Parks, Joseph - 91400C

COAS741 ❑CAMA ❑ DREDGE & FILL NO* 91400 A B C D
y Previous permit
Date previous permit issued
GENERAL PERMIT
❑ 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 _
Address
City
Phone # ( )
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
P
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 lend
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift _
Beach Bulldozing_
Other
SAV observed:
Moratorium: n/a
Site Photos:
Riparian Waiver Attac
A building permit/zoning permit may be required by:
Permit Conditions
rit
(Scale: )
❑ 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 Fee(s)
Signature
Check #/Money Order Issuing Date
Expiration Date

❑ CAMA ❑ DREDGE & FILL INTO 91400 A B C D
GENERAL. PERMIT Previous permit
Date previous permit issued
0 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 _
Address
City
Phone # ( )
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
P
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)
f
j 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
f Other
SAV observed: yes no
IMoratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
i
j A building permit/zoning permit may be requirea Dy:
Permit Conditions
i
(Scale: )
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
0 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)
i
i
Agent or Applicant PRINTED Name
Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit"
'r Application Fee(s)
Signature
Check #/Money Order Issuing Date
Expiration Date

Styron, Heather M.
From: Karl Taylor <[e-mail]>
Sent: Friday, March 24, 2023 12:45 PM
To: Styron, Heather M.
Subject: [External] 1710 Tiny Bryan Road, Havelock
Attachments: 1710 Tiny Bryan Road.pdf; Flanagan - AdjacentRiparianForm.pdf;
Dabant - AdjacentRiparianForm.pdf; Agent Auth.pdf
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an
attachment to Report Spam.
Hi Heather,
Please find the attached documents for 1710 Tiny Bryan Road, Havelock. Please let me know if you have
any questions or concerns.
Thank you,
Kari Taylor
Eeue 'dice President

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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT RE VESTED ar HAND DELIVERY
(Top portion to be completed by owner or their agent)
Narne of Property Owner'. Joseph H. Parks
Address of Property:
1710 Tiny Bryan Rd, Havelock
Mailing Address of Owner:
5430 Adrian Road, VVilson, NC 27896
Owner's email: [e-mail]
Agent's Name: Carteret Marine Services
Agent's Email: [e-mail]
Owner's Phone#: [phone]
Agent Phone#, 252 631-9435
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Rortion to be c0m2leted by the Adjacent Prorty 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,
—7'--
Tf 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
-OR-
I do not wish to waive the 15' setback requirement (initial the blank) _D c��
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: Roy Flanagan
Mailing Address of ARPO: 4217 Pike Road, Raleigh, NC 27613
p c C
- -- ?z) ARPO's email: k 1AWt"sPhone#:/ _
Date:
*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 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: Joseph H. Parks
Address of Property:
1710 Tiny Bryan Rd, Havelock
Mailing Address of Owner'.
5430 Adrian Road, Wilson, NC 27896
Owner's email: [e-mail]
Agent's Name: Carteret Marine Services
Owner's Phone#: [phone]
Agent Phone#: [phone]
Agent's Email: [e-mail]
. ...... ... . On -
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom 2ortion to be completed by the Adjacent ProE!y 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 le
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 Mall.
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 sl9n
the appropriate blank below.)
.4 A
1 00 wish to waive some/all of the 15' setback
WOO"
Signature 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:
Typed/Printed name of ARPO: Ann Dabant
Mailing Address of ARPO: 338 S. Sharon Amity Road #179, Charlotte, NC 28211
ARPO's email: ARPO's Phone#*
Date: f *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
ff
2_3
Phone Number: 236 -7 041
Email Address:
'y
I certify that I have authorized
Agent i Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: �YlLk kA k PC Y( lio ADn S
at my property located at
-by o an at- _11W DC- 4 L_
V V
in LMfCA_, 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 application.
P owner Inforflulio-n:
Signatu
Print or Type Name
Title
Date
This certification is valid through 11