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f�CAMA ElDREDGE & FILL N° 84242 A B (D D
GENERAL PERMIT Previous permit
Date previous permit issued
t
New ❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized by the SSttate of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC �-1 H L I �VO ❑ Rules attached. 'General Permit Rules available at the following link: wywww�.deq.ncgoy/CAMArules
Applicant Name .3Mi— Authorized Agentffi V L lL o ,
n
Addr s c Project Location (County):
City '�% Staged zip �. St e`t Address/State Road/Lot�#is)
Phone # (R1 /} ) `� '1 M; 7 RenLi (ee—
Ix-
Emaildb (o *a`)abi. [ io M Subdiv' n
CityZIP
Affected NKcW SKEW [TA [Vs ❑ PTS Adj. Wtr. Body C 1(lO(I AA �j( ULL.� Cn7� an/unk)
AEC(s): /�❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body A l Vy • —
ORW: Ves/ho l PN ves o
Type of Project/ Activity
Shoreline Length
Access Length
Pier (dock) length e/
Fixed Platform(s)
Floating Platform(s)
Finger piers)
Total Platform area /'
Groin length/# /
Bulkhead/ Riprap length
Avg distance offshore /
Breakwater/Sill /
Max distance/ length /
Basin, channel
Cubic yards
Boat ramp `
Boathous Boatlift K
Beach Bulldozing
Other
SAV observed:
yes
no
Moratorium: n/a
yes
Site Photos:
yes
no
Riparian Waiver Attached:
yes
no
A building permit/zoning permit may t)e required by
Permit Conditions
CRC RULES AND CONDITIONS THAT APPLY
(Scale:
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
ease read comp- cFEement on back of perdw
-3 02-
Application Feels) ec #/ oney Order
Date

#F-]New
❑CAMA ❑ DREDGE & FILL N° 84242 A B C)D
GENERAL PERMIT Previous permit
Date previous permit issued
[]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:
I SA NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Address
City
Phone #
Email
Authorized Agent
Project Location (County):
State ZIP Street Address/State Road/Lot #(s)
Subdivision
City
P
Affected ❑ CW ❑ EW ❑ pTA F], S ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PIN ! no
Type of Project/ Activity
Shoreline Length .%
Access Length
Pier (dock) length
Fixed Platform(s) i
Floating Platform(s)
Finger piers)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel -
Cubic yards
Boat ramp
Boathouse/ Boatliftf b(;
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 required by:
Permit Conditions -
(Scale: )
❑ 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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: m - 0;
Mailing Address:
Phone Number:
Email Address:
&I
I certify that I have authorized Qa- -e
Agent t Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: ir,S �Csy 1). E� 1- I .(-t
at my property located at 9 6-3
in On S1 �") County.
I furthermore certify that 1 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:
ignature
/i nAn 1_71p At VS..00- C i
Print or Type Name
Date
This certification is valid through

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION (MINOR PERMIT)
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERED
7 - l 7 — l�
I Date
Name of Adjacent Riparian Prer Owner
�e I 'gjQn-pppr I'm Ln
Address Q
5"n C" J��C.r�l /IC 0 ��
City, State Zip /
To Whom It May Concern:
This correspondence is to notify youasa riparian property owner that I am applying for a CAMA Minor permit to
S on my property at � � 3 e i -Tree Lanz S YI P acl s TV ILL 2-9- y b 0,
in n S I b VJ County, which is adjacent to your property. A copy of the application and project
drawing is attached/enclosed for your review.
If you have no objections to the proposed activity, please mark the appropriate statement below and return to me as soon
as possible. If no comments are received within 10 days of receipt of this notice, it will be considered that you have no
comments or objections regarding this project.
If you have objections or comments, please mark the appropriate statement below and send your correspondence to:
(LOCAL PERMIT OFFICER, NAME OF LOCAL GOVERNMENT, MAILING ADDRESS CITY, STATE, ZIP CODE)
If you have any questions about the project, please do not hesitate to contact me at my address/number listed below, or
contact (LOCAL PERMIT OFFICER) at (PHONE NUMBER), or by email at: (LPO EMAIL).
Sincerely,
9 0
roperty Own is 1 are Telephone Number
Address - City State Zip
�I have no objection to the project described in this correspondence.
I have objection(s) to the project described in this correspondence.
Print or Type Name
Date
!710 "-0q p M
Telephone Number
Address City State Zip
Revised July 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION (MINOR PERMIT)
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERED
-�0-�3
Date
1/a�o�ec- vL.�
Name of Adjacent Riparian Property Owner
`-tom �s , Try 1�
Address $ C r1
City, State Zip
To Whom It May Concern:
This correspondence` is to notify you as a riparian property owner that I am applying for/ a CAMA Minor permit to
(z()Q' L `-F-i- io h "e'4 ssiQ4— 4 4.5 d g. ,,< eid "' 94�4, 11.�4 GI t ✓ �..t�
on my property at � G 3 Ac,&Tree, Lane_ , S ne,L P NC. 2-&1� D
in (D r\ S I o�,. County, which is adjacent to your property. A copy of the application and project
drawing is attached/enclosed for your review.
If you have no objections to the proposed activity, please mark the appropriate statement below and return to me as soon
as possible. If no comments are received within 10 days of receipt of this notice, it will be considered that you have no
comments or objections regarding this project.
If you have objections or comments, please mark the appropriate statement below and send your correspondence to:
(LOCAL PERMIT OFFICER, NAME OF LOCAL GOVERNMENT, MAILING ADDRESS CITY, STATE, ZIP CODE)
If you have any questions about the project, please do not hesitate to contact me at my address/number listed below, or
contact (LOCAL PERMIT OFFICER) at (PHONE NUMBER), or by email at: (LPO EMAIL).
Sincerely,
_ 90-6o /L)
Property Ow rer's Na e Telephone Number
Address
City
State
I have no objection to the project described in this correspondence.
I have objection(s) to the project described in this correspondence.
a�4P1-129o�
Adjacent Riparian Signature
D tti�ti � { . tile,,
Print or Type Name
al 3 v, 33
/ Date
-704-16�-Y )-;
Telephone Number
Zip
Address City State Zip
Revised July 2021

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:
Mailing Address of Owner:
Owner's email:�t� %
Agent's Name: i
Agent's Email: /- tug
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be completed by the Adjacent Property Owner)
CC" & 6
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 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 15from 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.) l l p
I DO wish to waive some/all of the 15' setback �h t { I �___
{{ � V � L
-OR-
Signature of jacent Riparian 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:
Mailing Address of ARPO:
ARPO's email:
Date:
ARPO's Phone#:
'waiver is valid for up to one year from ARPO's Signature'
Revised July 2021