Hughes, James 91396C

❑X CAMA ❑ DREDGE & FILL
GENERAL PERMIT
o New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
N9 91396
Previous permit
Date previous permit issued
A B ICj D
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:
ISA NCAC n % d , I I D() O % d . � � OO ❑ Rules attached. IN General Permit Rules available at the following link: wwwdesInc gov/CAMArules
Applicant Name _ m V+. P 5 f ,ii" `l �l i, (' i Authorized Agent A,i J,e Webb
Address Project Location (County): i'+%11"
City i I! 6' ., State ZIP ),�4 i 12 Street Address/State Road/Lot#(s) Sm vnP
Phone # (_) - / ✓, o3/
Affected ❑ CW NEW ❑ PTA ❑ ES ❑ PTs
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS
ORW: yes/do,, PNA: yes/no
Type of Project/ Activity
Shoreline I encth
Subdivision
City F:
Adj. Wtr. Body
Closest Mal. Wtr. Body
(scale:/VTS )
Access Length
T I i
Pier (dock) length • D'
I
—t_
Fixed Platform(s) ` I J
_�j-
___
..
1 I
I
__._
Floating Platform(s)
I
I
Fingerpler(s)-
Total Platform area
Groin length/q-
Bulkhead/Riprap length -Ti,
Avg distance offshore -r
Breakwater/sell
r
—'-
I
I
-
-
l—
c
--
--
'
x
1
-
Max distance/length
Basin, channel ---
_
_I
-"
-�-
Cubic yards
—I-
Boat ramp
Boathouse/ BoatllR ;�,t
Beach Bulldozing -' u: !
Other
h.
,
rd
j
r
i
/1 -T
p
r
_
y
_ —
-
-
�'I"{
l
-
L.
-t
SAV observed: yes no
Moratorium: n/a yes no — �-
Site Photos: yes no
Riparian Waiver Attached: (yee7 no
-
—
-
-
-
-
{—
i—
�-
--
--t
i
_
A building permit/zoning permit may be required by:
Permit Conditions . 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) :C''iy
Agent or Applicant PRINTED Name
Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit**
Application Feels)
Check p/Money Order
Signature
Issuing Date
Expiration Date

A§t0A", ❑CAMA ❑ DREDGE & FILL N9 91396 A B CC D
GENERAL PERMIT Date Previouspermit issued
Date previous permit issued
N 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 L2 ! it I I "I) i/ i If . I r: l ,61 ❑ Rules attached. IN General Permit Rules available at the following link: wwmc1eq.ne.gov/CAMArules
Applicant Name . i
Address i
City i h ,it ttI�... }State A/ zip A) l V,
Phone#( ;`I) `iyl :t',
Email ' A II D "4 Lt /1 r)(. , C. v I,,
Authorized Agent A 1 J Webb
Project Location (County): [ , - r , " i
Street Address/State Road/Lot #(s) S - ''
Subdivision
City
Affected ❑ CW V] EW N PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. War. Body
ORW: yes/i!i.) PNA: yes/fio')
Type of Project/ Activity I �l C .„'. 1 % d E , A 15
(Scale:/V l� )
ci.—fi.o i..o k I S
Access Length
I
!
—
r
!
Pier (dock) length
Fixed Platform(s) /• X i
_.-4
Floating Plafform(s)
Finger pier(s) "'
Total Platform area % O + 4-
Groin length/N
-_
L_
1
_
Bulkhead/ Riprap length--
I ,
-
.__s
Avg distance offshore
x
—�_
_
_ _
`-li`
�
;
I
_
Breakwater/Sill-
-
Maxdistance/length --^
-",
-
'I--
--
-
—
T-
`--�
4-
Basin, channel
Cubic yards-
�
I
I
!
Boat ramp ----
-
Boathouse/ Boatlift
Beach Bulldozing
ki+7
Otherit
u-
SAV observed: yes 60
-
--T
-
_
i
`
5j
Moratorium: n/a yes no
-
V
Site Photos: yes
1-
--
-�—
-F-
-
—
RlparianWalverAttached: ryes
_
I
A building permit/zoning permit may be required by:
Permit Conditions
i
I AM AWARE OF STATUTES, CRC RULES AND CON
Agent or Applicant PRINTED Name
Signature **Please read compliance statement on
Application Feels)
Permit Officer's PRINTED Name
,i[** Signature
Check q/Money Order Issuing Date
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please Initial) ee"
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Rm e. S R, 'L q .. e C 77f
Mailing Address: 1� I m I'`P I CT
Q%LN t-
�.BSIZ
Phone Number: GI -3) 1 q O % 127;R
Email Address: . AA ,0 13P A o L t G Uwe
1 certify that 1 have authorized f Nil r-1,' W`e- L
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: W AC.'e— I S r Q Dl L1 eaJ
AND fko-o G � x 1S ' J)Oc-�
at my property located at 4 d t { M APl E GT �.Nv f�"d�� Shur eS _IvC
in C C,(� ef-e_"T County.
28512
1 furthermore certify that l am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information•
Sig ature j I
Print or Type Name
Trtle
S, 6,2Z
Date
This certification is valid through � I/ 2 ` 1�

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONANAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner. JrIII o H'I6N(s
Address of Property: It `l /4jNf'(( (-�)Of11 Fir(- j0vol (. SN01*70
Y
Mailing Address of Owner �4rn-2.
Owners email: A—�LY 3 P--AV Owner's Phonetk 1 3Li —� v-"
Agent's Name: Ah72(- 1n4-'�4 Agent Phone#: 2S 1 - Eli 1 Y 3IF
Agent's Email:
/.c.,.n,
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(bottom Portion to be completed by the Adiacent Property Owner)
i hereby certify that I own property adjacent to the above referenced property. The individual applying for th is
Pernik has described to me, as shown on the attached drawing, the development they are proposing. A
I DO NOT have ob*bons to this proposal. I DO have objections to this proposal.
N you bare objections to what is being proposed, you must notify fire N.C. Ahdsion of Coastal
Management (DCAQ In writing witlYn 10 days g1 receipt of this notice Correspondence should be
malledto t00 Cowneice Ave., Uo►ahevd Clity, NC 291557. DCAfrepresmblyves can also be cordaded
at (M 806-2900. No ►asponse is considered the same as no objection if you have been notified by
L': Dire=iCL • 1
I understand that any proposed pier, dock, mooring filings, boat ramp, breakwater, boathouse, Eft, or
groin must be set back a rninumrm distance of 15'from my area of riparian access unless waived by me
(this does not apply to bulkheads or fiprap reverrents). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive somelall of the 15' setback
of rR Ptoporty Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner.
amIXr
TypedRdr*ed name of ARPO ri f S St"71i // (/
Mailing / J PAddFwm of ARPO:1_06 /o,, (-_,•
ARPO's email: l� Q s i1 a r, �gQeal co+ARPO'a Phwtt# Z S.L oS�y%
Dais / a -a °a' 3 'Mlver is valid for up to one year from ARPO's Signature•
Revised May 2021

--�7
N.C. OIVMM OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTWATMWANER FORM
CERTIFIED MAIL RETURN RECEIPT REnuEsTFD or HAND DELIVERY
(Tap Potipon to be completed by owner or their agent)
Nan e of PmpedV owner. Nv6Nt-s
Addnws ofProp".1' T P Ne lr s Ins (�
Mmlirtp AdOress of Owr W I,r• -L
� UO, 3
owners email: �Q }�/! Q �- • G ownersCi
nerPhoned 1 y 9
npem Phor"W 151 -645'' y17R
Agent's Name: ANON( IJV &
Agent's Emei:
ice_.:_ :..•:.. r�•, •.... •..,.-.r
) hereby aanffy VIS i Own rxmP&Ay adjacent ro the atwve rerereaced aony The •,drool OPP%Vw Ior Um
permd has des«wed to me, as shown an the aaadred drew.-. the del-W� UmY m orovas N A
des - . _ W
f DO NOT have ogedlons to tho WOPdSS! f DO have abtedions to this Propo"
(I � tI�IT {V w1/R O � �-�• /�� wMQe .^�I �rR R.M M��a�v. v- —�.-�.
Ilaenaparrrertr (DCd+ in we at 0 wAMn 10 d"S or retatr o/ ltds nowt Correspondence sboam be
mNNdloIOACoamm-ceAve,Me h N-CftNC2d6d7.00WMPrnsw*@Ommcanaaroa4edtldded
ar (262) t10P2ruspoWe is eonshO&md VW Sanw as no objectlon it YOU hetre begirt reollAed by
Cot~A"
tl AMER SECTION
I understand that any proposed pier. dock, mowag PIP. boat ramp. breakwater, boathouse, tilt, or
groin trarst be set back a nwrerarrh datartoe of 15, lrom my area of ripanan acoess unless waived by me
(this does not apply to bukhsads Or *M M%'Mmertts). (11 you wsh to waive the setbadr'You
the appropriate bbnk below,) . Q I
I Do wish to waive sonWad Oahe is,
-OR-
I do not wish to wavMe the 1 S' selbadr nmWembnr tewo" um "r ?
Typed/Pri m I mmm of ^RPO: _ l�/�7 '/tiC� 7jbNNE L c'V
ARPWS Wmak 7
4W. _ _/ — /I - 2'Z 'NAW ris vmM b. up Io am "ar trap AP"S sWA"
Revmd M"

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WE33 DRPfi1N6a DESIGN
VVE"
541301.DNRPORf ROAV
NEW XN, NC 28562
252-665-4378
HUGHES DONNELLY
104 MAPLE COURT / 105 CEDAR ROAD
PINE KNOLL SHORES NC
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PROPOSED SITE PLAN
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