Duben, Corey 90019C

oa°1`°"S'41 �❑CAMA ❑ DREDGE & FILL 9 90019 A B 11 C D
z GENERAL PERMIT Previous permit
i Date previous permit issued
❑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 ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name Authorized Agent
Address Project Location (County):
City State ZIP '- "l) r. Street Address/State Road/Lot #(s)
Phone#(_)
Email "' rif 0'T4 .' ' Subdivision
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ 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
Shoreline Length
Access Length
Pier(dock)length
Fixed Platform(s)
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 re uired b • f e" I ( J,:!
Permit Conditions
(Scale:,:., )
q Y•
r 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 Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit" Signature
Application Feels) Check #/Money Order Issuing Date Expiration Date

No 90019 A B . c D
a�F(00.Rq',110c❑CAMA ❑ DREDGE & FILL
0
GENERAL PERMIT
Previous permit
Date previous permit issued
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 1 ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name r
Address ) "
City i State I ZIP
Phone #
Email
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision ^"
City /,, ,.,_ t:��' i +. ZIP
Affected ❑ CW ©EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC s : OEA IHA UW SPIMA PWS ;= -. l
O ❑ ❑ ❑ ❑ ❑ Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale:.,.; I )
Shoreline Length _
Access Length _
Pier (dock) length _
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap le
Avg distance offsho
Breakwater/Sill _
Max distance/ Iengi
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlifl
Beach Bulldozing_
Other
SAV observed:
Moratorium: n/a
Site Photos:
Riparian Waiver Att
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 Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit" Signature
Application Fee(s) Check #/Money Order Issuing Date Expiration Date

Drawing Prepared By: C3 Scott, Inc.
Date: 12/16/22
Scale: I ": 40'
1 2'x 16' F
Dock L-
ApproximatiF
137' f rmn
water's edg
196 Dogwood
s ten®
188 Dogwood Lane
Newport, NC 28570
Property Owner:
Corey Duber
0
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AGENT AUTHORIZATION FOR CAMA PERMITAPPLICATION
Name of Property Owner Requesting Permit: e04r. V
Mailing Address:
Phone Number: 2, Y_/
Ernail Address-. e, j e ✓
I certify that I have authorized C3 Scott, Inc
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: = 6 t 4O je-oc
at my property located at
A� /, ' -,4
-fdA 4XF41000 /V/c '?Vpr�v
in -County.
/ furthermore certify that / am authorized to grant, and do in fact grant permission to
Division of Coastal Management staf
f, the Local Permit Officer and their agents to enter
on the afore -mentioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
Print or Type Name
0'f'1'_qeV
Title
Date
This certification is valid through 31 RFCFWFD
JAN 3 1 Z0Z3
D(;m.MHU CITY

low
6-' 5 'j4
1 hereby certify that I own property adjacent to 6�C C t'/% 1 s
'(Name of Property Owner)
property located at ze
(Address, Lot, Block, RoaS609.)
on 44� r,'4— SOVOvel in N.C.
W (Waterbody) (Cifyhown and/Or County)
The applicant has described to me, as shown below, the development proposed at the above
Initial loclitlow
Here on of I have no objection to this proposal.
one
these I have objections to this proposal.
lines
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a 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
Initial me. (If you wish to waive the setback, you must initial the appropriate blank below.)
Here on I do wish to waive the 15' setback requirement.
one of Ir,
these I do not wish to waive the 15' setback requirement.
lines
(Prop ty Owned Information)
S i yylture
(- V/zi.,V
Print or Type Name
Man Address
I -
Telephone Number email address
Date
(Adjacent Pro"rty Owner Information)
ALI'— R"
Print or T N-
lq6 10'1')C2d'J
MailitIg Addres-i
/ .\J -7 6
City/State p r Ve4
tot i cc
Telephonle,Nurqber� email addr
Dole*
(Revised Aug. 264) 312023
*Valid for one calendar year after signature*
0(;M-iWHU UTY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to - /510i' 4,
tf 4ame of Property Owner)
property located at Alyo(-50 Z—"-�
(Address, Lot, Block, Ro9d, etc.
Z7j /'t'j eq
on Jn A",-1111 "I'lle-1 A "" i/-/ N.C.
(Waterbody) (dity/Town and/or County)
Initial The applicant has described to me, as shown below, the development proposed at the above
Here on location
one of I have no objection to this proposal.
these
lines I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
A7��\�����
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin pilings, -w in
must be set back a minimum distance of 15' from my area of riparian access unless waived by
Initial me. (if you wish to waive the setback, you must initial the appropriate blank below.)
Here on I do wish to waive the 15' setback requirement.
one of
these I do not wish to waive the 15' setback requirement,
lines
Owner nformation)
Si
gVoure
Print or Type Nam
7i
Mai'n Address
CitylSfatelZip
Telephone Number/ email address
Date
*Valid for one calendar year after signature*
(Adjacent Property OwTer In or ation),
Print or T pe Nam f
ing Ad&e
ie-vvnri rT.
Brd----Cik- 05011 -C I rneeki it q
Telephone Number/ email address
vn6„ 1, (0)1)
RF-CLLAOLD
(Revised Aug. 2014)
- i A N 31 Z 0 233
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