86888A - Lanb, Allen & Connie

AdOmy" OCAMA ❑ DREDGE & FILL N9 86888 �K (Ai B C D
go) GENERAL PERMIT Previous permit
: Date previous permit issued
[XINew ❑ 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. Y❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMAruks
Applicant Name Authorized Agent
Address Project Location (County):
City State ZIP Street Address/State Road/Lot #(s)
Phone # ( )
Email Subdivision
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (naU,man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body
ORW: yes/no PNA: yes/tto
Type of Project/ Activity
(Scale: )
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/p
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/Boatlift `iJ
Beach Bulldozing
Other
SAV observed: yes r no 11-7
Moratorium: n/a yes no Tet(
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required
Permit Conditions
❑ TANPAM/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)_j�
I
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature **Please read compliance statement on back of permit**
Application Feels) Check q/Money Order
Signature
Issuing Date
Expiration Date

N.C. DMSION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTiFiCATIONIWAIVER FORM MAR 2 0 2023
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent) D C M W E C
Name of Property Owner. r &!sr bled" Lz,," J'
Address of Property:
Mailing Address of Owner /Z. 7 U-'t'r We )a P/r} b L( fv C 7 -7S YY
Owner's email: alkw ie^tvN Snp WAgv. cOtmees Phone#: 2 SL- S)Z -(a (o
Agent's Name: Ina- '/I &� _A( -
Agent's
Agent Phone#. ) -,-3 L—& d
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owned
I hereby certify that 1 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 pmposmg_ A
if you trove of oms to what is being proper you must nofffy the N c wwsron or vOOS r
Management (OCtlt? in wn&W within 10 days of receipt of M15 notice Correspondence should be
mailed to 401 S. Grrifp St, Ste 300, Effmabeth City. NC� 2790! DCM rqueserdadves can also be
contacted at(2VJ 254s, 9 - No response is considered the same as no objection if you have been
notified by CedfRed Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp. breakwater, boathouse. K or
groin must be set back a minimum distance of 1T 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 somelall of the 15' setback
Signature of Adjacent Rpawn Properly Owner
EEO
I do not wish to waive the IF setback requirement (Initial the blank)
Signature of Adjacent Riparian Property Owner.
TypedlPrinted name of ARPO: < A- L Va y s T E
Willing Address of ARPO: I U l 1 e r v i l y ,�5 r (N h �
ARPO's email: Na )VU;�' L 6WASPO's Phoneme
Date: 'waiver Is valid for up to one year from ARPO's Signaure

N.C. DNISION OF COASTAL MANAGEMENT " " C 9 " E
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATiONIWANER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY MAR 2 0 2023
(Top portion to be Completed by
/I owner or their agent) D C M o E C
Name of Property Owner 6/Jew a (ns w L CrM b
Address of Property: l77 D-ii/' LJt del'%'A N C 276 `f 4
Marling Address of owner. I ZZ 6 Are w v / den � �rof N, C
Owner's email: � .�o.�� �wnn rj� Q�oacc,,.�driOwner's
Agent's Name:�Q�I�i�I o.-tI- Agent Phone#. Ds P 331
Agents Emait
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be cornoleted by the Adjacent ProperW Owned
I herehycertify Quit I own property adjacent to the above referenced property. The hwfividual applying forthis
permit has described to me, as shown on the attached drawing, the development they are proposing. A
description or d9wWwith danenskm must be provided with this letter.
I DO NOT have objectons to this proposal. 1 DO have objections to this proposal.
ff you haws oohs to what is being Pry you must noddy fire NC Division of Coastal
Uanglement (DCN) In wriffiW within 10 days of receipt of 0ft notice Correspondence should be
Dialled to 401 S. O iin St, Ste 30% Elizabeth 0% NC, 27M MU representatives can also be
canUcied at-M 204.390 . No response is considered the same as no objection #you lava been
notified by CedWed Nail
WAIVER SECTION
I understand that any proposed pier, dock, mooring ptgngs, boat ramp, breakwater. boathouse. ItR, or
groin must be set back a minimum distance of I from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revelments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
100 wish to waive some/all of the 15' setback
- ignatu a ofAdacentRiparian Properlyter
-OR-
I do not wish to waive the 15' setback requirement (nitiai the blank)
Signature of Adpnoent Riparian Property owner:
TypmWrk ted name of ARPO: ) 0 r a h / n l
Mailing Address off ARPO: I 6 +4- e L� a u r � � e� + ) o
f
k�a.ro;1 Q �'- n V. _ 0,
ms
ARPO's eail:.5 ARPO's phoneik -7 D 3 —3
Date: '3 / I / )� .3 'waiver is valid for up to one yearf om ARPO's SignaLue

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