86570A - Clough, Ricky & Penny

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""' *AMA ❑ DREDGE & FILL iNY 86570 `J B C D
'-� GENERAL PERMIT DatePrevius rmit� S
Date previoous permit issued 'L�--
❑ New ❑ Modification Vcomplete 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 7 Zak -- ❑ Rules attached. �6eaeral Permit Rules available at the following link: www.deq.nc gov/CAMArules
Applicant Name /C C.l� cf pe q h Authorized Agent _AJ o gG. e. r 0..l l A _
Address A O 68_- i✓ Project Location (County): -V ci Q—
City _J^n:frr1nn � �(_�State _ ---zip Z% g �3 Street Address/State Road/Lot #(s)/� S Al 3 Y
Phone # (�`1 7 9 N �r-r-- (o35e C V\ J w 1
Email '"- Subdivision as U t>`f i7 o t- /­►4- y
City —Z4 o 4 zip 2-7 y
Affected CW 5 EW MPTA ES PTS Adj. Wtc Body r O o.'� 6�/� sJ �nr`� / (na man/unk)
AEC(s): OEA IHA U UW SPIMA PWS Closest Maj. Wtr. Body
ORW yes no PNA. ye no
Type of Project/ Activity C' c' f'�c `t a n o-� SfJ 5- P r Q--F t J a 44-
plJa_J r� 17" 2 r X 20 �o, �i'�� 9 /3 is /3 /�a �: F"� (Scale: AfT:L 1
Shoreline Length - 2 _
Access Length
r
Pier (dock) length 51CJ(S �.
Fixed Platform(s) ':� o , K 20
Floating Platform(s)
Fingerpler(s)—_.____-- _-_----_
Total Platform area O
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore -_--___-_ __
Breakwater/Sill ____ __ ___-_
Max distance/length
Basin, channel
Cubic yards -. _ _,_ _ _
Boat ramp
Beach Bulldozing
Other 0. C
, i . -.
0
*?'?e _---.
t=
SAV observed:
— Ex, w0 i `" �
yes no
Moratorium. t a
yes no I
Site Photos:
es ,/ �� C [� p (.k 7f�
Riparian Waiver Attached:
yes
A building permit/zoning permit may be required byt-
Permit Conditions-fi
+f- w
—ll
M W L--
Ex, Js
N�)7%o r
W
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)
'�- JA i,-e- rl'o"
yvn ,i n-,- C cL-ryRr-
or Applicant PRINTED Na a
Permit Officer's PRINTED Name
t_
Sig re "Please read compliance statement on b k of permit"q
A plication Feels)
Check tf/Money Order
Issuing Date
Expiration Date

CAMA ❑DREDGE & FILL? 1 � 0D
tt�
r—
t� A Previous permit
GENERAL E MIT IT Date previous permit issued
(alp New [] Modification omptete 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:
1 SA NCAC l! f Rules attached. General Permit Rules available at the following fink: wwwdcq.nr.ggvICAMAruies
Applicant Name t� � h A C . ct Authorized Agent 01(4
Address _! T7 +", x" - — Project Location (County): !&4"'"!!
Oty i AJ So.0 state � ZIP � � � �* Stre/ettAddresss/State Road/Lot #(s)
Phone # } ` f / t v —sty dds V�v-'C-
City-.-M71i,--
Subdivision Lt �t cs Z1P _ ' - �i ✓�
Affected . ❑ CW - _ [.EW [B.PTA ES J PTS Adj. War. Body _...... t. S" �* u, tK.a^ m +` Cat ! A�tttan/utgc}
AfC(S}: � OEA � INA � UW El J PWS Closest Maj. Wtr. Body —� ------
ORW: yes PNA: yes r O )
Type of Project/ Activity 4, -gy .s
Ikt.StR tir 4vS C i
Shoreline length In
Access Length..
Pier (dock) length
Fixed Platforms) r—_�` 0
1 .5
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
Boathe. Boatiift ? tr
Beach Bulldozing
Other
5
tree' uS t ` 4 l •r
SAV observed: Yes r no
Moratorium: n/a yes, nab l sa u q �.•
Site Photon yes
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by.
Permit Cond ti°ns A { 1, "` ` f� v4C
15 � c-'r-
--_—
IV," L.,
Uil
CLC'G -S
(Scale: jjj
TAWAM/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. V(Please Initial) _
nt or Applicant PRINTED Namaj Permit Officer`s PRINTED Name
�,,ce
Si ure •'Please read comt on back of permit"* Sign t e
Application Feels) Check #/Money order Issuing Date Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
�131 ?,(
Name of Property Owner Applying for Permit:
Mailing Address:
•a 4
,
YfflWW%� I M
I certify that I have authorized (agent) marl n to act on my
behalf, for the purpose of applying for and obtaining all LAMA Permits necessary to k
install or construct (activity) wv
at (my property located at) k--)
This certification is valid thru (date)
Property OwnWSignature 6/ Date

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICAT10N1WAIVER FORM
QERTIFIF.12 MAIL RUURN E 1P RE EST D r HAND D LIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner:
Address of Property:
Mailing Address of Owne!
113
LLA
Owners email:.,_..._ . __._�_�._ .___._ _- Owners Phone#, _i - ii�__ f V��i
' • � t�
Agent's Name: ��� �_.._ Agent Phone#: a �� c7s
Agent's Emai l e c ir, n S • C- O�
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(e�gQm. portion to be ggmpieted hy the Adlaunt P operty Owner)
t 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. 9
det, p E n drawl__g with xn nsicZns must be ov��f with t l i r
Y�` t Yt�j?1 i �� 2 11 fJ �i f Y
_ I DO NOT h� e objections to this proposal. t DO have oblections to this proposal.
H you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (OCM) to writing within 10 days of receipt of this notice. Correspondence should be
inalled to 401 S. Grffffn St, Ste. 300, Elizabeth Ctty, NC, 27909. DCU representatives can also be
contacted at (252) 2"3901. No response is considered the same as no objection if you have been
notified by Cert/tled Mail.
WAIVER SECTION C
�r 1 understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, tiff, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me x
j (this does not apply to bulkheads or riprep revetments) (If you wish to waive the setback, you rinust Sian
the appropriate blank below)
I DO wish to waive somelail of the 15' setback
-*Signature o A scent parian Property Owner
1 do not wish to waive the 1 5' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: _North Carolina, Depatment of Transportation CIO Steve Trowell
Mailing Address of ARPO: 113 Airport Road Suite 100, Edenton, North CarolinaT27932
ARPO's email: M Sitroweli a�7nedot_90v` ARPO's Phone#:
Date: __Au_gust 18, 2f)21 "waiver Is valid for up to one year from ARPO's Signature`
Revised May 2021

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