Lewis, Mark - 84263C

yes
Yes
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1141 oNlcar 5i-
IS) GENERAL PERMIT Previous permit —
'� / Date previous permit isstA:rl i
[q ew ❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized by the State of N�l
North Carolina, Department of Environmental Quality and the Coastal Resources Commission In an area of environmental concern pursuant to:
I SA NCAC V 1 LI . 1100 0� !� ❑ Rules attached. Q General Permit Rules available at the following link: wwwdeq.nc gov/CNMmles
Applicant Na{{ma , A Authorized Agent
Address ' 1 O Y ``�Ii c (- _ Project Loatfon (County);
City State W(� Mp ! Street Address/State Road/Lot#(s)
77
Email CAY�1Li.CA�31S fdi e.Y!%rXY7! V/\ A4 . [,V M Subdivision
Clay ZIP _
Affected ❑CW ffEW OKA ES ❑pTS Ad). Wa. Body rat/ n/unk)
AEC($): ❑OEA ❑IRA ❑UW ❑SPIMA ❑PINS Closest Mal. Wtr. Body IVQIA] �Jl'r �v
ORW: ye n3f PNA:
Type of Project/ Activity j W e
11
Shoreline Length 100 VXll5
Access Length
Pier (dock) length 1� rr--ssrr,�
Fixed Platform4s) z: c, 2) --_' - -
Floating Platform($) 1�
Finger pler(s)
Total Platform area low-
Groinlength/# /
ulkhea iprap length / Mb
Avg distance offshore
Breakwater/Sill
Max distance/length
Basin,channel /"
Cubicyards
Boat ramp
Boathouse/BoatliR /
Beach Bulldozing /
Other
SAV observed:
Moratorium: n/a
Site Photos:
Riparian Waiver Attached:
A building permlt/zoning 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. (Pleaselnitial)
MAAft� L, uW,S
Agent 'orr Applicant PRINTED: dame / Permit)d)IBcer's PRINTEDJYaae ,
Signature "Please read cmripliance statement on back of permit'"
Application Fee(s) ck" oney Order

#E�J/Nevv
DCAMA ❑ DREDGE & FILL N° 84263 A s (DCD
Previous permitGENERAL PERMIT Date previous permit issued ❑Modification ❑ Complete Reissue ❑Partial Reissue
As authorized
bby�the
eSState ofN/orrth Caryolina, DeJp�.a(_rtmennt of (En1vironmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I5A NCAC t/ I l 1 ,' 1 lJ0 1 �� ` 1 � ! r J0 ❑ Rules attached. [ General Permit Rules available at the following link: www.dea.nc aov/CAMArules
Applicant
Phone # (`1L_VI 'JrAU
1
Email �fAr�) PAr�.IyS
Authorized Agent /
Project Location (County): O `S 10
Street Address/State Road/Lot #(s)
Subdivision
City ZIP
Affected ❑CW E�PfA Es ❑PTS Adj. Wtr. Body fn(n an/unk)
AEC(s): ❑ OEA ❑ IHA ❑]rU.W ❑ SPIMA ❑ PWS Closest Maj. Wtc Body
ORW: ye0 }�PNA: yeNaD t-�� ^r\ `
Type of Project/ Activity -0d- td W � I W (i
Shoreline Length I �/
Access Length
Pier (dock) length
Fixed Platforms) )O (lam (i _5 2)
Floating Platform(s)
Finger pier(s)
Total Platform area (OOO-
Groin length/N /
Bulkhead iprap length fi00
Avg distance offshore /
Breakwater/Sill
Max distance/length
Basin, channel /
Cubic yards /
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing /
Other
SAV observed: yes
Moratorium: n/a yes
Site Photos: yes
Riparian Waiver Attached: yes no
A building permit/zoning permma it be rr
Permit Conditions
Agent or Applicant PRINTED Name
� clu_`Lo
to �C I 0c), S k 6 e_ T"o
I 1 le OCAJ t car 5�'
Signature **Please read compliance statement on back of permit** �-7
IL
Application Feels) heck H oney Order
AND REVIEWED
(Scale:R �)
TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
See additional notes/conditions on back
(Please Initial)
Permit fticer's PRINTED a e
SiVure
fi 13 1202,3
Issu ng date Expiration Date

#[71New
❑CAMA ❑ DREDGE & FILL N° 84263 A B C D
Previous perm
GENERAL PERMIT Date preio slpermitissued
❑ 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: w ..deq.nc.gov/CAMArules
Applicant Name
Address
City State
Phone # ( )
Email
ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision J
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body 1 d Tnat%1ti, an/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body
ORW: yes/no PNA: yes/no
i
Type of Project/ Activity 1
(Scale: f1 S j
Shoreline Length
Access Length -,
Pier (dock) length 1'
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
ruhir vnrdc
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed:
yes no ( - j
Moratorium: n/a
yes '. no i
Site Photos:
yes 11 no
Riparian Waiver Attached:
yes no
A building permit/zoning permit may be required by:
Permit Conditions
I
I
I
ir
TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
See additional notes/conditions on back
1 AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name
Officer's PRINTED Name
Signature "Please read compliance statement on back of permit"
Signature
Application Feels) -Check#/Money Order Issuing Date Expiration Date

00"'141&❑CAMA ❑ DREDGE & FILL NQ 84263 A B "C 1)
Previous permit
4.�3 4. 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 i i ❑ Rules attached. 0 General Permit Rules available at the following link: wwwdeg nc gov/CAMArules
Applicant Name Authorized Agent
Address -4 Project Location (County):
City State ZIP Street Address/State Road/Lot#(s)
Phone # ( i -
Email Subdivision
Affected ❑CW DEW ❑PTA
AEC(s): ❑OEA ❑IHA ❑uW
ORW: yes/no PNA: yes/no
Type of Project/ Activity
❑ ES ❑ PTS
❑SPIMA ❑PWS
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platforms) I '
Finger piers)
l � I
i � !
Total Platform area (( i
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore i
Breakwater/Sill
Max distance/ length It
Basin, channel i i
Cubic yards ( 1t
Boat ramp
Boathouse/ BoatliR I
Beach Bulldozing
Other
4
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
City
Adj. Wtr. Body
Closest Maj. Wtr. Body
(Scale:,
1
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. (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 JJ/Money Order Issuing Date Expiration Date

■ complete items 1, 2, and 3.
" '"'"""'-'" Agent
■ Print your name and address on the reverse
X ❑ ddresses
so that we can return the card to you.
B. ecelved Panted Name) to D 'v
Ill Attach this card to the back of the mailpiece,
or on the front if space permits.
Y
1. Article Addressed to:
D. I delivery address different from Rem 1?
1 YES, enter delivery address below: ❑ No
�DSef�i .C4e. D( A
S,VeAk d �'�6
Service Type ❑ Priority Mall Express®
r
II I lll3.
❑ Aduk Signature D Registered Mail*a❑ Adult signature Restricted Delivery ❑ RDegl eared Mail Reatrlctetl
151911
9402 7769 2152 1017 37
Certified Mail® 1'0
❑ Certified Mail Restricted Delivery EI Signature D Signature Congrmatlon�
❑ collect on Delivery
❑ Collect on Delivery Restricted Delivery Restricted Delivery
❑ Insured Mail
2. Article Number (Transfer from Semice label)
7021 2720 0002 4273 8771
I'IResiricled Delivery
Domestic Return Receipt
PS Form 3811, July 2020 PSN 7530-02-000-9053
Is Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Sef1/4,4✓e.✓ )(V LLC
sfie ,26o0�S
III'lllll I'll I'lll'lllll III II II I III II I IIII I III
R
❑ Agent
B. eceived by (Panted Name) C. Date of Delivery
�IUhel Kpu�� ' In 123
D. Is delivery address different from item 1? ❑ Yea
If YES, enter delivery address below: ❑ No
IDc
9590 9402 7769 2152 1017 20 0 t
Dr
7021 2720 0002 4273,8764
PS Form 3811, July 2020 PEN 7530-02-000-9053
Delivery Restricted Delivery
e
AI Restricted Delivery
❑ Priority Mail ExPresO
❑ Registered Mail-
0 Registered Mail Restricted
calivary
❑ Signature Confirmation-
❑ Signature Confirmation
Restricted Delivery
Domestic Return Receipt

=_C. DIVISION OF COASTAL MANAGEMENT
:OJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
=R T iFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
0 op portion to be completed by owner or their agenti
Name of Property Owner. I r! /i /V- ,1VIQ Lo, S /r
Address of Prooerty: I io ! r l C , C"'t A CY J ejoS pPz/L,
Mailing Address of Owner ((a /ylCJi,Cnrt-
Owner's email: Mj4PKCeLy,g2en�tdkeemol.O ner'sPhone*; %/o Sao-Sard'
Agent's Name:
Agent Phones`
/4)e "WW'el
lgenfs Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(-Bottom portion to be completed by the Adjacent EM1121 v OwneF
,ereby certify that I own property adjacent to the above referenced oroperty. The individual applying for this
Permit has described to me, as shown on the attached drawing, the development they are proposing. A
I cnttlon or drawing. with rrtmensinnc m—+ K- ..'� .:._ ._.._
NOT have objections to this proposal. 1 DO have objections to this proposal.
rr you have objections to what is being proposed, you 'must 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 some/all of the 15' se
-OR- signature of Adjacent Ripanan Property Owne-
I do not wish to waive the 15' setback reauirement (initial the blank)
Signature of Adjacent Riparian Property Gwnen
Typed/Printed name of ARPO:
Mailing Address ofARPO: dal 1160it thti-e , eAcQ3 �/1/Cyi �e /i0G,',
ARPO's email:
ARPO's Phones,:
gate: 2 L o b o 'waiver is valid for uo to one year from ARPO's Signature'
'devised Mav mi

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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: / 7 /)9/2k tow, S
Address of Property
-
Mailing Address of Owner.
Owner's email: r �i111K L2 �r t FCJ Pv/1 OOwner Phone* —9/0- J do J a
,Agent's Name:
Agent Phone#:
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be comnleted by the Adjacent Properly Owner)
9'yY'4' a
A/C e9Y'16o
I hereby certify that I own property adjacent to the above referenced property, The individual apply 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.
it you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (OCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City, MC 28557. DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection if you have been notified by
Certlfred Mail.
WAIVER SECTION
1 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 nprap revetments). (If you wish to waive the setback, you must sion
the appropriate blank below.)
I DO wish to waive some/211 of the 15' setback
Signature of Adjacent Riparian Property Owner
1 do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner
ryped/Printed name of ARPO: rtQc—
c52fa
i I �} 11 B
/e VC C
#failing Address of ARPO: 9 Sa /
0-t,cX 0.
ILI Ue-
S�Coi(g O-a' '&Mo,41 % L .336 FS
ARPO's email:
Date:
ARPO's Phone#:
*waiver is valid for up to one year from ARPO's Signature'
evised Mav 2021

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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit'
Mailing Address:
Phone Number:
.mail Address:
I certify that I have authorized
Agent 1 Contraccc
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
,
in County.
I furthermore certify that ! 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 apolication.
Property Owner Information:
-Tint or Type Name
Tiff.
This certification is valid throuorF

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: m)VLz acol S
Address of Property: Ul Ca o
Mailing Address of Owner: n a M C V t CRR.. /
Owner's email: /Yl/1i2/C.Lpw� s CPPM` B7d1lb`Nne s Phone#: 9/D sad swig
Agent's Name:
Agent's Email:
Agent
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 proposea, you musr noury me rv.6. urvrWorr ur UUdDLdr
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 some/all of the 15' setback
Signature of Adjacent Riparian Property
M
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#:
Date: *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

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