86735A - Ainsworth John & Joy

�CAMA ❑ DREDGE & FILL
GENERAL PERMIT �J° hE73� � g ` °
Previous permit
New Oate previous permit issued ,_ _
[]Modification ❑Complete Reissue [_J Partial Reissue
As authorized by the Stxe of Nonh Carolina, t?eparvnent of Em'irbnmrmal Qlwbry and tk C..,,d Re,aucn Con,, —,:on kl -area of emirommcntal concern Pursuant to:
ISA NCAC _Qi)
.. ❑Rub atuchcd. X General Nermit Rufes avnlabfe at the folio—g link: v wv_idS 290C M=Otg
APPI,cant Na,
Address-17�-�.`J'4V.CyT
FGcbo'rr 12ti_i . _ -
c" -.. ---
M, _ 4K, ah _ Snte -
Pho-e. k8i 41 33 — q lfA ZIP 2� I12
Ema,l_�pyt
vaA.vt�.Ca.Ne
Authonxed Agent D -,J_.Y) _ /J1.�.L A-%0 7�� -•�"'—
Proiert location (Coumy):
SNtw AdMe,JState Road/Lot M(s) �1 V r. '..1".� ✓ �{dr
s,rbdim:on �1
ARM ed r1 CM/ CA0 6 /�_7 Li �EW �pTA Q FS OPTS A,dj• Wer. �dY CS _
COEA JINA A• 1
AEC(s). L� UW ❑ SPIMA [:] PYVS Gbsou Maj. Wtr. Body I'� l ■i�_s/sl�L{.y/Uu �_ "il�-�`�i7 _—_
ORW; Yes tf. ) PNA- yes
Type of Project/ Activity _ COJ&S't r I CA- eZ CjI X (!o
S (ScatefjT5
1
Access length t"_ I `J'1 I hij g(h11r�j1
Pier (docL) length yr� 6oil �-^� P i -f-p � 1✓)
�
AL �
Floating Platform(s)
Fingrr pierlsl ��
i o,wi ?uric^^ •
.7
-
�21n len a
'
Y
o
Bulkhead/ R. leprap ngth
Avg d,stance offshore
Breakwatcr/Shc
Mat distance/length
Basin, channel
Cubic Yards
Boat ramp
soatnouse/ Fsoathh
Beach BuIldox.ng
Other
�
7
t
r lL1 •'lY1 )�J
�rx J6'P1O41
n �
'jam(J
SAV observed yes p
56
MOratprium. d ves np
S,te Photos: [rc o F ISiI hQ f/
R,px,an Wawermadled: ©o r Q.✓Q/(JQ,(.�
A building perms/toning permit maT be required by: vwx
Permit Condmons
TA11/PAh11NEUSFAUFFER (circle ane)
See note on back regarding Rh,er Basin rules
ElSee additional notes/conditions on back
1 AM AWARE OF STATUTES, CRC RULES AND CONDITIONS TNAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initiaq
�r•nl pi Fppl1 PP.INTFG Namt PtNnll fllCcr i PRINTED ' me
)Ni1�t.t'lo� 4aln hQ
Signature ••Pease read compliance :Ialrmenl on ba rmll— Signautre ` ►
s�ZoU. co c #3�- �i3I IV 1?�3 p(ra
Appllwhpn FrelsJ Check a/Money Order Issuing Date E■prrahCn Date

AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: v (A)NA-V t1 ()S'vq0(A-V1
Marlin
9 Address: , �1 $ Oat tllhbY 0�i �fl UY Nl1d i vim, an V c,
Phone Number O�li • 33�• 99�-----
Email Address: JOI (@ aYJ a 5 O�cv�
I certify that I have authorized _ &A,l <-wAAs N C_
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: -Sj1_\p ()()c\4 W I-tto
s A7t �1 �x V•. .
at my property located al-4 O l-1 Piy-k vj"
in ��-. County. ..7i
/ furthermore certify that l 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:
161, QIU.SWDYfiA.
Signature
Joy Ainsworth
Print or Type Name
Title
8/19/2022
Date
This certification is valid through
AUG Z 5 2022
DCN/
RECEDED
AUG 2 5 2022
DCM-EC

C ECG
M.C. DIVISION OF COASTAL MANAGEMENT A U 6 2 5 2022
ADJACENT RIPARIAN PROPERTY OWNER NOTIFtCATtONJWAIVER FORM
CERTIFIED MAIL- R 1 URN HEC'E411 f21 �UL� f 'i� ►1��,(.� L�ELIy t i
(Top portion, to be cornpleled by owner or thew agent) D c M - E c
m Ptae or Property Ohh 1- _-b 'sz"Dfkv ! . _ _ -. _ ... . ----
st Addreo+� ,, �10�� pi e �vo Or "u� Nf- ail Uq
Aad►e�s os ovnwr lQ $"1 �a,rtn�oc Y ow�h Or_ _ _ i 0 itan �J 0�?_31 YL
Ow+rer : eat J 4 i s Phonef �04 33-1 -. q 9`T y
Ager>t s Nart►e CIA _ AW A Ptlones.? Dy Ltl% $ 4!0�
AgerXc Ernaeo.,In��U3 Ca? 9rw,,►1-co,n�t-___ __--_ -- --
ADJACENT RIPARt&% PROPERTY OWNER'S CERTIFICATION
{�4SI;Q+n bortbn to tw corr►fltvtod RY iM AdLac4n1 Ar224ftY OWT1010
1 hereby certifY that 1 own properly adjacent to Me above roteremed p(operty. i he mdrv+dual applying lot tNS
permit has described to rno as shown on the attached drawing nhe development they are propos" A
Aesuption or dra"T with dimensions, must be 1yovide4 vvdh th►s letter.
' - ! 00 NOT have obfecLores to lira proposal. I DO have Wpidlons to this proposal
1 tti t. i
r ynu hew obtfoctlwrs to -tun is being D+opos@d you Mua nOWY Ow N. - D#';7&JZW d Cossu+f
Agaraegerym t fOCAf) An w+rlrfr►g NeW30n 10 days or riCelpf N rhrs OOOCe. ConQspondwK9 should be
palled to AO! S. Gr)rhn Sr_ Sot. 300. *Wzabvfh City. NC, 27"S. D -N rsPrQsantsovcs can also bill
conaw:rerl or (252) 2"39ot. No r spomm )a consrd~ On aam* as no ob)ecooin d you have been
prot)rArO by CwVftod MaN.
WAIVER S£CTtoN
i w4erstand that arty proposed pier_ dock. mooring pilings, boat ramp. breakwater. boathouse. lint. or
orpn must be set bads a mvwnu+n d►star'ce of 16 from rryy area of r+parien acuass unless waved by me
(aw does not app►y to txAWwads or rjprW reve"Iera)- (tf you wish to waive the seibask. you MUM tlW
tr)e appropriate blank WOW.)
1 E)O tM..,h to wars sonle)ali ad Me 16 setbea
Sognefwe of A44rea Rgm..n 0'~
c r S( e,`e► o!
d0 rxg wish go wahv the 1S' sc�dt fegtlart' fWd (hit�ai the biartif) , f`1l: 4A
S19ratve 01 Adgami Rowle►► Prtrpert)► Ov+flef ----- -=�- ---
T.Vfpo pr~ naa w of AR> O: C.
�ttinp ,add.... of jwRPo _ f Q �,r
A Rp(ya enrtsdt: � � l l' Y � I � n � ! • � � �A R P4's ptta+ari: � 6 -� r�-i ,
•Wf*vW M v&W for up ep tlrw rawr frwn AJtPO'f+ p21
path

RECEdV
N.C. DIVISION OF COASTAL MANAGEMENT AUG 2 5 2022
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATiONfWAIVER FORM
�tR71FrEU MAIL r�F7URN RECEIPT RL.QU ST D or HAND UELIVERY
(Top portion to be completed by owner or their agent) p C M - E
Brame of -
Address of Property: LA 01-1 - Pi ywJ NJ Nt, �� 4 q
Mailing Address ofOwner 1gg'i 1-7aX %bvrou h a( 4IQA-Ie4'0L►\l0,112
Gw s email,� w► r�r 5 Plwne>< �o� 3�-_ q9� y
6�Qel•da� eta
Ayenl s Name _ ��_ AgerA Prtonee:-7 04 41� a 2�o
- -- - - --
Age,x"s Emad DVann'%B(43
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
{Bottom portion t0 he cornytetpd try the Adsarceni Property Owner)
t hereby ceelrty that 1 own Property adjacent to the above relerery ed property. The irX34wduai applying If)[ this
Permit has des,%"I Pd to me. as shown On the attached drawing, the development they are proposing. A
rlrscrrPh�i__p� d•av 1 wdh dirnenstons, must be orovided with this letter.
DO NOT have objections to This proposal. 1 Op have
�t'ti t objections to this proposal
!1 YDu ob/ect+wrs to what is being Proposed you must notify the N.C. Divisfon of c."w
Managerrrent (DC" in writing within 10 days o/ receipt of this notice. Correspondence should be
mailed to 401 S. Grrffrn St, Ste- 3M. Elizabeth City, NC, 27909. DCfif representatives can also be
00100ed b at (tIrs d Mail. D1. No respons4 is conrfdQred Nrc ssme as no obja t/on H you have been
IrotNred by Carfified >rtalJ.
WAIVER SECTION
1 understand that any proposed pier. dock. mounng pilings, boat ramp, breakwater. boathouse. rift or
growl must t:e Set back a minimum distance or 157 from my area of riparian access unless waived by aw
(this does not apply to txAkheads or nprap revelrrteryg)" (N you wish to waive the setback. you EUI sign
the appropriate blw* below.)
I DO wish to waive some/aA of the 16 setback
-OR Signature of AG)BMW Riparian Properly Owner Plt
wj
I do not vAsh to wage the 15, sergwk reQwernM (initial the blank) _ /� S(9� of
Signature of Agacent RIvirtan Property Owner-
#S.lrK,9, Address of ARPO: - G 2 t t Q�_� T Oti 1 C ;► t t r.l ` `i
ARPO's *or : C326,'x (6; ARPO's Phone*- -1 'S 3
>Das+ 'warvsl is va bd for up to one yrlir from ARPO's SpnatuW
<-Qx, f" I i I RevaW July 2021
1) LA
❑C

A U 6 2 5 2022
DCM-EC

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