Donnelly, Lawrence - 91395C

#FX]New
❑CAMA ElDREDGE & FILL N9 91395 A B (c) D
Previous permitGENERAL 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 ❑ Rules attached. ® General Permit Rules available at the following link: www.d .nc. ov CAMArules
Applicant Name r. Authorized Agent J- ✓t' w" i {)
Address Project Location (County):
City State ZIP Street Address/State Road/Lot#(s) 105 Gr'�j>+— ii •�.-,�
Phone # ( )
Email r Subdivision
City itri,, 1/ ZIP_e1�5/✓(
Affected ❑ CW NEW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body P10 (fiyman/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/fib? PNA: yes/no
Type of Project/Activity w 9o;t JS A 1 5
(Scale:1V S 1
Access Length
Pier length—
7----1
—
(dock)
s
Fixed Platform(s)
T
T--
i
I
)
Floating Platform(s) —
IfL
i
Finger pier(s)
Total Platform area ' 0 g it
Groin length/# ---
!
BulkheadfjRiprap length
Avg distance offshore + z
-t-
p -
-
15
��_
—
Breakwater/Sill
i
Max distance/length'jBasin,
channel
J
--
----
x-
—
Cubic yards
vT
hi
,Boat __
P
Boathouse/ Boatlift
Beach Bulldozing4J
Other
—
,j-f
—
—
I
S
--
—
—
—
c
SAV observed: es no
y
�'
Moratorium: n/a yes no
-
Site Photos: yes no
yes no
It
oRiparianWaiverAttached:
L
I
_�_
_
A building permit/zoning permit may be required by:
Permit Conditions
r' 4/
❑ 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
Signature"Please read compliance statement on back of permit•• _ Signature
Application Feels) Check q/Money Order Issuing Date Expiration Date

#F\!New
❑CAMA ❑ DREDGE & FILL N9 91395 A B ,1P D
GENERALPERMIT Previous 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 7 1 , 1 06 U / 0 1 UG ❑ Rules attached. © General Permit Rules available at the following link: wwwdeq nc gov/CAMArules
Applicant Name
Authorized Agent A 1 , I IC
Address / 5
Project Location (County): I
City . f
State N L .
ZIP
Street Address/State Road/Lot #(s) !OS Ate., J
Phone #
Email i
Subdivision
City I'. r,. IG-. ,� Il Ei6,: .. ZIP ��1 Sl.•.{
Affected ❑ CW
E] EW N PTA
❑ ES ❑ PTS
Adj. Won Body nat/man/unk)
AEC(s): ❑ OEA
❑ IHA ❑ UW
❑ SPIMA ❑ PWS
Closest Mal. Wtr. Body �' •'J
ORW: yes0
PNA: yes69)
Type of Project/ Activity 1�: ,; ,1 1
1 I1-, d 1, .: ,,1 ..,; ' d
i� - A 1 i
(Scale: A/7
Access Length "--
j-
Pler(dock)length
I
Fixed Platform(s)
_
4'
I—
Floating Platform(s)
—.
Finger pier(s)
Total Platform area %——
_
_
.�
_
Groinlength/# —
Bulkhe d/iRiprap length
Avg distance offshore---
Breakwater/Sill
Max distance/ length
Basin, channel
—
'
—
—
Cubic yards —_-
Boat ram p.
t��nl
_-
.
Boathouse/ Boatlift
Beach Bulldozing
Other
�-
__
I—
,l
--
SAV observed: yes no 1�
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes; no
A building permit/zoning permit may be required
❑ 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
Signature "Please read compliance statement on back of permit" ) Signature
Application Fee(s) Check A/Money Order Issuing Date Expiration Date

Name at Property Owner Requesting Permit.
qq- ffL
MaAmg Address
��q (ot�7 2473
Phone Number
19
Emai Address; pq
N7R• �"fir
1 oertdy that 1 haste ak&Ota d Apent+co *
to act on my behalf. ror the purpose or WptywV for and oWaW4 an CAMA POt"%"
�oe'SW for the foltowm Proposed dewWOO"4
at my property located at
inCounty-
! furthermore certify that! am augx)nzed to gam• lad do in fact grant permission to
nt staff, the tocat i�erfrt+t Officer and their agents to enter
Division of Coastal A � invwth evahrating information related to this
on the afaer»ent�+>c'd
comechm
permit appt'ca600.
Owner kdwnabw:
Part or ryM N9me
irfA-
0// /l Z3
Date
cIftation is valid f ough _I_..=

K.C. DIVt M OF COASTAL MANAGEMENT
AWACENT RIPARIAN PROPERTY OWNER NOTWICATIONIWAJVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be cornpleted by owner ggtvir agent)
Name of Property owner. rC U I CX '
Address of Property: (t ��S' _—J (eda ✓�� L Pine 1 / 1 �� 5 ,?-s N<•
Mailing Address of Owner ` { T rl dryn w Ad"
owners errrarl: I ( Owner's Phor". ( `t l I - 007 — 29 %3
Agviil's Name: 1pe % Agent Phone# - t9(dj - g Z lt
Agent's Email VejLr4Ak, /& A Mn . i Ce) (1..
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
!Boner^ Dort"on to be completed try tIn AdiacaM Prowrty Owner:
I lnvoby ck.Mdy rlrat (own Ixoperry;rdl:rcent ro ltx. op „efererx:rd property The individu- l apply" for this
r0ki-41lion or•gcnbeQ 10 me as shpwn on the an.xhed drawrnA the Aeveklpment they are proposing. A
.tr`ccrlgiar cx_dr:+wvxy wah duhkvospns. muy_I be prv_..C_vd w4r this kilo
X _ I DO NO) have 14WOrons to this Ixoposal I DO havr oblectnms to this proposal.
N you haw oblActions to wbil !s baiting prpPeSod, you must
ManagarrteM (DCM) M writing w/thin tD d nom the N-C. O/vls/on of Coastal
mailed to 400 Commerce Ave., Morehead of ncs pt of INNS nobce- Correspondence should tie
at (232) WS-26" )Yo MS Ne, same . DCMrepresenbtiyes can also be Contacted
Carmel Map_ Aonse Is cons/d*red the same as rro oblectlon It you have been ^Dulled by
I understand that WAIVER SECTION
�Y proposed per. dock. maxng prigs. boat ramp. breakwater, groin must be set back a mmenum distance of IS. kom my area of boathouse. �• or
(this does not apply to bulkheads a riprap revetments If ^Parris^ access unless waived by rote
the appropriate blank below.) t t you wish to waive the setback. you must e
I DO wish to waive Soule/all of the S6'sritback
-OR. S>Jarure JI
Adiac'ent Riparian propeRy owner
! do not wish to waive the ) 5' setback requuer"" (tnittal the blank)
Signature or Adjacent Rlphah
property
Owner.
TylpedtPoInted name Of ARM: C' G /o
,a vC dtl7-vs
Mailing AddMs of ARPO;
ARPO's email: ST. /yA yFlti tic /U,
Date: PAones: 4yo, s/�� 25'0b>
lvaiver is valid for uP to one year fWn ARPO'g
Signature'
Revised May 2021

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: L.,a w j/`j (-F 9oNN(-LL }'
Address of Property: /OS CC-7�L �oAv �^�` /lwcl SN�ie6-s N�
Mailing Address of Owner.
vbs PYND
A16 2758 Z
Owners email: 7/l/4;I�/ �Y-j/'bv . i'' Owner's Phone* /29 7�
Agent's Name: �k2m %C'�S6 Agent Phone#ZS2-66S'c/i98
Agent's Email:
ID Ll/Nt��
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
Bottom portion to be completed by the Adjacent Properhr O Wrw
I hereby certify that I oven 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.
y I DO NOT have objections to this proposal. I DO have objections to this proposal.
!f you love objections to what is being wopose4L you onost moody One X.G. Lassa " OF k pascal
Afanagwnw* (DM in m*k3g wWd n 10 drys of receipt of this notice. Correspondence sAodd be
malted to 400 CommerceAve., Abrehead City, NC 26W. DCMrepresentaffves can also be contacted
at (252) Sag-2"g. No response is c onsideredthe same as no objection #you have been noW ed by
CerEifiad Atari.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pddhgs, boat ramp, breakwater, boathouse. lift, or
groin must be set back a minimum distance of 19 from my area of riparian accesq unless waived by me
(this does not apply to bulkheads or dprap revebmenls)- (If you wish to waive * You must sign
the appropriate blank below.)
I DO wish to waive some/al l of the I & setback / / // //YL 0-77 X
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: X
Typedf Wftd name of ARPO �JN r"'&S V c -) /I
Mailing Address ofARPO: I (),I (VI "(--e LT . ,e A"-" � S ^Wr' NL
ARPO's emery. JJ ARPO's Phones: a 7 - � � B $
3
Date: /-A)- / ')�t7 7 3 'waiver is valid for up to one year from ARPO's signatwe•
Revised May 2021

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20--6°
50% NNAGLE CHANNEL
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N7:136172PF11NG a Di51GN
Vv w
341301.0 A10'012f POAD
NEW XM. NC 28562
252-565-A398
HUGHES DONNELLY
104 MAPLE COURT / 105 CEDAR ROAD
PINE KNOLL SHORES NC
xrs
PROPOSED SITE PLAN
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