Borgmeyer, Nathan 90066C

0 1*°``°"""lac❑CAMA ❑ DREDGE & FILL NNI?90066 A B C D
—0GENERAL PERMIT Previous permit
y 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.deq.nc.gov/CAMArules
Applicant Name Authorized Agent
Address Project Location (County):
City State ZIP Street Address/State Road/Lot #(s)
Phone # (_)
Email
Affected ❑ CW
AEC(s): ❑ OEA
ORW: yes/no
❑EW ❑PTA
❑ IHA ❑ UW
PNA: yes/no
Type of Project/ Activity
Shoreline Length.
Access Length _
Pier(dock)length
Fixed Platform(s)
❑ ES ❑ PTS
❑ SPIMA ❑ PWS
Subdivision
City
Adj. Wtr. Body
Closest Maj. Wtr. Body
nat/man/unk)
(Scale:, ?r;: )
SAV observed: yes no i
Moratorium: n/a yes no Site Photos: yes no - -----
Riparian Waiver Attached: yes no
t
A building permit/zoning permit may be required by:,'�
❑ Permit Conditions TAR/PAM/NEUSE/BUFFER (circle one)
'
`'t'!
„{h+;,f < r ❑ 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
Signature "Please read compliance statement on back of permit"
Permit Officer's PRINTED Name
Signature
Application Fee(s) Check #/Money Order Issuing Date
Expiration Date

1o1COAST4I&c❑CAMA ❑ DREDGE & FILL N° 90066 A B C D
ti
Previous permit
y = 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:
I SA NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Address
City
Phone # (_)
Email
State I IZIP
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) 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
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by: _
Permit Conditions
(Scaler ♦ C; )
❑ 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

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Number:
Email Address:
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at _ £'' U C��✓� S`c'w� %'� . ����--.C.`��`
in County.
/ furthermore certify 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:
Signature
P�N\V. , Cl-
Print or Type Name
r.
Title
Date
This certification is valid through ��l_ts�1�
MAr� :), fl ,i, >

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: � �� �`' "���
r~
Owner's email: 0 rl),Y, Owner's Phone#:
Agent's Naive:
Agent's Entail:
Agent Phone#:
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 90 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 28557. ®CM representatives can also be contacted at [phone]. No response is considered the same as no objection if you have been notified ed Certified Mail.by
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 My§
the appropriate blank below.) sican
I DO wish to waive some/all of the IS ootbaok -.
�)
OR_ Signat leof Adjacent Ri a tan Pr y Owner
I do not wish to waive the 15' setback requirement (initial the blank)
%
''-- " Gignature of Adjacent Riparian Property Owner:
__77
Typed/Printed name of ARPO: 14 n(a Ai AA I
Mailing Address of ARPO:
ARPO's email:
D ARPO's Phone#:
Date: waiver is valid for up to one year from ARPO's Sign
Revised July 2021
MAP,

N.C. DIVISION OF COASTAL IUTANAOEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RErPIPT ► C:ni . _
(Top portion to be completed by owner or their agent)
Namer
p
e of Pro `
ry Owner:
CLt',N, llc� - ,
Address of Property:Jp
C \ 9 V l
Mailing Address of Owner: !�rc>`.
.1z,:n
Owner's email: 1`i , f -- ---
Owner's Phone#: e
Agent's Name:
Agent's Email:
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
N
ottom wortion to be cmmnoa,6, 4 — - ..
-- , %' G« Uwner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying
permit has described to me, as shown on the attached drawing, the development they are proposing.
descri tion or drawing,with dimensions must be rovided with this IettRr for this
p p rng. A
6AL-- 1 DO NOT have objections to this proposal.
If You have objections to what is mein i DU have objections to this proposal.
Management (®Cly1) in writing within 90 days of receipt of this notice. Correspondence should
you must notify the !N. C. Division of Coastal
mailed to 8- Comrrrerce Ave., Morehead City, INC 2ggg7. DCM representatives can also be conbe
at (252J Mail. 08. !No response is considered the same as no represen a you have ,been n ontac contacted
Certified Mail. (acted
notified by
WAIVER SECTION
I understand that any proposed pier, dock, mooring groin must be set back a minimum distance of 15' from my area of riparian access unless waived b
y m
(this does not apply to bulkheads or riprap revetmenpllings, boat ramp, breakwater, boathouse, lift, or
the appropriate blank below.) s). (If you wish to waive the setback, you must sL era
I DO wish to waive some/all of the 15' setback
-OR- Signature of Adjacent 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:
FrVlAPI'';
MAR
Mailing Address of ARPO:
ARPO's email: w _ �.� -C ��� ABC
ARPO's Rhone#: `lr
Date:`
-��*waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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