name .0
Address
city T State ZIP
Phone#(j.!�) MGt;
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
.h
Email �t e-t , 1 L Subdivision T V
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/OWunk)
AEC(s): ❑ OEA 0 IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body (.
ORW: yes/ho PNA: yes/no
Type of Project/ Activity
(Scale:
Shoreline Length,
Access Length
Pier (dock) length
Fixed Platform(s).
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes 11.9
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by: l v v W,
Permit Conditions
❑ 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) IXI
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #/Money Order
Signature
Issuing Date Expiration Date

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: W lL L / 14 n g . p b \N e I- L—
Address of Property: 119 DDL - /,41 ti CDT �o /l �7'-Y� 7 ll� . �', Z 7 `7 -7 Q
Mailing Address of Owner: /d q W& AJU 7" ST ,1,4 0� rON t 1)
M)4If- ,C'cfin 7
Owner's email l3/1.=Py66CZc:464iFZ 6 ' _ Owner's Phone#: �� % =�' -40
Agent's Name: A Agent Phone#._
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion 12 k2 cgtmaleted by the Adlacvnt Propj!ly Owner)
I hereby certify that I own property adjacent to the above referenced property. The: individual appiying for this
permit has described to me, as shown or, the attached drawing, the development they are proposing. A
description or drawing, yAlb dimensions must be provided with this 10f gr.
VtiI DO NOT have objections to this proposal. 100 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 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM _representatives can also be
contacted at [phone]. No response is considered the same as no objection N you have ,been
notified by CertiAed Mail.
WAIVER SECTION (Choose only one
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 r ve etments). (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 v
iiidatulre- 4fAdjdc.ent Riparian Property Owner
-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: ,1(P 2 N 01FI 1b AJ 1212, eti96- \N . /, Z 6 3-1-'
`*-ARPO's email: Lv(RKUCIe&< ,O G P A14 PONARPO's Pie#: 30.4• YA6_ 12 72—
Dater % q o�o` _"waiver Is valid for up to one year from ARPO's Signature*
Revised August 2022

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
QERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: \#A I l I A 101 R . P 0 WE LC.
Address of Property' j q VnL PLt 1 N CT.' (o R19N� Y,� t�l . C . 2 7 q3 9 ,
Mailing Address of Owner: O 9 W MCN L1_r <J, H )OVA" 6" VA- 2 - 10
�n,NiL com
Owner's email: �1 VYcu-A641 @_ Owner's Phone#: i 'S! ' a 69- 40 41
Agent's Name: _ Iql�l T Agent Phone#:_A/_f�_Y
Agent's Email
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
421LOID.F0dig L12 bQ 22MfTIFW_.by_the AdIgC2nt Pr922rty Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying for ;his
permit has described to me, as shown on the attached drawing, the development they are proposing. A
description or drawing, with dimension6. must be 2rgvioed with this teller.
L__� DO NOT have objections to this proposal. 100 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 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response Is considered the same as no objection if you have been
notified by Certifled Mall.
WAIVER SECTION (Choose only one
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 sunless waived by me
(this does not apply to bulkheads or riprap revetments). ,If you wish to waive the setback, you must slan
the appropriate blank below.)
1 c
I DO wish to waive some/all of the 15' setbar_k �I��c/v// i+✓
Signature oil Adjayent Riparian Property Owner
-OR-
I DO NOT wish to waive the 15' setback requirorrient (initial the blank)
Signature of Adjacent Riparian Property
Typed/Printed name of ARPO: a I C 14 M ID l" . 94 T T bN
Mailing Address of ARPO: 11119 �f Dot,. PN I N GT <e K d Y�f C� Z`Mg?
ARPO's email:
ARPO's Phone*- 2 52- A 21 ^ O fg S
RICHpQIp LE6N S4'►'7oN yAi-wo-GOh7
Date: *waiver is valid for up to one year from ARPO's Signature"
Revised August 2022

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