Mueller, Lorna & Greg - 88964C

o1*°i& FI CAMA El DREDGE & FILL NO 88964 A B C D
;
y = 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:
5A NCAC `1 i� ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name`
Address
City StateZIP
Phone #
Email Subdivision
city ..t ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body `' .,h- """' "`, l.' �l -e (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Authorized Agent (i
Project Location (County):
Street Address/State Road/Lot #(s) '
Type of Project/Activity i"'�'�J�'�e_`:�'=4 C��.�Y"�t�'�cit %�'� �.)
(Scale:
Shoreline Lengtl
Access Length _
Pier (dock) lengl
Fixed Platform(s
Floating Platforr
Finger pier(s) _
Total Platform a
Groin length/# _
Bulkhead/ Ripra
Avg distance off
Breakwater/Sill
Max distance/ IE
Basin, channel _
Cubic yards _
Boat ramp
Boathouse/Boa
Beach Bulldozin
Other
SAV observed:
Moratorium:
Site Photos:
Riparian Waiver
A building permit/zoning permit may be required by: , _.� �1 � �C``.��'i � . t'�t` �'i Y'�`�" �1
Permit Conditions �� '''y ;''� _ ` `( °' +'' !•»,.;),{{ '" `> r '"- ' t 'r� ❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
V-
❑ 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

���`°"�'�N- ❑ CAMA ❑ DREDGE & FILL T 88964 ABC D
c
y =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:
15A NCAC t ?-f ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name y1,R + =, rrt wlt'111'
)
Address
City 6 ;t: �' y.. State ilk ZIP
Phone # ( ) I
Email
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s) 2 J!�� t i i 1` 5 L," .
Subdivision
City �'4 : + .. ZIP C`.'' r
Affected ❑ CW `f EW ❑ PTA ❑ ES 1-1PTS Adj. Wtr. Body r' ` ` ` `'' !'" .. `tiT' ,l' %� (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ ActivitydC'%t" f gi"t 1,�' i`i'`Y'�'
(Scale:j\�
I
Access Length
i
Pier (dock) length
.
I l.........................................
Fixed Platform(s)
i
_
_.............. .... ..
.........(....
Floating Platform(s)
Finger pier(s) ............ .........................
.......................:.........................................................
...
...
i
~
Total Platform area".
w
Groin length/#
Bulkhead/ Riprap length ...................................
Avg distance offshore
......... ... ............ ......
..........................
..... .............
..._
i Breakwater/Sill ....
Max distance/ length
w
}
-j-0--
Basin, channel
.......... _.i
. .
;
.... ___ . .... _ .
_.._.,.... _._...
Cubic yards l
�.....
Boat ramp
i
Boathouse/ Boatlift
Beach Bulldozing"
i*.
..........................._......................_.._............`
^:......... ti.....
.....
............
............. :.............
............
Other al
'
3
SAV observed: yes no
Moratorium: n/a yes no
w
t(._._
`
Site Photos: yes no
I
.................._._._...._y_........._..............
i
.........
. ...
Riparian Waiver Attached: ves no
A
A building permit/zoning permit may be required by: _
Permit Conditions~'"
r tf:. r ` f'f , y.) I ❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
,r
❑ 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)
1
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit"
Application Fee(s)
Check #/Money Order
Signature
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit.
Mailing Address: �-� i�,� Dr.
rr-f
Phone Number: 04 75
Jt
Email Address: ��"�` Af
certifythat I have authorized '36 !�'�' /
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development- C
at my property located at I�G�d.t J4,7 � J'; / 6t)d 1el't '['
in County.
1 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 r Type Name
Title
D ate
This certification is valid through � / %

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)
NAmP of PrnnPrty Owner I Or ,�, �+ 477r(fel
Address of Property
5 2-
AIC Z,0539
J
�) 7 .►q
Mailing Address of Owner: t�, O ► I F��� �"�r C'��`J�J
Owner's email: NJ Owner's Phone#:'
Agent's Name: ��� �� Agent Phone#:
Agent's Email � � G� �� C0yrl_
ADJACE'Vi T 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 some/all of the 15' setback
Signature of Adjacent Riparian Property Owner
-O R- f
I do not wish to waive the 15 setback requirement (initial the blank) l_ f
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: O,A_az t— L—,
Mailing Address of ARPO: 2 I c 4c",
ARPO's email:
ARPO's Phone#: 9 iv 3 N 9 0 zs—
Dater 4-3-2-3 *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 NOTIFICATIONNWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner.
j rt 1-' 67 r 5, M,)(-1-1 fltl
Pr N4,)t
Address of Property.0, ;3,, 40
, 1 /
Mailing Address of Owner:
Owner's email: Owner's Phone.#:
Agent's Name:
�i'- -- Agent Phone#:�-
4b,
�, 1Agent's Email: rJ� cc, M
M�JV Iti ilk IIIIII
I /ti1�1 1 1 Q \ 1 ■ s t
(Bottom portion to be completed by the Adiacent Property Owner)
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.
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. Correspondence Division
of should al
Management (DCM) in writing within 10 days of receipt 57, �C�seprtesentat representatives an also be contacted
be
mailed to 400 Commerce Ave., Morehead City, NC
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 setback waived
au must me
(this does not apply to bulkheads or riprap revetments). (if you wish to waive the , Y
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
lc y ;a�urg of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank) _
Signature of Adjacent Riparian Property Owner: �y�g/yg@ �4
" e'f L-
Typed/Printed name of ARPO:
Mailing Address of ARPO:_U
ARPO's email: ;(. ARPO's Phone#:
Date. i 5l a 3 *waiver is valid for up to one year from ARPO's Signature
Revised May 2021
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