Hickory Shores HOA - 90100C

tour - Na 90100
�� "� ❑CAMA El &FILL A B (C�i D
Previous permit
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:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deci.nc.gov/CAMArules
Applicant Name _
Address
City .
Phone # (_ )
Email
State ZIP
Authorized Agent G, rKr.36 t}j
Project Location (County): C Ct.,c i77- /�
Street Address/State Road/Lot #(s) '.',.F•^ !),I—dyo a C...�
Subdivision
City
Affected �.❑. CW DEW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body - i. (nat/man/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body
ORW: yes/no PNA.,yes/no
Type of Project/ Activity -4 Q rh r
/ f
(Scale: j
Shoreline Length
Access Length f
Pier (dock) length '! P'r I-.r r us'%
---
Fixed Platform(s)
Floating Platform(s)
_I-
C_.
Fingerpier(s)
I
I
h
Total Platform area
Groin length/#
Bulkhead/ Riprap length I
-
Avg distance offshore-I--
Breakwater/Sill
- —'- —
—
—
Maxdistance/length
Basin, channel-
Cubicyards
Boat ramp T
Boathouse/Boatlitt
Beach Bulldozing
Other
iI chile
SAY observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
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
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'*
Application Feels) Check #/Money Order
Signature
Issuing Date
Expiration Date

CAMA ❑ DREDGE & FILL N10 90100 A B (01 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. 12, General Permit Rules available at the following link: wwvvdeq.nc.gov/CAMArules
Applicant Name P. r' - '==J--"Q, Authorized Agent
Address r I �A-y'G
q- Project Location (County): ,
City
Phone #
Email
State ZIP rt. `� -)i? Street Address/State Road/Lot #(s) /•Yz A),, -C4
Subdivision
City
Affected 0 CW © EW ©PTA ❑ ES ❑ PTS Adj. Wtr. Body ( (naUman/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body
ORW: yes/no PNAi,yes/no
Type of Project/ Activity
Shoreline Length ✓/r''�
Access Length "
Pier (dock) length / H
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area L
Groin length/q
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill /-
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ BoatliftY
Beach Bulldozing
other ;
SAV observed: yes no !, --�
Moratorium: n/a yes no { j
Site Photos: yes no j
Riparian Waiver Attached: ryes 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 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
r'
Application Fee(s) Check q/Money Order Issuing Date Expiration Date

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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: Hickory Shores Subdivision HOA
Address of Property: (To the left side of) 116 Hickory Nut Ct. Newport, NC 28570
Mailing Address of Owner: 102 Hickory Nut CL Newport, NC 28570 icons=== naaa .>i
Owner's email: N/A Owner's Phonatt: N/A
Agent's Name:
Johnnie Roberts (HOAP(esident)
Agent's Email: [e-mail]
Agent Phone#: [phone]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom oortion to be completed by the Adjacent Property Owner)
thereby 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 I tier.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 28557. 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 C\�-- - ,
Signature of AdjacenISIparian Proporij, Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO;-
Phone#:
Date: '"j I I L) l 4�-� -) *waiver is valid for up to one year from ARPO's Signature"
���'S7b
Revised July 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: Hickory Shores Subdivision HOA
Address of Property: (To the left side oft 116 Hickory Nut Ct, Newport, NC 28570
Mailing Address of owner: 102 Hickory Nut Ct. Newport, NC 28570 (HOA Secretary Addrew
Owner's email: N/A Owner's Phone#: N/A
Agent's Name:
Johnnie Roberts (HOA President)
Agent's Email: ha
mail.com
Agent Phone#: [phone]
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Progarty 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.
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 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection /f 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 sion
the appropriate blank below.)
I DO wish to waive some/ail of the 15' setback
Signature of Adjacent Riparian Property Owner
io
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Ripa6
TypediPrinted name of AIR
Mailing Address of ARPO:
ARPO's email: t�Mayo a� 9� Im: — ARPO's Phone#: 919 - R �.�i —6 f� D—
Date: fD _-waiver Is valid for up to one year from ARPO's Signature'
Revised July 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CER_T!F[�O MAIL RETURN RECEIPT REQUESTEO or HAND _QL VERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: JL2 r/i G C. Ra,�/d
Address of Property:
Mailing Address of Owne
Owner's email: t�WictctDU�aA4,'/.caa,.OwneesPhone#:
— U
Agent's Name:
Agent's Email:
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
( ottom pgLtion to be completed by the Adiaoent Property Ownerl
I hereby certify that 1 own property adjaoentto the above referenced property. The individual applying forthis
permit has described to me, as shown on the attached drawing, the development they are proposing. P
deaOnffon or drawing, with dimensions must be provide with.Otis) .
jL,-' ._, t DO NOT have objections to this proposal. 100 have objections to this proposal,
If you have objections to what is being proposed, you must notify the N.G. Division of coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
malted to 400 Commerce Ave., Morehead City, NC 28557. 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 WMaLsjftn
the appropriate blank below.)
t DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property Owner
_OR -
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner.ar�
TypedtPrinted name of ARPO: W Jz J _
Mailing Address of ARPO: r,1 1 & - Rdp' ike ' I Let Nc. „Zj%-irp �3
ARPO's email: r-nnMAyn aO 2htn: JIre4.ARPO's Phone#:
Date: �el W l 3 "waiver is valid for up to one year from ARPO's Signature'
r
Revised July 2021
APR 26 M0 )
0""HD CITY

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWA1VER FORM
CERTIFIED MAIL �ECEIPT REQUESTED Or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner. { r f � / a
Address of Property: �e,'i it P� _€""t}t +1 7•".1Jc4 t#�
Mailing Address of Owner:r�>-
Owner's email' _ Owner'n Phone#: `x w
Agent's Name•. _ f. vnl,Jr�_ i J� is _ Afloat Ph/ollog'
Agent's Email
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be completed by the Adiawart_PropoRv Owner)
I hereby certify that I own property adiwont to the above referenced property. The individual applying for this
permit has described to me, as sham on the attached drawing, the development they are proposing. A
dgscript t r drawing,_ witM1 Aimensions must be ofoyided„witty _his loiter.
i
_ I DO NOT havo ob}actlons to this proposal.-1 DO have objections to this proposal.
___-_-.-___.. _^ .____._-_..._..ot ._.._�.�v
If you have oblesNons to —What !s being proposogl yo0 must not�ffy fire N.C. Dlvtsfan of Coasfa!
Management (DCM) in writing within f0 days of reaelpt of this nations. Correspondence should be
malted to 400 Commerce Ave., Morehead CIV NC 28557, DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection It you have been notified by
Certified Mad.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, fife, or
groin must be set back a minimum distance of 15' from my area of hpanan access unless waived by me
((his does not apply to bulkheads or riprap revetments). (If you wish to waive the setback. you midst slap
the appropriate blank below.)
100 wish to waive somehill ofthe 15'setback
Signaiura of Adfacen ipariatt Prop[jOwnor
-OR-
1 do not wish to waive the f S' setback requirement (Initial the blank) .___.--,--,__,.___
.
Signature of Adjacent Riparian Property Owner:
TypodiPrinted name Of ARPO —J -C
Mailing Address of ARPO• JL_.,ko(1 'A?iUYI ��,C` ci f? } L_ �Xfl
ARP atltail: �C,�lg,^Y7_L� ARPO'a Phonep:
Date: ` �C ` � -) `waiver is valid for up to one year from ARPO's Signature"
Revised July 2021
RECEIVED
APR 2 6 20.3
DCM-MHD CITY