89649A - Humphries, Romona

otmr* ®CAMA W DREDGE & FILL N° 89649 OB C D
fA GENERAL PERMIT Previous permit
+ Date previous permit issued
OgNew [:]Modification [-]Complete Reissue El 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 714 r 1100 I] Rules attached. IK General Permit Rules available at the following link: w%W dea.ncgovlCAMArules
Applicant Name
Address t' 4
City —Imi,
Phone # 211:0
Email ss
(*P4P- Pa
12
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Authorized Agent ri, M.
Project Location (County): e_v
Street Address/State Road/Lot #(a)
Affected Elm ZXW 2,PTA OF$ CK"S Ad). Wtr. Body tt] u nth, /LG (ZgnaMunk)
AEC(s): � OEA � IHA � U W � SPIMA � PWS Closest Mal. Wtz. Body 0 o h Lag el I'
0.�12 i d a r
ORW: yes(19 PNA: ye�
Type of
Shoreline Length
Access Length _
Pier (dock) lengtl
Fixed Platform(s)
Total Platform area
"a
ulkhead/ pray length 5GT
vg ntan[e o%shore �..
Breakwater/Sill _
Max distance/length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
hl GAS+
t3oa+inats��.'
S©o pRoPosl✓p
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REPLAC CM C-AST;,
4/. 2bit `
lro N C DOT
12 ow
(Scale:14
'FULL 3Ay
- E ast Access (eawi-k
I-IUldi in�5
SAV observed: yes `'Y 1 /
Moratorium: yes no
Site Photos: no
Riparian Waiver Attached: s no
A building permit/zoning permit maybe required by: CAIf V-1 "''U/f'�C� C^U N+T
Permit Conditions ._gt--P— TSGAG o�71�. (i lS ,Ll._[_L1tli�rza I
1,1521 ♦D
I,
[TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
See additional notes/conditions on back
nemwwt
2 4ll 7 /2oz,� s3 /17 zox.3
Check H/Money Order Issuing Date E piration Date

❑CAMA ❑DREDGE & FILL N9 89649a_ A ;B C D
° Previous permit
G E N E RAL 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:
1 SA NCAC - ❑ Rules attached. ❑ General Permit Rules available at the following link: vwwvdeq.nc.gov/CAMArules
Applicant Name V j - Authorized ,agent � •-(�l
Address Project Location (County): t
City State ZIP? Street Address/State Road/Lot #(s)
Phone#O 11.%,.:2..1 I�..:k -�._ i.•.,i
Email FJ tr " *.jam Subdivision
city ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES :PTS Ad!. Wtr. Body j' i,V O'a� i I �1 an/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Mal. Wtr. Body t��r-i4""{-I i..--.i I 7+
ORW: yes/no PNA: yes/no {{ II !
Type of Project/ Activity t' �7 i% F k ° -chi_ Y :i?,'°
(Scale:1.11 %)
Access Length
Pier (dock) length
Fixed Platform(s)
._ I
j
;ff�
t,
tt
L
a
`.
-
_
Floating Platform(s)
Finger pier(s)
-
Total Platform area
�-
t.
Groiniength/#
--j-
i
-
—
L}.%ff
Tft
�
_
-
Bulkhead/' prep length �?Yl
Avg distance offshore
,
.I
_
Breakwater/Sill_
•
f
Max distance/length ..
-
Basin, channel 1•>>
Cubic yards f
1
_t -
_
ip.
��,.
/�;
_._
I ,
!
�.
�,
_
_
Boat ramp
.__�
i/
�F
__—
_
Boathouse/ Boatlift
Beach Bulldozing
2
�t
Other
t _L
SAV observed: yes no
•-...0
'—
°
Moratorium: n/a yes no
,,•,
-
!
_
I
--
Site Photos: yes no
i
Rioarian Waiver Attached: yes no�--
A building permit/zoning permit may be required by: '''
❑TAR/PAM/NEUSE/BUFFER (circle one)
Permit Conditions
❑ See note on back regarding River Basin rules
t ? nAr; f u - ) ❑ 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
is
Application Feels) Check #/Money Order Issuing Date Expiration Date

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: F-P, Ramji4 401dinQ5, i. C
(Larwana, Nt<rnph '�s'
Mailing address: PC IEOx 3C1
Mold. N G 2-I�iS $
Telephone Number: off ice ��•.�-'F'�5-�a3'7�e home,
I certify that I have authorized (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of R, t Kheca
at my property located at
This certification is valid through
(Property Owner Information)
Rarwnno- l.. ktumphne-s
Print or Type Name'
Ti e co. owner or truste or property
15� o'g 3
Date
252---(a3`7(v Z52- 232-21S�-g
Telephone Number
Finail Arlrlracc bi
(date).

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 Owner
Address of Property:
/I t2PS
Mailing Address of Owner. PQ Am 6q moyodk--4 N6 a�gSg
Owners email: iY)ff rt0Y5-r-OYY1Df110-LO Owner's Phone#: 252-435"%3'7& 752
%32-ZIS b'
c ay$mcui• torn. ! 1
Agent's NameRsyi 1AAgent Phone#1 2S2Ag2-&055'
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
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
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)
Signature of Adjacent Riparian Property Owner: f
Typed/Printed name of ARPO: 4 % J'
Mailing Address of ARPO: . ` _/4d u/jf�(Jjn(yt� /
ARPO's ame11: E «y/�0 6h�Aj�AETPb'g Phone#: 12�7
Date: ( /T S *waiver Is valid for up to one year from ARPO's Signature*
Revised July 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: F & R Family Holdings LLC - Ramona Humphries
Address of Property: 1541 Tulls Creek Rd., Moyock, NC 27958
Mailing Address of Owner: PO Box 39, Moyock, NC 27958
[e-mail]� 252-435-6376/252-232-2158
Owner's email: Owner s Phone#:
Agent's Name: B.E. Singleton Agent Phone#: [phone]
Agent's Email: shelby bldinc9outlook com
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 forthis
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.
X 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
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
Ili
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Ala I✓sUSM,..s
Typed/Printed name of ARPO: NC DOT, Paul Williams, Division Env. Officer
Mailing Address of ARPO: 113 Airport Dr., Edenton, NC 27932
ARPO's email: pcwi11iams2(&ncdot.Rov ARPO's Phone#: [phone]
Date: 4/11/2023 *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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Distance to
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