King, Michael 90041C

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AMA ❑DREDGE & FILL Nn 90041 A B" C D
ENERAL PERMIT Previous permit
z 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:
15A NCAC 1' ' 0 (j D ❑ Rules attached. n General Permit Rules available at the following link: www.deq.nagov/CAMArules
Applicant Name
Address
City State ZIP +" 2;
Phone # (_)
Email ! "0 w\
Affected ❑CW ❑EW ❑PTA
AEC(s): ❑OEA ❑IHA ❑UW
ORW:•yes/no PNA: yes/no
Type of Project/ Activity
SllnrPllnP I Pm,th
❑ ES ❑ PTS
❑SPIMA ❑PWS
Authorized Agent //�� /�
Project Location (County):—[CG��l4�xit�r,-4
Street Address/State Road/Lot #(s) 31 I—ti e--
Subdivision
City
Adj. Wtr. Body �..�
Closest Mal. Wtr. Body
(Scale: )
Access Length
1
Pier dock n h
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T
Fixed Platform(s)
y
Floating Platforms)
i
4
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L_
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�it
Finger piers) :-"
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Total Platform area
I
ZI'
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Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
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F:T't---
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Breakwater/Sill
-
i t
_
Lk
Xl
/
Max distance/ length
Basin, channel
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4
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—
-
Cubic yards
i
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Boat ramp
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Boathouse/ Boatlift
7
Beach Bulldozing
Other
----
SAV observed: Yes no
i-
Moratorium: n/a yes noSite
Photos: yes no..
Riparian Waiver Attached: yes no
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.
Agent or Applicant PRINTED Name - Permit Officer's PRINTED Name
Signature **Please read compliance statement on back of perfAit** Signature
Application Feels) Check#/Money Order Issuing Date
(Please Initial)
Expiration Date

CAEDGE &FILL
N9 90041 A B, c 'D
(il
❑MA ❑DR ,
Previous permit
GENERAL PERMIT Date previous permit issued
k]Mew ❑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 2 0 VD ❑ Rules attached. �'i3eneral Permit Rules available at the following link: w%vmdeq.nc.goy/CAMArules
Applicant Name %( Vi ryy
Address a I a A./Pn><•=rye:%l.
City state �f _ zip—" k ( I
Phone # (:' S•'..) S `)(.
Authorized Agent
Project Location (County):
Street Address/State Road/Lot#(s)
Email ra f ^0! 1( ) a ,�. o-, -(..u. q !-� ".'+ Subdivision
City {.'-..,-z.r Ca. J_ra.e.'_. zip
Affected ❑CW EW 0_PTA ❑ES ❑PTS Adj. Wtr. Body D(-"- / 16,at/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 i
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 i
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift 1 1
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:1 )
❑ 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

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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: I"r l c ji } c L r< K!
Address of Property: �� !✓E�%��l _DP
Mailing Address of Owner. -5AAW
Owner's email: MPM/ g2 !7 fMArl/ `Owner's Phone#:
Agent's Name: /✓i4 Agent Phone#: N4
Agent's Email: /V .17 _
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent 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
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 or coasrai
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 ttoowaive
'the setback, you must sign
the appropriate blank below.)
I DO wish to waive somelall of the 15' setback
Signature of acent Riparian Property Owner
-OR-
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:
ARPO's Phone
`waiver is valid for up to one year from ARPO's Signature'
Revised May 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER 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.
Nip-y{AEC k jONCx
S-! 4 /VIP )-v /vE 0
Owner's emait: /YI^Alf& ad meNQr` wner's Phone#: o1S2--3Z2-4
Agent's Name: /f/ 4 Agent Phone#: lylf
Agent's Email: /V14
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
100 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 hprap 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
Signature of Adjacent Riparian Property Owner
-O R-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Prop rty Owner: 7 "
Typed/Printed name of ARPO:
Mailing Address of A PO
ARPO's email: 's Phone#:
Date:- *waiver is valid for up to one year from ARPO's Signature*
.Revised May 2021