Suralik, Cheryl 90033C

❑CAMA ❑ DREDGE & FILL N9 90033 A B (c)D
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
Rules attached.
- General Permit Rules available at the following link: www.degoc.Rov/CAMArules
Applicant Name
( fun �c5 11 1/
Authorized Agent
Address
tcnr• i',y
Project Location (County):
City
State Pxl( ZIP '' N` t, 4
.
Street Address/State Road/Lot #(s)
Phone # ( )
--Y [ 1) ,J
Email
a.oA+.st r •; .iY
Subdivision
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS
ORWryesJ -:o __ PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length
Pier (dock) length
Fixed Platforms)
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 .1no,,
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
City
Adj. Wtr. Body (nat)man/unk)
Closest Mal. Wtr. Body
;r I
(Scale:] -(PO )
❑ 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.
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
(Please
Signature **Please read compliance statement on back of permit**
Feels) Check R/Money Order
Signature
Issuing Date Expiration Date

tee, N9 90033
❑LAMA DREDGE & FILL A B C i D
❑
Previous permit
GENERAL 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 i I } ❑ Rules attached. ❑"General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Address.
City State ZIP -. `� !-
Authorized Agent
Project Location (County): 1,
Street Address/State Road/Lot #(s)
Phone # (_)
Email i. .I Subdivision
City ! r,x �'.A' ,. (� r; ZIP ' ...J
Affected ❑ CW EJ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body Ad 6' .24 r' t ,(na�man/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Mal. Wtr.Body PwD)i'-
----ORW. yegK - - — - PNA:-yes/ho---- - -- -- -
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/q
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/length !'
Basin, channel '
Cubic yards
Boat ramp
Boathouse/. Boatlift
Beach Bulldozing
Other J
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: es�no
Riparian Waiver Attached: `ye. no
A building permit/zoning permit may be required by:
Permit
(Scaleq'=
❑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
i
Application Feels) Check p/Money Order Issuing Date
4f ",I
Expiration Date

ia1ao0
N.V. UIvIsION OF COASTAL MANAGEMENTa6G3
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(I op portion to pe completed by owner or tnelr agent)
Name of Property Owner: L beQy/ 56r✓K("�<
Address of Property: k3)�O pcinr loop go
Mailing Address of Owner: a,3dV (-<1111) i✓2l /ov2 /ZD
Owner's email: X Y1l� )_T4W6wne s Phone#: X
Agent's Name: _Oev01) /3v✓y7c< Agent Phone#: d)5d- 7A3 3699
Agent's Email,0wU/), 13o151'esue
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.
AAddescription 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 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 127 Cardinal Drive EXT, Wilmington, NC 28405. 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( s ��
Signature of -Adjacent Ripan n Property Owner (ARPOJ"
-OR- I
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: ->< A J� �J/zit
r
Typed/Printed name of ARPO: -k { 1� l_V, 6 k% k y T(i y L fo h
Mailing Address of ARPO:
ARPO's email:
Date:+/ A 3 1-_� C'r3 ]� *waiver is valid for up to one year from ARPO's Signature*
u
Revised May 2021

0
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: G�/1 5kt (klie
Address of Property: a) 3A& Cru> Doio % /epp /ZCAV
Mailing Address of Owner: 3aU 60r4 Awr /odp RC'
2') V\ Owner's email: t Gb til�
Owner's Phone#: —4=1
Agent's Name:O2e ripe 13015ACr Agent Phone#: 9)5-a 12A3 369y
Agent's Email: Oc✓o12. CDrv2
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 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 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 127 Cardinal Drive EXT, Wilmington, NC 28405. 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.)
k I DO wish to waive somelall of the 15' setback
`7, r
Signa ur of Adjacent Riparian Property Owner (ARPO)
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property
Typed/Printed name of
ryt
-.i1 plu c:i i Y
Mailing Address of ARPO: k 2.3 / `/ C AViii) 19'r. <r -A,d, -, rue, ,elf jjAv)
ARPO's email: �c
ARPO's Phone#: j- Aa 2 — J `rf 2 Z L'
Dater `waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Perms: Sit'rake
Mailing Address:
Phone Number:
Email Address:
I certifv that I have authorzec
a3ao C,rckb Poll- loop Rcd
r1o�e.hea�l ��7`�r, NG �b'ss7
7277
Agent
ckh 0o , C C
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: (/oc!' wi P) -IK-4 /
and /3oa7- /%FT :0de5 ;�3o FT ove--aN W�lo/00 7_Aeki
at my property located at 9,3ol0 c+Kb Poi,-17 LoW PL4
in C ar7 6Gi County.
furthermore certifv 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:
S'w I,W)4)(
Signature
�her�l Sura lIK
Print or Type Name
TO-
3 d C
Date
This certification is valid through / i
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