89663A - Newman, Denise & Keith

°``°"'"a,�❑CAMA' ❑DREDGE & FILL NU 89663 A B C C
Previous permit
3 :GENERAL 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: www.den.nc.gov/CAMArules
Applicant
Address _
City
Phone #
Email
_State NC.,. ZIP
Affected ❑ CW ❑ EW ❑ PTA
AEC(s): ❑OEA ❑MA ❑UW
ORW: yef%no: PNA: yes/no
Type of Project/ Activity
❑ ES /s PTS
❑SPIMA PWS
Authorized Agent 1- ; �:. 3 i S , i
Project Location (County): l.. ;
Street Address/State Road/Lot#(s) C,, r:( kZ.• !,
Subdivision
City
Adj. Wtr. Body
Closest Maj. Wtr. Body
(Scale:
..... ...... .... _ .
Access Lengthr—
Pier(dock)length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
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1
__'S
Total Platform area
Groin length/ff
Bulkhead/Riprap length (Cu
�a
Avg distance offshore drt
Breakwater/Sill
Max distance/ length •.:
Basin, channel
Cubic yards
Boat ram Boathouse/BoatliftBeach Bulldozing
Other
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SAV observed: yes no
Moratorium: n/a , yes no
Site Photos: yes no —.
Riparian Waiver Attached:; ves no
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A building permit/zoning permit may be required by: f'
Permit Conditions 1 i-t
❑ 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 PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name n o
Signature **Please read compliance statement on back of permit** Signature y�
Application Fee(s) Check dJ/Money Order Issuing Date Ekpiration Date

DECEIVED DIVISION OF COASTAL MANAGEMENT
APR 14 2023 AGENCY FORD FOR PERMIT APPLICATIONS
DCM-Eli
46 /Vct�_A ✓✓�%4 ouner of the property located at:
—4' (proper owner
3? o 'I-/ / Y9,e2[�
{prcp�:: address
do hereby authorize
- _ - - acting as agent)
to act as my agent for the purpose of ob in .-�- ' - Ccasal Area Management Act and/or
Dredge and Fill Act permits, that may be n -or me =^posed development at the above -
indicated property, which entails:
(describe proposed developmenr vor wh£ah permits are being sought)
This agency authorization is limited to the specific activities described above, and will expire on:
A/ l
(date on whic agency authorization expires)
(signature)
(printed name of owner)
y-/fl-27
(daze)
(title, if offcer of Corp. owner or trustee for property)

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: K , rT �j -D `Ly
Address of Property: �:J; Z6 [ 2
/' 6
Mailing Address of Owner: d - 1 ?65< 9.3 c1
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UMr;er -
Owner's email:. /-f G//, en�eusniA Ni 2Owner's PhonCa/e#: `$6 y— S ] L - 3(c
Agent's Name:
Agent's Email:
Agent
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Ownerl
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
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 ofAdj cent(Riparian Proillerty 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: 4�2� lz &\]ZH \ )CA VA, 1
Mailing Address of ARPO: , (7�i
ARPO's email:
Date: 3 zzL 3
ARPO's Phone#:
*waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

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