89662A - Hudson, Rick

#(X'New
❑CAMA ❑ DREDGE & FILL NU 89662 g� A B C D
Previous permit
GENERAL PERMIT
Date previous permit issued
❑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 ' I F' � I ..' ❑ Rules attached. ®, General Permit Rules available at the following link: www.dea.nc goy/CAMArules
Applicant Name
Authorized Agent
Address
.x
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Project Location (County): t Y Y i 1 U G` ItI
City I'sJ) D State
ZIP •''S
Street Address/State Road/Lot #(s) l 31 ) T C) I t
`
Phone#( ;L
C �. G
Email
1�))
Subdivision 11 r7 �7c".i_ti-0 CQ 16VI
ppTU `!4
City - I"✓5' `.1;; C,.� ZIP '.'.,
1:..- `5
Affected ❑ [W EW 0 PTA
❑ ES ❑ PTS
,,`` 1 t
Adj. Wtr. Body Q- I i"r� NCi f .) t't u_la"'�:i i
a.:' (nat,!m.nfunk)
AEC(s): ❑OEA ❑IHA ❑UW
❑SPIMA ❑PWS
Closest Maj. Wtr. Body I
..
ORW: yes/no PNA: yes/no)
Type of Project/ Activity L t? '-A;!C 11 ct j
t c:
(Scale: N `T,5)
.._....... ....
Access Length-
Pier(dock)length
Fixed Platform(s)
7--
-
i
-
I
Floating Platform(s)
_
20
Finger piers)
T
Total Platform area
Groinlength/N
Bulkhead/Riprap length
Avg distance offshore'f•
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boa[ramP —,-
Boathouse BoatliR� 13 rf 1 (
Beach.Bulldozing b•;3.;gi}d'wX`
Other-
-
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SAV observed: yes no..
Moratorium: Sf4i%a� yes no
Site Photos: 'n i no
Rioarian Waiver Attached: Caves.+ no
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A building permit/zoning permit may be required by:
Permit Conditions
I AM AWARE OF STATUTES. CRC RULES
Agent or Applicant PRINTED Name
eA (
Permit
❑ TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please Initial)
Signature "`Please read compliance statement on back of permit'
Application Fee(s) Check ft/Money Order
Signature •a `
4 a
Issuing Date -� Expiration 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: X %C kFt r C L 14J S >n
Address of Property: r
Mailing Address of Owner: SA01 &-
Owner's email:
Owner's Phone#: 25 Z- 333 -03 Ca 7—
Agent's Name: QPk ard -n Agent Phone#: 333 -0 &L 2
Agent's Email: ?gym 25 2 C) (r•t✓1A.L
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 � 1 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' setbac�t��
�Si a re of Adjacent Riparian Property Owner
-0 R-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: X 1 Co\�
Mailing Address of ARPO: X \ --)v9 i A) CZ eel Z� tlrWUn�K . d� 9 g--:'38
i
ARPO's email: X g 0-02nM//1VkARPO's Phone#.,Jl(„7�a),/203-9E H
Date: t1 o'U off+ waiver is valid for up to one year from ARPO's Signature*
o909-3 Revised May 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTWICATIONIWAIVER FORM
^E=R i {F!(=D MA1,L RETURN r E Eip f RcQ_S_ "tD or HAND IIELiV'tRY
(Top port!or to be co,"--oleted by ow.n.le: or their agent)
.'J,me cf Property Owne. _,_
ess ? P-operty 1315 ^�u 115.. �-i e !'_ ,C .T`} 5
Ad Of Owf( el
----
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
:Bottom portion to be completed by the Adiacent ProUerty Owner!
ereby-::er.� hat own propene ac A
r'escrtceo- qS
av-
If you have objections to what .s being, prop oseJ, you must notrfy fhe N.C. Division o/ Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., site. 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
u. u�;rssr.i �t any ;, apesed p,o ... !"'9� u.. `a'": ^ eakwate' naathouse nf. or
yr r ..st e,v ;a:;F 3 :n!.,,r ,t, cT; r, �r nca �,_-a es .r<,'-.va-e .i-r;r��e
G e (+ J.:S .apply ;0 ,,..�><neads r F . \, ,h ', vaive ine ,et5aca. ,cu must sign
the. appropriate Manic be',ow
100 wish ;o wa'.va sore'all of tl: 4 crt!bac6 E
/qp ppyy � f
nR_
4
f do not \N Sh tL Wa Vc the 15setback-.--
_ -
r
Adjacent R!panan
TypedlPnnted name of ARPO
yr � ure _ - --
Mailing Address of ARPO: __.��
ARPO s ell'I. __ "� v's Phones': �( ----
`waiver is valid for up to one year from ARPO's Signature' .J
Revised May 2021

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