McDonagh. Michael - 84277C

°"° "�❑CAMA El DREDGE & FILL N9 84277 A B c D
° 3 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:
I SA NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: vywwdeq.nc goy/CAMArules
Applicant Name Authorized Agent
Address Project Location (County):
City State ZIP Street Address/State Road/Lot#(s)
Phone # ( )
Email Subdivision f/
City ZIP
Affected ❑ CW ❑ EW ❑PTA ❑ ES ❑ PTS Adj. Wen Body ' (nat/man/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Mal. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale: )
Shoreline Leneth IV-)
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV 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
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
Signature "Please read compliance statement on back of permit"
Permit Officer's PRINTED Name
Signature
Issuing Date Expiration Date
Application Feels) Check tf/Money Order

❑CAMA ❑ DREDGE & FILL N9 84277 A B C 'D
30
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 Cotnmission in an area of environmental concern pursuant to:
I SA NCAC ❑ Rules attached. General Permit Rules available at the following link: www.deq.nc.goy/CAMArules
Applicant Name Authorized Agent
Address Project Location (County):
City State ZIP Street Address/State Road/Lot #(s)
Phone # ( )
Email Subdivision
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat than/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger piers) 1 "
Total Platform area
Groin length/M -
Bulkhead/Riprap length --
Avg distance offshore
Breakwater/Sill '
Max distance/ length
Basin, channel -
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV 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
(Scale: j j
❑ 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
Signature **Please read compliance statement on back of permit"
Application Fee(s) Check #/Money Order
Permit Officer's PRINTED Name
Signature
Issuing Date E/piration Date

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AGENT AUTHORIZATION FOR CAMIA PERMIT APPLICATION
Name of Property Owner Requesting Permit: _y4lr- � A.- Y�C I
Mailing Address: `iSi G'h9dv Gf< S/.trs ,
Phone Number: of - 461q - �71,'yt0
Entail Address: v tshm�cin411
I certify that I have authorized A La Ij t) )yr, a ti !=o !/c�ld
Agent! Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: i Ad ems. Jg � e o-
at my property located atti
in jQp oty , County.
I furthermore certify that I 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.
_ � 1 e 6 � r�z
Sig t re
Print or Type Name
092 N c
Title
-S r 5 1_ �S•_•__
Date
This certification is valid through i /

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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: 11 r1tG i /%1 G16,y,� qA.
Address of Property:
Mailing Address of Owner: _11>4m y
Owner's email: Owner's Phone#: 5W - S;Ll _ %l,.Ilo
Agent'sNsme: trctl N1441b Agent Phone#: L710-JJ?-J'f95.
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be comgieixgd by the Adlacent 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
W—/— I DO NOT have objections to this proposal. I DO have objections to this proposal.
rr you nave ob)ections to what is being proposed, you must notNy 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 Clfy, NC 28557, DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection If you have been notlRed 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 Sian
the appropriate blank below.)
i DO wish to waive someiall of the 15' setback
-OR-
Signature of Adjacent Riparian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank) �—
Signature of Adjacent Riparian Proarty Owner: -tolp ' J. I"
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email: �b ' arr`� ARPO's Phone#:
Date: '5 — I— ;� ) *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
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion tobecompleted by owner or their agent)
Name of Property Owner: ) r t 1 d c 1 ii G A)A QA.
Address of Property: `% S I C44 4),Le �vrs
Mailing Address of Owner: —5,%m o his Jk i, a -
Owner s email: Owners Phone#: 5141^ Sm - 7.Uo
Agent's Name:./-PQ4 4� M M''Nti Agent Phone#: q10- J - 3`f %S,
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom 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
.ktp j descrip4lon or drawing, with dimensions must be provided with this letter.
I
L / 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 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.).,._*- -
.�� dV I DO wish to waive some/all of the 15' setb d.��.
rI 1 AJ OR Signature of Adjacent Riparian Property Owner
I do not wish to waive the 16 setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:C`;
Typed/Printed name of ARPO: t �`fl�y rA 9
Mailing Address of ARPO: `S W t e r+- appMS �f
ARPO's email: ARPO's Phone#: �i{) 3! V 15-0 b0,1'
Date: A,;�-3*waiver is valid for up to one year from ARPO's Signature*
Revised July 2021