89654A - Soundside Estates POA

It�`°"'� CAMA ❑ DREDGE & FILL N° 89654 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:
15A NCAC ❑ Rules attached. 19 General Permit Rules available at the following link: wwwdeg nc yov/CAMAruIes
Applicant Name !A Authorized Agent
Address Project Location (County):
City State ZIP Street Address/State Road/Lot #(s)
Phone #(_) Lt'
Email Subdivision -
City ZIP
Affected ❑ CW ❑ EW R PTA ❑ Es ❑ pTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no j PNA: yes/no
Type of Project/ Activity
LengthAccess
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pleris)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Max distance/ lengt I
Basin, channel
Cubic yards ILA
Boat ramp
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observed: yes no
Moratorium: n/a yes no f
Site Photos:
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Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
❑ Permit Conditions 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 PROJECTAND 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 Fee(s) Check q/Money Order Issuing Date - Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
Mailing Address:
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I certify that I have authorized (agent) G!%+��z`AM Ffg"--/L,4/, > ftr� to act on my
behalf, for the purpose of applying for and obtaining all CAVIA Permits necessary to 1
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install or construct (activity) eoVeWo ,qp::FA '10� 6414e /fwa R!tW ,_ L '/%3 f �� e�Jic'�•
at (my property located at) ,SOc/N/JS•D� �ST��S �i�T t AUNT �`�A A
This certification is valid thru (date)
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Property Owner Signature Date

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: 4F
Address of Property: �i//✓O i C �s C�✓fi" G/t'j�iCdot! �q�1ir?b.✓ �f <°�jq
Mailing Address ofOwner4f( " ��"9x-/pu✓�E.Q /fig /J�) ftylS®�yDS„p�GSf ¢%�fS' Qie,
Owner's Phone#:��
Owner's email: y/
Agent's Name: le-"4 ¢ti(//K Agent Phone#: 7s %' 777- 5-VV/
Agent's Email: tJ� /Zp, 7 C% %-1Vf,+; /�c9NJ
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.
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 90 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
-OR-
Signature of Adjacent Riparian Property Owner
I DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: ���
Typed/Printed name of ARPO: �omaS iz. �iok
Mailing Address ofARPO: 13 Spa.+osiDE EaaATEi OQ Cs�nNo Nc t'Y13`i
ARPO's email: ARPO's Phone#: L��b�o aoa-u19,�
Date: I I E13 1oa3 *waiver is valid for up to one year from ARPO's Signature`
Revised August 2022

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Fri Receipt $3.35
Tracking k:
9590 9402 5869 0038 1162 52
$8.13
Grand Taal : $8.13
Cash Q(I.00
Change-$11.87
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❑ Agent
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❑Addressee
'so that we can return the card to you.
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B. Received by (Printed Name)
C. Date of Delivery
■ Attach this card to the back of the mailpiece,
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or on the front If space permits.
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1. Article Addressed to:
D. Is delivery address different from item 11 U Yes
If YES, enter delivery address below: ❑ No
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Type
❑ Priority Mail Express®
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3. Service
0 Adult Signature
Restricted Delivery
0 Registered Mail -
O pelive Mal fles ricted
9590 9402 5869 0038 1162 52
❑ Cenifled Mall®
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M turnerchReceipt for
ndise
❑ Collect on Delivery
D Collect an Delivery Restricted Delivery
❑ Signature Confirmation^"
El Signature Confirmation
(trans/e/ from service label
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7022 3330 0000 9789 0614
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Mail Restricted Delivery
Restricted Delivery
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PS Form 3811, July 2015 PSN 7530-02-000-9053
Domestic Return ReceiDt

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legal Name
Soundside Estates Prol," Oeiners'Assodation, Inc
Information
Sosid: 0626329
Status: Curren4Actr e 0
Date Farmed: 4142002
Citizenship: Domestic
Annual Report Due Date:
Registered Agont:@p¢g. Wham @.
Addresses
Principal Office
6633 Caratoke Higtlray
Grandy, NC 27939
Reg Office
6633 Caratoke Highway
Grandy NC 27939
Reg Melling
P 0 Box 386
Grantly, NC 27939
Officers
Searches
Links
OnUne FIUng

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 6), V
Name of Property Owner Applying for Permit:
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Mailing Address:
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I certify that I have authorized (agent) Gf/r���'AM ��z1�n/fl to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
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install or construct (activity) 40VI'D AACA ''fil e LeF /fw0 9<49 "A -
at (my property located at) CS147-S 9,4
This certification is valid thru (date) Z Z 3
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Property Owner Signature
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Date