Westport III Inc 91136C

"IF COASTgTI ❑CAMA ❑ DREDGE & FILL Na 91136 A B C D
9
GENERAL PERMIT Previous permit
2 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.deg.nc.gov/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 ❑ 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
}. (Scale: �7)
Shoreline Leng
Access Length
Pier (dock) len
Fixed Platform
Floating Platfo
Finger pier(s) _
Total Platform
Groin length/#
Bulkhead/ Ripi
Avg distance o
Breakwater/Sil
Max distance/
Basin, channel
Cubic yards _
Boat ramp _
Boathouse/ Bc
Beach Bulldozi
Other
SAV observed:
Moratorium:
Site Photos:
Riparian Waivf
A building pen,,,,,
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

'IN\�i COASt4l&FICAMA ❑ DREDGE & FILL N9 9P 136 A B C D
GENERAL PERMIT Previous
20i
Date previousous 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.de.nnc.gov/CAMArules
Applicant Name _
Address
City
Phone # (_ )
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
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) len
Fixed Platform
Floating Platfo
Finger pier(s) _
Total Platform
Groin length/#
Bulkhead/ Ripi
Avg distance o
Breakwater/Sil
Max distance/
Basin, channel
Cubic yards _
Boat ramp _
Boathouse/ Bc
Beach Bulldozi
Other
SAV observed:
Moratorium:
Site Photos:
Riparian Waivi
A building per
Permit Conditions
(Scale: )
U TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
1 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"
Application Fee(s) Check #/Money Order
Sig nature,
3-
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: W4E� TPOR T . 1WL.
Mailing Address: P ). Box lgci6
Phone Number: LOSQ)a L4 `I -
Email Address: �712ADy BCACONS fPCACH
I certify that I have authorized «45STAL COAS r LANDSAP S INJC•, FtT-6 t-IgkC;rf if-
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all LAMA permits
necessary for the following proposed development: ApDrr ,c)NAi- izt i> kAp- Ow -
No i>,Ttl S IDe oN -EX(S i f NGr 9UL!�Q-lCAt> aN BCC UE -SO-
at my property located at 5'q0 kJCSTP0'RT Pi k_No+-i s�a�E
in CAj;->T£RC— i County.
l furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff. the Local hermit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
�cacR,� ,.,J . iti� c�✓— -
Print or Type Name
Title
/ / , li- /� z-�.
Date
This certification is valid through
alk
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N.C, DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONlWAIVER FORM
CERTfF1ED MAIL RETURN RECEIPT REQUESTED.or_HAND_pELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: Wsa Q -' --- — __."--
Address of Property: S90 taiti.��a.t- �r+nl'`� �••.tc �•o�\ St-,�.� ..J,G 2t"sStL
Mailing Address of Owner: _4AA)s. �r s.�, ^, 'L
h_c�,nsrwcy.
Owner's email: _ --Owner's Phone#: �ln'2y7-'-to1`►
�,�t�.(�
Agent's Name: ��
�, ��-- �� Agent Phone#: 2,41-'l 'v]
Agent's Email: --
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent 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
descri tlon or dfawing, with dimensions must be provided with this letter.
I DO NOT have objections to this proposal. I DO have objections to this proposal. _
!f you have objecflons to what is being proposed, you must notify the N.C. Divlsion of Coastal
Management (DCM) in writing within 90 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City; NC 28557. DCM representatives -can alsorbe contacted, -
at [phone]. No response is considered the same as no objection !f you have been notified by
Certified Mail,��..
WAIVER SECTION'
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lifr
groin must be set back a minimum distance of 15' fby me
rom my area of riparian access unless waived 4j
(this does not apply to bulkheads or riprap revetments). {If you wish to waive the setback, you must s' k
the appropriate blank below.)
1 DO wish to waive some/all of the 15' setback
Signature of jaoent Riparian Property Owner
-OR-
I do not wish to waive the 16 setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner'
Typed/Printed name of ARPO: TOr , 'CN --1-t��—
Mailing Address of ARPO: �-
ARPO's Phone#:
ARPO's email:
Dater *waiver is valid for up to one year from ARPO's Signature*
j ,� Revised July 2021

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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner:
Address of Property: 3cio t�K'+t t ¢-1'� ^rL tG' wal�g�,`'°� n1� 2�s► 2_
Mailing Address of Owner- O goat vo%!Ns QMckx—Zmis."� , 2s`Sr�
Owner's email: At4- Owner's Phone#: 252-2'r?-`eel i
Agent's Name: s~.tl ►xrr Agent Phone#:
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
Bottom oortion to.roperty 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
descri tion or,.drawing, with dimensions must be ovided with this letter.
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 400 Commerce Ave., -Morehead City; NC 28557. 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 mug# s!on
the appropriate blank below.)
I DO wish to waive some/all of the 15'
-OR-
setback
ignatu of Adjacent Tian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: t3. r T.L ,t ) �f �;; R+rA 1�`�,. ✓lvoe
Mailing Address of ARPO: fl,_ �+�-• r n1G 246f2-
ARPO's email: 3/ �J tea et' ,. ARPO's Phone#: Qtc�-'81,$- J mz
Date: 1� 1 may~ *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021