86989A_Coastal Proisons, Inc. c/o David Foster_20231209

4,140CUSTk&TCAMA % DREDGE & FILL N° 86989 CI)B C D
GENERAL PERMIT Previous permit
Date previous permit issued I /
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 3 4 , I 100 ❑ Rules attached. W General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name C06>'1•c. 1 9"Oyi Sim I i 7r+r. 4/0 C6v+cl 1;;,Sk r
Address I15 A le ycr { - } 1Zc1
City OUC, V- State N t_ zip q Lt t1
Phone # (mil) L-18Cl - 3 1 -+11
Email�7L.fj�, 10 C,M,
Authorized Agent 1-S Z JV14r 1 rk C,,,i Jeu t , -y % . LLC_
Project Location (County): bG r{ n
Street Address/State Road/Lot #(s) I L1 9 LA l�u L IL 1 ` d
Subdivision VIA
city Dy C k ZIP -X4ci 4't
Affected ❑ CW 1K EW X PTA & ES A PTS Adj. Wtr. Body C., r r • T.. L So.. r J c�timan/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body C v e e A o t, IC !E�3
ORW: yes& PNA: yes r�
Type of Project/ Activity t� u ni ( 30 �'C'}14, Scr , w, w i k+n A41 li r%eK, ni
(Scale: W. �. S. )
Shoreline Length t L(a-CLI
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin ngth/# r
ulkhea / Riprap length C. S + l ( t
Avg distance offshore of
Breakwater/Sill
Max distance/ length (Z er
Basin, channel l
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
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(C 5 ASAV observed: ye no
Moratoriurtf� yes no '
Site Photos: <� no
Riparian Waiver Attached: yes®
* building permit/zoning permit may be required by: To Q i.J cJ� 7�
Permit Conditions LAf, 1 t
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❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I ANAWARE OF ST TUTES, CR RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) AgT!g::;=J
M I ci
nt plica N Name A Permit O s PRINTED N
Signa **Please rea compliance statement on back of permit"
'ti0Q�00 a 1 a3
Application Fee(s) Check #/Money Order Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: F b TAex-
Mailing Address: 1 '--1S A 1 `"'t 5� � , W C. 2 49 1-f
2'S2-- 418c) i }y Phone Number:
,YnoQSI CU lcer-4 ZO-1 Y-Y—Wk , �'•Cc''�^ Email Address:
I certify that I have authorized L, S j (Y \ k"
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:u�k�Kad
at my property located at 1 y 3'A `)
in A re- County.
1 furthermore certify that I 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:
Signature
Print or Type Name
i�ll]t1E �
Tide
'10 1 Z} / 2Z_
Date
This certification is valid through I I

Cu
EXISTING PIE
EXISTING BOAT RAMP
TO BE REMOVED
1436 DUCK RD
PROPERTY OF:
FORBES
IS' OFFSET'
P/L
P/L
1434 DUCK RD
r, 100' +/- m
PROPOSED NEW PROPERTY OF:
6' X 90' DOCK W/ FRONTAGE _
12' X 12' PLATFORM & FOSTER
12' X 12' BOAT LIFT
3 ,
EXISTING P/L
OFF
BULKHEAD TO BED
REPLACED WITH A �
NEW VINYL
BULKHEAD _
_ a
1
_ 1432 DUCK RD
CURRITUCK SOUND
PROPERTY OF:
BERRY P/L _
SOUND SEA AVE
PROPOSED NEW PIER, PLATFORM, LIFT & BULKHEAD @
1434 DUCK ROAD, DUCK, NC 27949 FOR DAVID SCOTT FOSTER
RIPARIAN DRAWING 1 OF 1 °- 1' = 40' - 10/27/2022 151
BY: SCOTT C SMALL OF LSI MARINE CONSTRUCTION LLC MARINE
252-473-7695 - [e-mail] - WWW.LSIMARINE.COM Construction, LLC

i Complete items 1„ 2, and 3.
■ Print your name and address on the t1everse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
_ or on the tront 0 space permits.
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9590 9402 6361 0296 8696 24
2. Article Number (transfer fmm service label)
7020 3160' 0001 2519 0513
i,s T;On i 1. July 2020 PSN 7530402-000-9M
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SENDER: COMPLETE THIS SE C,
■ Complete items 1, 2, and S.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mallpiece,
j or onjotfront if spaos permits.
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'020 3160 0001 2519 0506
PS Form 3811, July 2020 PSN 7530-02-000-9053
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B. Reoehred by (Prk tad Name) C. DateAf Deliver
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D. Is delivery address dMerent from bm 1? O Ye9
If YES, enter delivery address below: p No
3. Service Type
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Domestic Return Receipt

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: DAVID SCOTT FOSTER
Address of Property: 1434 DUCK ROAD, DUCK, NC 27949
Mailing Address of Owner:
135 A JAYCREST, DUCK, NC 27949
Owner's email: SOGGYDOLLAR42(a.,GMAIL.CON6wner's Phone#: [phone]
Agent's Name: SCOTT C SMALL
Agent Phone#: [phone]
Agent's Email: SCOTT(a-,�LSIMARINE.COM / MONICA(a�LSIMARINE.COM
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent 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
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 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 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
Sigiiaiure of Ad auerii nipa/ian P'iup&dy Ownel.
I do not wish to waive the 15' setback requirement (initial the blank)
.42
Signature of Adjacent Riparian Property Owner: ✓►•7 /j
Typed/Printed name of ARPO: RICHARD W BERRY TRUSTEES & KATHLEEN K BERRY
Mailing Address of ARPO: 7472 STRAWHORN D$rMECIh�ICSVILLE, VA 23116
,! '0 010 AQ If c/
ARPO's/email: �' ` �s ARPO's Phone# T 4- 3 49 /
Date: !�2 *waiver is valid for up to one year from ARPO's Signature"
o .� J
/ l Revised July 2021
cz P_ ,� .�

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1
14-46 DUCK RD
1. Provide elevation of pier, dock and boat lift.
PROPI R'rY M 21KY there be a roof over the boat lift or
EXIST,N-G PIER dock? tf so, provide ebevabon.
F(?Rt3ES
i
I~VIS il'J -0 BOA T "UP PIL
7-01iJ: ftlsAtDYF.i?
bled platform.
lift (hor—
Shift ! relocate the pier and
' boat lift far north as possible to i
the 15 offset; setback line. 11
1434 DUCK RD
f 00' +t-
PROPOSED NEW FRONTAGE PROPERTY OF:
r
V X W OOCK WI o
17 X 12' PLATFORM 8 � FOSTER
12' X 12' BOAT LIFT /
EXISTINGPIL
BULKHEAD TO BE Is OFPSL�
REPLACE[ WITH A :.....:.�,�_
NI:W VINYL
BULKHEAD
2432 DUCK RDi L'FtRFTG` bC 50U7JD SOUND SEA XN
r . PROPERTY OF:
in-
BY'SCOTTBERRY PIL
IER, PLATFORM, LIFT& BULKHEAD --D, DUCK, NC 279�49 FOR DAVID SCOT I FOSTERRiPA'RtANDRA �'�ING1OF1� 4 10/27/2022
C SMALL OF LSI MARINE CONSTRUCTION 2 7t"w'619Cca S ARIN .COM .�c � 1
.S"�ARINE.COM
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Business Corporation
Legal Name
Coastal Provisions, Inc.
Information
Sosld: 1446128
Status: Current -Active O
Date Formed: 5/18/2015
Citizenship: Domestic
Fiscal Month: December
Annual Report Due Date: April 15th
CurrentAnnual Report Status:
Registered Agent: Foster, D. Scott
Addresses
Mailing
1209 Duck Road
Duck, NC 27949
Officers
President
David Scott Foster
1209 Duck Road
Duck NC 27949
Stock
Class: Common
Shares: 100
Principal Office
1209 Duck Road
Duck, NC 27949
Reg Office
1209 Duck Road
Duck, NC 27949
Reg Mailing
1209 Duck Road
Duck, NC 27949

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