86827A - Houser, Jimmy

ateAS/u '�t: CAMA El DREDGE & FILL n (1 N° 86827 A B C D
GENERAL PERMIT +LI`� 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. ❑ General Permit Rules available at the following link: www.den.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # ( )
Email
State ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS
ORW: yes/no. PNA: yes/no
Type of Project/ Activity
Shoreline Length,
Access Length
Pier (dock) length
Fixed Platform(s),
Floating Platforms)
Finger pier(s)
i
I
Total Platform area
Groin length/!t--
Bulkhead/Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length Basin, channel
Cubic yards
Boat ramp:
-
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I
—--
-
-
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Boathouse/BoatliftBeach Bulldozing
Other
SAV observed: yes no (—
Moratorium: n/a yes no
Site Photos: yes no F,
F"
Riparian Waiver Attached: yes no _v
A building permit/zoning permit may be required
Permit Conditions
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City ZIP
Adj. Wtr. Body '(nat/Jnan/unk)
Closest Mai. Wtr. Body -
(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"* Signature
Application Feels) Check #/Money Order Issuing Date Expiration Date

MAR 0 6 2023 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: Q 0 /'7 M h PO t4 S f
Address of Property: 7 s 0771°i LAN A C �yY
Mailing Address of Owner. s/V/✓!
Owner's email: ��� Owner's Phone#. � %' ��� / ? 3`
Agent's Name: iuyC1 � jn 1@ i�*C— Agent P1h`o%ne,,#, �33/`
Agent's Email:—Tt�rAodG�I I ' cx(-i/l Pe, / 6—A r ° L ` /v /vL
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.
ti 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 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909- 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.)
1 DO wish to waive some/all of the 16 setback 0 ;//1/-
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:
Mailing Address of ARPO:
ARPO's email:
Date:
ARPO's Phone#:
*waiver is valid for up to one year from ARPO's Signature`
�a de',
PleG�e (Zesatbrn4 0, Bo/ lla5
eqq

MAR 0 6 2a23
N.C. DIVISION OF COASTAL MANAGEMENT
�' CM
'* Is -E ADJACENT CERTIFIED � AIL - RETURN RECEIPT PTREQU REQUESTED orIHAND ADEE M VERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: ..I
Address of Property: _ ! t, ,5
0 /-
Mailing Address of Owner: > 7
Owner'semail:.__. 'I Owner's Phone#.11' (P- 5-t?'- 1! `-�e`
Agent's Name: s-Afttidyo�[
Agent's Email:._____ I"
Agent Phone#:,r�
o (9aw,
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Ad(acent Property Owner)
I hereby cortity that I own property adjacent to the above referenced property. The individual applying forthis
permit has described to me, as shown on the attached drawing, the development they are proposing. A
descnen or drawing with dimensions mus be pro
ptivided with this letter.
7 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 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Cerhfrred AfafL
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
-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: {-1" r_r{ 1� (yj } r'.-Y' p.-+
Mailing Address of ARPO: �� 1 I y + 1 iE " {- � ("-(J + N Q,
ARPO's email: ARPO's Phone#: lc t` l
!late: `waiver is valid for up to one year from ARPO's Signature`

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pe'r(V-,f T�S�tER 01,0- �iretf, o6 JaVf:xG
-. y7CAMA/ ODREDGE &FILL 1
®GENERAL PERMIT Cep' B C— D
Previous permit #
WNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
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 r/ �'� ' /.1 cx'.'
ORulesattached. '"—
Applicant Name I%(YtVN. 1•� x,..J�''>•' Project Location: County
Address— je�t _ _ Street Address/ State Road/ Lot #(s) LY
City1' ,a,_. rTSr-C State_N('_ ZIP o2•) `7'cf.9
Phane # (n7`/A) : 3 j"" 1`l 3`1 E-Mail _ Subdivision �;VCYS c c CP 12
Authorized Agent City rlr z6 ZIP
Affected DCW INEW V)PTA DES ❑PTS Phone#
River Basin
AEC(s): D OEA ❑ HHF D IH D UBA O N/A
El PWS: Adj. Wtr. Body_�ij_}-�{ _b y ,r O<iWyma,tn_Lunkn
ORW: yes / (o ) PNA yes / r�,�) Closest Mai, Wtr. Body— ` l eI C.tr Ic Jo•,.:.r6'"_„__--
Type of Project/ Activity
Pier, (dock) length_
Fixed Platforms)
Floating Platform(s)
Finger pier(s) '
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore -
Basin, channel ^` -
cubic yards_
Boat ram
BOatilunSO/ Boadift I
Beach Bulldozing_ _-
Other - - "-
Shoreline Length _1_f C_i- r
SAV: not sure yes
Moratorium: LNa\ yes nu ei
Photos:
es no
Waiver Attached: yes no .- -
C -�
A building permit may be required by:
( Note Local Planningjurisdiction)
Notes/ Special Conditions 6
.J f
Agent or!
compliance statement on back of permit **
Application Fee(s) ("k—u x
(Scale: 1.l' SCSI
h
3 �y
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❑ See note on back regarding River Basin rules.
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