86675A_Henry, David & michelle_20220818

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'Nt;AM A __. D K E U tot tit I - I L L C` N O 7S ii r„ U t.,
PrevG UI E RAL PERMIT Date us pousp _
Date previous permrt rssued —
XNew 7,-� Modification `t] Complete Reissue F.] 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 t��cc _._ � Rules attached. � General Permit Rules available at the following link: www.dea.ncgovL(;AMAru►e;
Applicant Name ��� ���i. �'�.1� Sri t� �/� _.._ Authorized Agent
J�
Address.. .. Project Location (County) ---_._...1✓1_L
C,cy_Ct Street AddressTrSate Road/Lot #(s) --_1 (a �,yE
_S,Phone # (&51io-q�8Q _56tit L.LEer2-5-eI.��ly1►a~L _
Email _ _ 51.5�� •. Q. — StdxhvtsiVon........_._I,�f'._..._pfew' /+�/fL*-.-,�
_...ZIP
Aficcted ^ CIN EVd PTA ES (r] PTS A(h. Wtr, Body i�\tom. fiV Lrt%N (.ir lnk,
._ � � ❑ l_._� - C - -(na ran.
AECty IDEA t IMA E]UW SPIMA '
Q l PWSClosest Mal. Wtr. Body�U-Y+
ORW , ,C PNA yc no
Type of Project/ Activity R, ' ; 4 !
—z_s• A CiLV1Z• i1-t_ti AA-7 3 �I ! h-Ct.� fqien�� G1:V (Scale: nj
Access Length
Pier Ideck) length
Ft*ed Pladormis)
Floating Platform(sl
Ginger piers) camat .+0
Total Piarfo,m area
Groin length/A
Bulkhead% Riprap;ength I
Avg distance offshore V
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathou
ee2rrg—f�
SAV observed yes no'
Moratorium: r• a yes no
Site Photon • r< ro �
-0..-
Riparian Waiver Atteched: yes no s ' A budding permit/toning permit may be required liptt��tn j! !(/ f ` F� +qt��
Permit Conditions
_� .. NCAC t. ► 2 i�;a �� c' `� iatr:�ra K� �cu't Lific'j
_ n"G,;.r- _.ylt.r av%+e✓ . vr., wt41 r I PLLV ►U.LI, at, tine
_ Ykkal.K..__ktl.k' _.4Z _ ice4 ✓% I Anti- 44 `ik 4'Gtik- L.
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F E R (circle one)
See note on back regarding River Basin rule -
See additional notes/conditions on back
1 AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPIV TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
�r Applicant PRINTS U Narnr Penult flftrcet's PItIN f[U t mr
S i nature Plvase tied compliance statetnent on bdck of pt•rmit" Signature
I. A.
pp ttatwn f ec (sl Check q/tvfuney Order Issu;ng Ue e � Exprr,rtrcrt Uete
Ir _ e. 0.► a,_I -'L 2 A- 00 _1. -► Lli

i AGENT AUTNORI2ATION FOR CAMA PERMIT APPLICAT)ON
t
Name of Property Owner Requesting�'^., �^�- Permit: i`�1 Ck(4 Q_ "��j
Mailing Address:
J o t's
Phone Number: _ �OLi
- 1 -- ----
Email Address: ISoW _ _ 1
1 certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: K
at my property located at ID 1,p ��,ne_
in -_x 4Z- County.
I furthermore terrify 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.
Properly Owner Informal ion:
m
Signature
Michele Henry
Print or Type Name
Title
Z' ' 9�
Date
This Certification iS valid through _� /
RECEIVED
J U L 0 8 2022
DCM-EC

K EGF IVE®
J U L t 8 2022
N.G. OWtON OF COASTAL MANAGEMENT �-. n
ADJACENTR#PARUAl1 PROPERTY OWNER NOTIFICATIQNM/A1VEAjF�O 1-
EC
F2TW1W "L • Rt l 6N R _C.l If' I Nit Ulll , � }_tANU ULLAL Y
(Tip portia) to be completed by ow w:r or their agent)
Nartie of 1�rop" OVANN _ _&I dc _ mle-0-1.
Aci[xess of Property: _1 t`Q . _ s-�+-1t \"Y 1
Maftnq Aftess of orjrtLj
c,,,mlcr s email u��ls�-@ is „ BOy S t tv. 9y94
• Agent's Name QA'dQA*QAW � � Ages t Phont*. a y- L4 1 b ''b (0{07
Agent's Email. Ur Ot*1g$41 @Q q ywc 4 • (CMA
ADJACENT RIPARIAN PROPERTY OWNER'S CERT1fMATtON
tB949M oortionto �2 completed by the Akilacent ProportY Owner)
I hefeby certify that t (YVJII properly arljarr-0 to 11fie above reStrenceol piopttity 1 tit �nciwnkr�t �+pptyN�y tgti t1ir:,
permit has describers to me, as sh(win on the attached drawing. the development they are proposiiuj. A
dcrscr pb�n or drawir �wih dimensions, must be_provided with this letter.
2T have objections to this proposal. I DO have objections to this proposai
N yoo_64 obi ctions to whwt is bvfng proposed, you must notify the N.C. Division of Coastnt
Management (DCfi) in writing wfthin 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Gruen St,, Ste. 300, Elizabeth City, NC, 27909, DCM representatives; can also be
contacted at (252) 2"3901, No response is considered the same as no obOCUon d you have been
notified by Certiflod Mall.
WAIVER SECTIOM
I ur;det stasxi that any proposed pier. dock. mooring pilings, boat ramp. breakvratei . boathotw. lift (r
WOO) must tie set back e IT*)irrwm kilstance of 15' from my area of riparian access unless waivers by me
(this does riot apply to bu ktieads or riprap revetrnerlts). (if you wish to waive ttte setback. you mw efM
the appropriate blank below.)
t DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property Ovow
-OR-
( do not msh to waive the 15' st Waco requkerrtertt (initial the btartic)
,ignalkire of Adjarern Riparian Property Owner.
Type"ririW naive of ARPO:
"fring Address of ARPDX
ARKYS errMd: ARPO's Phoo"Coj -N-
pwatvQr is vs9d for up to one year from ARPO's Signat imV
Rourcow . h dw 7n7 r

• Complete items 1, 2, and 3.
• 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 mailpiece,
or on the front if space permits,
1. Article Addressed to:
10 -7 -7 C4 LA
1111111111111111111111111111111111111111111
9590 9 02 7539 2098 8951 42
—
022 0410 Oool OS63
2, j 7
PS Form 381 1, July 2020 PSN 7530-02-000-9053
RECEj\/E-O
jlj� 13 IM
A. Signature
Agent
x rOAddressee
B. Rec"' 7d bygPr��ined.Namq) C. Date of Delivery
1"
D. Is delivery address different Tr6m item 1? Myes
If YES, enter delivery address below: 0 No
3, Service Type
0 Adult Signature
11 Adult Signature Restricted Delivery
0 Certified Nlail(3)
17) Certified Mail Restricted Delivery
" "­ -- --ve'y
7426 very Restricted Delivery
I C! insured Mail Restricted Delivery
• Priority mail ExpressO
• Registered Mail-M
• Registered W RestelOtec
Delivery
Cl Signature Carifirrnation'
Cl Signature Confirmation
Restricted Delivery
Domestic Return Receipt

N
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIEU MAIL - RE I URN RECLIP 1 RLQUESTED or HAN-Q1L11LhY
(Top portion to be completed by owner or their agent)
Name of Property Owner -M 1__-.-
Address of Property: -vlmQ � i _ Cn_r '—i V _{3"+L1_tt] 11
Mailing Address of Owner
Owners email �`011l rM 'C .�t'�i 1 twner's Phone# EOLA _51_ �fl, '_t
Agent s Nanic tQdfirct��Agent r'hnne#: �Tay - c. � � �, ';F� (oc6 7
Agent's Email. Vr. 0,4Nis_43---
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be compiet+ed by the Adjacent Property Owrrerj
I hereby certify that I own property adjacent to the above referenced property. The individillat 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 haue objections to what is being proposed, you most notify the N.C. Division of Coastal
Management (OCAf) 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 Mall.
WAIVER SECTION
I understand that any proposed pier. dock. mouring pilings, boat ramp° breakwater. boathouse. lift or
groin must be set back a minimum distance of 15' from my area of nparian access unless waived by me
(this does not apply to bulkheads or rixap revetments). (it you wish to waive the setback, you Must lion
the appropriate blank below.)
I DO wish to waive somelall of the 15' setback °
Signature of Adjacent Riparian Property Ownerp / D
-OR- m V
I do not wish to waive Ow 15' setback requirement (initial the blank) !%t-- 1 U L 1 9 2022
Signature of Adjacent Riparian Property Owner _ ___ �4wr4fr
Typed/Printed naune of ARPO: r K b l.yc k e l' - - - "
Mailing Address of ARPO: T (� I'RN� Te Gt &1' �{/ J ()c? r 2
ARPO's emaii- (t[Ot�/ `�`4/W-eoM ARPO's Mlionei: 772-570 ` 62 7�
Date: _a Z 'waiver is valid for up to one year from ARPO's SignatuW
Revised July 2021

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RECEIVED
J U L 0 8 2022
®CM -EC
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This map is prepared
from data used for the
inventory of the real
• 'J%
property for tax
..v ,
purposes. Primary
+ !"•
information sources such
as recorded deeds, plats,
wills, and other primary
ti
public records should be
kI!! f \10
consulted for verification
of the information
contained in this map.
106 Pine Cone TRL
Kill Devil Hills NC, 27948
Parcel: 004136000
Pin: 988305280361
Owners: Henry, David Lee Jr -Primary
Owner
Henry, Michele Dawn -Primary Owner
Building Value: $184,500
Land Value: $174,600
Misc Value: $9,000
Total Value: $368,100
AV
��4
Tax District: Kill Devil Hills Out
Subdivision: Baum Bay Harbor Secs 1-4
Lot BLK-Sec: Lot: 2 Blk: Sec: 2
Property Use: Residential
Building Type: Traditional
Year Built: 1989
009136-000 12 988305-009 04' 11

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