89676A Dilday, David & Donna

❑CAMA ❑ DREDGE & FILL N� g96%G �� A e c
GENERAL PERMIT 1211i. 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:
I SA NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: w .deq.nagov/CAMArules
Applicant Name
Address
City
Phone # ( _
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑CW ❑EW ❑PTA ❑ES ❑pTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑OEA ❑IHA ❑uW ❑SPIMA ❑PWS Closest Maj. Wtr. Body
ORW: yes/no. PNA: yes/no
Type of Project/ Activity
a
Shoreline Length.
Access Length
Pier (dock) length
Fixed Platform(s),
Floating Platform(s)
Finger pier(s)
Total Platform area
Gro h/JJ
/ Riprap length I ��
Avg distance offshore 1'
Breakwater/Sill
Max distance/ length a,
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no=-
RlparlanWalverAttached: yes no
A building permit/zoning permit may be required by:
Permit Conditions
(Scale: )
❑ 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) ii
I
Agent or Applicant PRINTED Name
Permit Officer's PRINTED Name
Signature **Please read compliance statement on back of permit**
i
Application Feels) Check g/Money Order
Signature
Issuing Date
Expiration Date

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: David Dildav
Mailing address: 3837 Larchwood Drive
Virginia Beach VA 23466
Telephone Number: [phone]
I certify that I have authorized Mitchell Brown (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of
A Replacement Bulkhead, Wooden Ramp Removal, Dock Stairs Replaced
at my property located at 321 Yeates Lane, Hertford NC 27944
This certification is valid through
(Property Owner Information)
Signature
David Dildav
Print or Type Name
Donna Dildav
Title, co. owner or trustee for property
March 15, 2023
Date
[phone]
Telephone Number
dgdiiday(ftol.com
Email Address
r`rFIVED
APR 0 6 2023
(date).

Name of
Address
Mailing P
Owner's
Agent's t
RECEI D
APR 0 5 2023
N.C. DIVISION OF COASTAL MANAGEMEN0CAA -:f� ,,
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bolton) 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' setbac� i
_ r
Signature f Adjacent Rip ran Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
oCA;4i
3-,-45(p
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: / f
Mailing Addres of ARPO: !_��
ARPO's em6i� � RPO'f Phone#: 2� � �7
Date: 1 f_ � Z3 *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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