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Home My WebLink About89651A - Sampler, Christopher°F`°"'° ❑CAMA ❑ DREDGE & FILL N9 89651 Y it— A B C D GENERAL PERMIT Previous permit Date previous permit issued QNew ❑Modification El 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 f ❑ Rules attached. }`' General Permit Rules available at the following link: wwvvdeq.nc¢ov/CAMArules Applicant Name _ Address City Phone # ( ) Email Authorized Agent I t rl ➢s"ci yr' (- Project Location (County): State ZIP Street Address/State Road/Lot #(s) Affected ❑ CW ❑ E W ❑ PTA AEC(s): ❑OEA ❑IHA ❑UW ORW: yes/no PNA: yes/no Type of Project/ Activity ❑ ES ❑ PTS ❑SPIMA ❑PWS Subdivision City Adj. Wtr. Body Closest Maj. Wtr. Body (Scale: ) Access Length- t Pier (dock) length Fixed Platform(s) Floating Platform(s) Finger pier(s) Total Platform area24 — >f1l -- Groin length/# -Aw - Bulkhead/ Riprap length Avg distance offshore re_ Breakwater/Sill — Max distance/ length it f . Basin, channel Cubicyards - Boat ramp Boathouse/Boatlift i Beach Bulldozing _'— Other ti SAV observed: yes no E { { " Moratorium: n/a yes no I( Site Photos: .yes no ,.. _ ____ Riparian Waiver Attached: yes no ll A building permit/zoning permit may be required by: - F" ti I : ' - TAI(/PAM/NEUSE/BUFFER (circle one) Permit Conditions ❑ 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 AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Christopher Sampler Mailing Address: Phone Number: Email Address: 114 Waters Drive Moyock, NC 27958 404-379-1945 mgsnodog@gmail.com I certify that I have authorized Affordable Bill'slWilliam Eger Agent t Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: install one -1 ok ib boat lift 12 x 14, install 12 x 26 boathouse over lift, install one jet ski lift at my property located at 114 Waters Drive, Moyock, NC 27958 in Currituck County. t furthermore certify that t 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. Property Owner Information: Signature Christopher Sampler Owner Print or Type Name Title �f�—lam Date This certification is valid through N.C. DIVISION OF COASTAL MANAGEMENT 7• ADJACENT RIPARIAN PROPERTY OWNER ;= NOTIFICATtON1WAtyER FORM CE_ R'rtFIED MAID • R1=T g a IIRN RECFroT n � r nAW6 i]F' CRY it a (Top portion to be completed by owner or their agent) p Name of Property Owner Chistopher M Sampler Address of Property: 114 Waters Drive, Moyock, NC 27958 Mailing Address of Owner. Same as above Owner's emaB: mgsnodog(mgmail.com Owner's phones: Agent's Name: William Eger/Affordable Gill's 252-489-9555 Agent Phone#: Agent's Email. atfordablebilis@gmail.com ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom oo an to be completed by tha disc + ProoeMv Owned I hereby certify that i own property adjacent to the above referenced property, The individual applying for this Perm'# has described to me, as shown on the attached drawing, the development they are proposing. 6 jeacrjoti)n-,,`lira ii w:H. .. v I DO NOT have objections to this proposal I DO have objections to this proposal. - :-- . --*:-.v=..,r:,a w wrrur .s using Praposed, You must notify the N.C. Division of Coastat Management (DCM) in writing within 10 days of recelpt 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 1252) 264-3901. No m5lionse is considered the same as no objection N you have been 1106fiert by Cartified Mail. WAIVER SECTION I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lik or groin must be set tracts 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/at) of the 15' setback nature of A j n l7ipadan Property ino I do not wish to waive the 1 S' seback requirement (initial the blank) Mailing Addrisss of ARPO: 112 Waters Drive, Moyock, NC 27958 ARPO's email: ARPO's Phone*: Datti; —`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 NOTIFICATIONIWAIVER FORM CERTIFIED MAIL RETURN RECEIPT REQUESTED gr AND DkL-tVERY (Top portion to be completed by owner or their agent) Name of Property Owner: Chistop mr M Sampler Address of Property. 114 Waters Drive, Moyock, NC 27958 Mailing Address of Owner: Same as above Owner's email: m9snod0910917100-00m Owner's Phone#. Agent's Name: Wiliam Eger/Affordable gill's Agent Phone#: 252-489-9555 Agent's Email: affordablebills@gmail.COM ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom portion to..be completed by the 641809PAProcr•rty Owner) 1 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 .. _ _ _:___ .__a I_ Oki. 1.0. I Do NOT have objections to this Proposal. — I DO have objections to this proposal tfVou {Jaya to what is being proposed you must nomy a♦o •�.* ............. of (DC H) in writing within 10 days of receipt of this notice. Correspondence should be mated to 401 S. GMgn St., Ste, 300, Elizabeth City, NC, 27909. DCM representatiues can also be contacted at WZ) Z04-39Of. No response is considered the same as no objection N you have been noWyed by Cardiac' Mail. WAIVER SECTION I Understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or gran 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 01.9 the approphate blank below.) I oo wish to waive somelall of the 15' setback Signature of Adjacent l?iparian Property Owner -Olt. I do not wish to waive the 15' setback requirement (initial the blank) ZL- TypedJPrinted name of ARPO: Charles or Nicole Loy ins Addreaas of ARPO: 116 Waters Drive, Moyock, NC 27958 AlWa date: C 1. Ccp$ i ARPO's Phonett: _ -i_--- *waiver is valid for up to one year from ARPO's Signature" p Revised May 2021 F, . 7. IME 9 gam/ a6(rn�k. t. P