Ballou, D A 90007C

0 1Of WAR4,&❑.CAMA El DREDGE & FILL N9 90007 A B C D
y =GENERAL PERMIT Previous permit
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:
I SA NCAC ' ' ❑ Rules attached. 0 General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Address
City State ZIP
Phone # (_ )
Email _
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS
ORW: yes/no PNA: yes/ho;
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City ir;;"tIllrc ZIP
Adj. Wtr. Body ) k' iE 1, *'r.( q<<:,,; jC (nat/man/unk)
Closest Maj. Wtr. Body C Imo, l :•" C 1t.:;
Type of Project/ Activity R`w&!?( X `":`, '>! 2.° t° , G,2
f. .
(Scale:! ' )
i
Access Length
Pier (dock) length
^LN AL!
i
Fixed Platform(s)
H
M
Floating Platform(s)
_
j
)
Finger pier(s) f
_
-
-
1-
...._IC
Total Platform area
Groin length/#
S
-
Bulkhead/ Riprap length
'e1
Avg distance offshore
Breakwater Sill
—
''c*"
0}(
Max distance/ length
Basin, channel
r
y;
--
-
Cubic yardsBoat
rampBoathouse/
4-V
BoatliftBeach
Bulldozing
Other
SAV observed: yes ' ni) �
i
-•-'
� '
•,� -•�
�•
Moratorium: n/a yes no
1
-
Site Photos: yes no
_
__. j
.._._.._-
—
Riparian Waiver Attached: yes' 66
A building permit/zoning permit may be required by:
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)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit" Signature
Application Fee(s) Check #/Money Order Issuing Date
Expiration Date

& FI CAMA ❑ DREDGE & FILL
y GENERAL PERMIT
N9 90007
Previous permit
Date previous permit issued
A B.C'D
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:
I SA NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Address
City State ZIP
Phone #
Email
Affected ❑ CW
AEC(s): ❑ OEA
ORW: yes/no
❑EW ❑PTA
❑ IHA ❑ UW
PNA: yes/no
❑ ES ❑ PTS
❑ SPIMA ❑ PWS
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City ZIP
Adj. Wtr. Body (nat/man/unk)
Closest Maj. Wtr. Body => a `Y =% l
Type of Project/ Activity t nri t7L X 4"t y ? ( -a {'; 4 , wy
1 (Scale: & `)
Shoreline Length Z
Access Length
Pier (dock) length
Fixed Platform(s) r
Floating Platform(s)
Finger pier(s) .,/
Total Platform area
Groin length/# -`
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel /2
Cubic yards i Ya•h
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing_
Other
SAV observed:
yes
no.,
j
Moratorium: n/a
yes
no
Site Photos:
yes
no./
i
------....i----
Riparian Waiver Attached:
yes
no
A building permit/zoning permit may be required by:
Permit Conditions
f ❑ TAR/PAM/NEUSE/BUFFER (circle one)
f' ❑ See note on back regarding River Basin rules
7
❑ 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 Fee(s) Check #/Money Order
Permit Officer's PRINTED Name
Signature
Issuing Date Expiration Date

C L i -61 6 � N v r
C13YAla
C-6
CI

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portiontobe completed
by owner or their agent)
Name of Property Owner: J� 1 C �� 0 c> .
Address of Property: 606 b-'��(' iL -tcc--
Mailing Address of Owner: P chi ccK �, R C ; Ci�KS;S-7
Owner's emaiLdlclo 3 ��,I'!�rli"CAZO,'bwner's Phone#:
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 400 Commerce Ave., Morehead City, NC 28557. 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
-OR-
i
I do not wish to waive the 15' setback requirement (initial the blank) `` f
l ��11
Signature of Adjacent Riparian Property Owner: I �� 7"l.�
Typed/Printed name of ARPO: ULV 1
Mailing Address of ARPO:
11
ARPO's email: L5�\G1; 0 Ct .()eA- ARPO's Phone#:
Date:�A\X"'7 Q3 *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021
JAN 0 9'0?3
r�.tiEJ PAY

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:G`\�l� v
Address of Prol
Mailing Addres:
Owner's email:
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 tYproviM 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 400 Commerce Ave., Morehead City, NC 28557. 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
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: /T/ (,� i JA/C-/j1('C2 ` /
Typed/Printed name ofARPO:A bVt/ F—Val
Mailing Address of ARPO:
/ % 7
ARPO's email: ARPO's Phone#: a_
Date: l m [ — xT 6zi *waiver is valid for up to one year from ARPO's Signature* c. �-
Revised July 2021
l r-�