86751A_Heidenthal, Dennis & Judith_20221026

,y?,* CWF41 ❑CAMA ❑ DREDGE & FILL n N° 86751 ':A B C D
GENERAL PERMIT r ` Previous permit
Date previous permit issued
New Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State 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 _
Address
City
Phone # ( )
Email `
State
ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA IiIES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no . PNA: yes/no
Type of Project/ Activity a;
(Scale, S )
Shoreline Length
Access Length
d h
atform(s)) l .
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 no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
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
Signature "Please read compliance statement on back of permit"
Application Feels) Check #/Money Order
Permit Officer's PRINTED Name
Signature
Issuing Date
Expiration Date

x
i
DWISION OF COASTAL MANAGEMENT
AGENCY FOILM FOR PEST APPLICATIONS
i
cvmer of the property located at:
(propeM owner)
/ 3 / Syt'�/ZSGA" Coc(Z
/` /I'l o y o cr/V C a2 7 9 .Sa
-7 (pro:. t;.: < < :tee«;
do here
v authorize ee_ �l u �svn n< rv�
(name acting as agent)
to act
i
my agent for the purpose of ob i �_ Area Management'Act and/or
Dredge
and Fill Act permits, that may be nz-ra—posed development at a above -
indicated
property, which entails-
I
I
(describe proposed development -,-or wh ch permits are being sought)
-'his ag
ncy authorization is limited to the specinc activities described above, and wi
i
I
expire on:
(date on which agency authorization expires)
(signature) (date)
1
NNO elDe*7-14 "
(printed name of owner) (title, if officer of core. owner or trustee
I
i
i
i
r property)

KC, DIVISION OF COASTAL MANAGEMENT
RIPARIAN PROPERTY OWNER NOTIFtCATIONIWAIVER FORM
(Top portion to be completed by owner or their agent)
Name of Pa perty Owner i � ) f A& I DC 1A­1T1f1 f I-.-
Address of Property 1 ,t S.tt,i.,) �` Cict( t1 % ! �' .� .
Mailing Address of Owners a ,'�hl,wtC 1Pd5 s y X V'g
H&A M q-41 ?) t'
Owner's em it _. .... ....._.. Owner's PhoneS .� S — 0270 — ` 7 ?�
Agents Narr a Agent Phone# 252 •
Agent's Emit{! RfiftAc Z 52. 110
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION!
;Bottom portion to be completed by the Adjacent Property Owners
t hereby certify that I awn 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
�r �ptE _drav+ng,__with dimenson must be, provided with this lef er _
I pO NOT have objections to this proposal- I DO have objections to this proposal
i-You hav(i objections to what is being proposed, you —must notify the IY.C. Division of Coastal
Managemeit,
(DCM) in writing within to days of receipt of this notice. Correspondence should be
mailed to 1 S. Griffin St., Ste, 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted [phone]. No response is considered the same as no objection if you have been
notified by bertified Mail.
WAIVER SECTION
I understand, that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift. or
groin must ' set back a nunimurn distance of 15' from my area of riparian access unless waived by me
(this does no t apply to bulkheads or nprap revetments) (if you wish to waive the setback, you must sign
the appropri ite blank below.)
I DO wish to i waive somelaii of the 1' 5' setback
i
Signature o! Adjacent Riparian Property Owner
-OR
I do not w4 to waive the 15' setback requirement (initial the blank) vH YYI
Signature of djacent Riparian Property Owner p�_ xcQ F. •dy�'ryl.
TypediPrtn d name of ARPO: ' 10 �hd
Mailing Address of ARPO(
ARPO`s em1tifr 7%oZ Q ft- (pl»ARPO's Phonalt.
Date: ,A _*waiver is valid for up to one year from ARPO's Signature -
Re vised July 2021

,.,--- 9s
-Plp xq, r,�rYg Q "'-2 V H--1- 1-4Y

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A
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N.C. DIVISION OF COASTAL MANAGEMENT
CENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
ZTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent) 1
Name of Property Owner:
Address of Property: % 5 ri x.)cfe 2 S a Al Cc)u iZ l /)/c)► 0C %C <-F- 7 9
Mailing Addr ss of Owner: y 7y7 LUfl Y/ [/i�9//U/.s Z3YJ�
< I/. CGS
Owner's em I: 144E1DC!tl7l� � f,4@ 5 Owner's Phone#: 7 1 a 70 - 9 U7 �
Agent's Nam Loz F}vj'&n Agent Phone#:z<2_ 3 4--O-3L Z
Agent's Ema l: Q u M C ZG Ik) %ryVI n- 1
ADJACENT RIPARIAN- PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certi that I own property adjacent to the above referenced property. The individual applying for thi
permit has d scribed to me, as shown on the attached drawing, the development they are proposing.
description drawing, with dimensions must be provided with this letter. _ _. _ _ _ . _ . _ _ _ —
I DO NOT have objections to this proposal. I DO have objections to this proposal.
It you have objections to what is being proposed, you must notify the N.C. Division of Coasta
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 [phone]. No response is considered the same as no objection if you have beer
notified by Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must b 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' set ack
/S1_911atu e o Adjacent Riparian Property Owner
-OR-
I do not wis i to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Prinled name of ARPO: V
Mailing Ad ress.�o�foA�RN� � PO: f `i' / X Z C 7
ARPO's a < i k �`� / i/ ARPO's Phone#: �< Ce? 7 5J�..[ �
Date: 0 7 waiver is valid for up to one year from ARPO's Signature" r ✓
Revised July 202

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