89607A - Smith, Gary & Barbara

,DREDGE & FILL N9 89607 A B C D
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
I SA NCAC
❑ Rules attached.
General Permit Rules available at the following link: wwwdeq.nc.gov/CAMAnuIes
Applicant Name
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Authorized Agent
Address
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Project Location(County):
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City
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ZIP M._.yyt�tal
Street Address/State Road/Lot#(s)
Phone#( i --:)I
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Email 1'7ct✓ Y):Lc%/A
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Subdivision j0, t' Y-•'r"
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City
ZIP
Affected ❑CW NEW PTA ❑ES OPTS Adj. Wtc Body i I y ¢= ' (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA 5W ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body ,j t
ORW: yes') o) PNA: yesj no IF
Type of Project/ Activity
Shoreline Length _
Access Length _
Pier (dock) length
Fixed Platform(s).
Floating Platform(s)
Finger pier(s)
Tote lgarea /
len
Groin length/q s
^-Bulkhead/ Riprap length '14 ) I
+',Avg distance offshore
Breakwater/Sill'--•^^'^"'
e, Max distance/length-+—.-
Basin, channel
Cubic yards
-"-'--"
--� --- -
Boat ramp
Boathouse/Boatlift ?}
Beach Bulldozing
rothel �?f'
SAV observed: yes no
Moratorium: - n/a yes no
-----
SitePhotos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may he required by.
Permit Conditions ... ,.. .
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(Scale: r'c
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❑TAR/PAM/NEUSE/BUFFER(circle one)
ftt ❑ See note on back regarding River Basin rules
,r fi , ,� i R t-j tY ( r �J I r I ❑ 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
'AiApplication Feels) Check It/Money order Issuing Date Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
Name of Property
Address of Property:
(Top portion to be completed by owner or their agent)
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Mailing Address of Owner: �oArye, 0-S
C°^^ 1 1 �r1 5- - cogs
Owner's email: Bcu-6a{eOwner's Phone#:
Agent's Name:
Agent's Email:
Agent Phone#:
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
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 noory me rv.L,. uwiswn v,
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 (Choose only one)
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 riprao 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)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of AR
Mailing Address of ARPO:
ARPO's email:
Date:
ARPO's Phone#:
*waiver is valid for up to one year from ARPO's Signature*
JAN 7 7 ZliZ3
®CM-E.G
Revised August 2022

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 Owners k-,)W LC.0 CA_ 11 �r I I I r v I 1
Address of Property: 633 -.�t I� © 16. �CO aa,� `,w- -)u
Mailing Address of Owner: ROrY\e ci-S clpQn
Owner's email: Box-6anOwner'
��}s Phone#: I L'
7'7 37z
Agent's Name: Agent Phone#:
Agent's Email:
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 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 (Choose only one)
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 ofAdjacent Riparian Property Owner
RE dIVED
-OR-
I DO NOT wish to waive the 15' setback requirement (initial the blank) y1jr- 2023
lAN 1
Signature of Adjacent Riparian Property Owner:
EC
Typed/Printed name of ARPO: V\ t \ \ f/j-16 K kw / CNN 04 IJ �-
Mailing Address of ARPO: \ � 3 C 0 0 V_ LA jJ � I tJ L p� �j 2 t
ARPO's email: 'n iN E � 1t ' CA I ARPO's Phone#:I �7 � � b _� l0
Date: t�i 'C k 1 2 'waiver is valid for up to one year from ARPO's Signature'
Revised August 2022

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