Meetz, Andy 91130

,`°"'" U CAMA ElDREDGE & FILL N9 91130 A B D
GENERAL PERMIT Previous permit
Date previous permit issued
New ❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized by thq 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 State
Phone # O j -. i'• ( - J l
Email
Authorized Agent 1 i'
Project Location (County): %
Street Address/State Road/Lot #(s)
I('
Subdivision
City
Affected ❑ CW NEW ❑ 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 !2 A/0111A N"/)'1--
Pier (dock) length X/)D/ IY11n'l
Fixed Platform(s) It ` )
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore_
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 required by:
Permit Conditions
(Scale:
l ❑ 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** -
Application Feels) Check #/Money Order
Sieyr`atUre .I
I �'.1,-)
Issuing bate Expiration Date I

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L CAMA ❑DREDGE & FILL N9 91130 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:
I SA NCAC ❑ Rules attached. N` General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant I
Address _
City
Phone # (
State ZIP
Authorized Agent
Project Location (County):
StreetlAddress/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 Mal. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
� t
(Scale: z )
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 i
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
Permit Conditions
i
❑ 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 Initial) _
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #/Money Order
Sigrlatyre'+
Issuingbate �xpirklon Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address: o i
_L 5 \jiRn Nod -L)O23
Phone Number:
Email Address:
I certify that I have authorized a --) QS 1-0 ei
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: R ` t) j C)O C-,c-
at my property located at � q \ �3 V- k v r' Q- o v) P 11 L�--a-tvd C N .0 ,
County.
l 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:
Signature
Print or TyPe Name
Title
2'Z
Date
This certification is valid through / !
DCI,r9- P8 tJ ti i': fi

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONANAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner. V) J r� I�� E 1 L-
Address of Property: N- iy tL I \a J� n
Mailing Address of Owner -�5 Nl ^� ; ! rd r Lc r•. t5 •y / I N. ,C .
Owner's email: � Owner's Phone#: 2 T z U S J
Agent's Nam (
e: r %-JQ_Q v) &'2 - Jg e3 Agent Phone#:
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
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 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 must sign
the appropriate blank below.)
I DO wish to waive sometall of the 15' setback
Signature of Adjacent Riparian Property Owner
M
1 do not wish to waive the 15' setback requirement (initial the blank)
X Signature of Adjacent Riparian Property Owner:
hr Typed/Printed name of ARPO:
r Mailing Address of ARPO:
X ARPO's email:
Y Date:
ARPO's Phone#:
`waiver is valid for up to one year from ARPO's Signature'
z-� o z_3
Revised May 26 .I(., E IV r.Imo,
JAN 17 21123
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JAN 17 20M

■ Complete items 1, 2, and S. A. Signatl
■ Print your name and address on the reverse X
so that we can return the card to you.
■ Attach this card to the back of the mallplece, B. Repels
or on the front if space permits.
1. Article Addressed to: D. Is deliv
If YES,
l�l Dat1-iz- Covl2"t-
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IIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIiII ❑Certfiea
9590 9402 6498 0346 6936 77 0 Ceruff"
❑ collect,
2. Ankle Number (6ansfer from service label) D Collect,
7022 1670 0003 0450 14260Insured
PS Form 3811, JDIy 2020 PSN [5 U- 2-ODD-9053
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address below: ❑ No
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❑ Signature Confnnation
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rOPCEIVED
lAN 17 2023

1/16123, 3:18 PM
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N.C. oMSION OF COASTAL. MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWA1VER FORM
CERTIFIED MAIL • RETURN RECEIPT RE U 5 or H SLIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner.
Address of Property: ^1
Nailing Address of Owner !� t C` rS i j (�014 Lc W- i-S . r-3I j� rN
Owners email:
Owners Phone# C CJ�O
Agents Narne: t 449<y) fJ4 - +'t6—� 5
Agents Email:
Agent Phone#' ,5 -Z
C.o,'q
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be corn Md by the Adjacent Property Ownarl
I hereby certify that I own property adjacent to the above referenced property. The individual applying sorties
permit has described to me, as shown on the attached drawing, the development they are proposing. A
desc v an or drawing with dimensions must be provided with this letter.
1 DO NOT have objections to this proposal 100 have objections to this proposal.
if you have objections to what is being pr000sen, you musr nuury uie rn. , ,�. ,. �• o�=�•
Management (Dcm) in whiting within 10 days of receipt of this notice_ Correspondence should ba
mailed to 400 Commerce Ava, Morehead City, NC 28557. DC11M representatives can also be contacted
at [phone]. No resoonse is considered the same as no objection if you have been noised 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 1 6 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 somelall of the 15'setback ,>9'
Sic nariu`"`ie of Adjacent Riparan P er y owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
X Signature of Adjacent Riparian Property Owner
r lypediPrintednameofARPo: E Camille Shelton
Mailing Address ofARPO: 4320 Keith Hills Drive,La Grange,NC 28551
[e-mail] 2525601710
X ARPO's emait: ARPO s Phone#:
Date: 1/ 14/ 2023 *waiver is valid for up to one year from ARPO's Signature'
Revised Allay 2021
iI%arJ- :a �l:r (;; y
https://maii.google.com/mail/u/0/#inbox?projector=l 117

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RF.rFIVED
JAN 17 2023
M-MMI) CITY