Tutor, Shaun & Kim - 91117C

CAMA ❑DREDGE 8t FILL, No G I ) I / A B COD
AVUGPrevious permit I
ENERAL PERMIT Paig��`is Date previous permitissued
❑NewModi�cation ❑CompfeteReissue -]Partial Reissue
As authorized by the Sta a of NM! �C�..altrolina, Department of Environmental Quality and the Coastal Resources Commission m an area of environmental concern pursuant to:
I SA NCAC I I UyC1QQ ❑ Rules attached. ❑ General Permit Rules available a the following link: www.dea nc eov/CAMFvules
n r-,
Applicant
Address
City,-j
Phone
Email
I�.i�GLRTAAW�P11I:N1 _ �r.E�R��r��Yr��aA�rL�37�lrJState JAIC ZIP Street AddmstSt*@ Road/Lot #(a)
Affected ❑CW FHA
PTA
AEC(s): I�OEA FHA �uuW
ORW: yes/ \( PNA: yes/rrb'7
Type of Project/ Activity _
Shoreline Length _ IIf 1
Access Length-I-----=------------
-
Pier(dock)length��� r:Pa---`--
Fixed Platform(s) "—
Floating Platforms)
Flnger pler(s)
Total Platform area -A;L
h/k
B khea Ripmp length
Avg distance affshore_�
Breakwater/Sill
�.
Max distance/ length
Basin, channel
Cubicyards
Boat ramps
Beach
SAV observed: yes
Moratorium: n/a yes
Site Photos: �
Riparian Waiver Attached: l7eJ 1
A building Per mit%io't perplit rr
AND
City � A YAP Q 1
❑ PTS Adj. Wen. Body
❑ PWS Closest Maj. Wtr. Body
Sinature "`PI read com nce statement on ck of rmlt•'
��,© M Q
Application Feels) Check p/Maney Order
(scale:
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
See additional notes/conditions on back
(Please
Expiration Date

CAMA ❑ DREDGE & FILLWUJF�ItDtk� N? `-1 1 W/ A B J D
6
GENERAL PERMIT Igl23 Previous permit
Date previous permit issued r--
❑ New X Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of NoNorthCar(o`lina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
y
I SA NCAC I CC l ❑ Rules attached. General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name Authorized Agent r
Address Project Location (County)
City i tStatej?7ZjP�Street Address/S Ro"ad�/LoAt #(s)
Phone # _ �Y .r al /ILL ��cl'l.Y// 1
Email Subdivisjoti
City (}y(/�_`Q V ZIP
Affected ❑ CW EW PTA ES ❑ PTS Adj. Wtr. Body (na m nk)
AEC(s): �II��-II �O\EA1�ql!HIA❑ UW SPIMA PWS Closest Mal. Wtr. Body
ORW: yes/'r/ PNA: yes/rO
Type of Project/ Activity b
(Scale: )
Shoreline Length ... _
Access Length
Pier (dock) length I -I AL a
Fixed Platform(s)
Floating Platform(s) p/�. `^ '
Finger pier(s) 1 J v
Total Platform area
h/p � - �1 70t(M�
B khea Riprap length ems_ �� - �J e
Avg distance offshore
Breakwater/Sill( I V�
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse Bo lift "f
Beach Bulldozing • r�
Other P
_ _G•� l�
'I
SAV observed: yes keir.!-w6'
Moratorium: n/a yes
Site Photos: y -
Riparian Waiver Attached: es(�r��/�A building Permlt%ior�RlggpperMit ma pi f� v 11 I c
❑ TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
See additional notes/conditions on back
M AWARE OF STATUTES, CRC RULES AND CO TIONS THAT APPLY TO THIS PROJECT AND R VI WED C M LIANCE T ME (Please Initial)
Agent or Applicant PRIN ED Name Permit O 'c P INTED Nai e
Si nature '*PlgaV read compliance statement on ck of permit" Signature
Application Feels) C eck u/Money Order Issuing D to Expiration Date

Al `MA ❑ DREDGE & FILL N9 91117 A B C 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:
I SA NCAC _ . _ _ ❑ Rules attached. ❑ General Permit Rules available at the following link: wwwden nc gov/CAMArules
Applicant Name _
Address
Gry
Phone # (_ )
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
J
Affected ❑ CW ❑ EW ❑ PTA \ ES ❑ PTS Adj. Wtr. Body (,b r (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW H SPIMA ❑ PWS Closest Maj. Wtr. Body
ORIN: yes/no PNA: yes/no
Type of Project/ Activity
(Scale:
Shoreline Length
Access Length .-_.
Pier dock length
Fixed Platform(s) -.
L --_ 1
i
_ 1
Floating Platform(s).� / l
Fingerpier(s) "--------
__
Total Platform area
�
Gsoln.length/q
/Bulkhead/
I
Riprap length•'
U
Avg distance offshore V Z�
Breakwater/Sill
Max distance/ length
Basin, channel --'-`
-.
Cubic yards
Boat ramp
Boathouse/Boatlift
Beach Bulldozing
Other
_-
i
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
T r I' -I (C r- r
—i
❑ 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) a
Agent or Applicant PRINTED Name.. ---
Signature *-Please read compliance st tementonfjackof permit**
i I
Application Feels) Check fl/Money Order
Permit Officer's PRINTED Name
Signature
Issuing Date
Expiration Date
i

❑CAMA ❑ DREDGE & FILL
GENERAL PERMIT
❑New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
N° 91117
Previous permit
Date previous permit issued
A B C 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:
15A NCAC Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
City
Phone # (
ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body -
AEC(s): ❑ OEA ❑ IRA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
i (Scale:!// )
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger piers)
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) Kly
Agent or Applicant PRINTED Name
Permit Officer's PRINTED Name
Signature "Please read compliance 56tement on back of permit"
Application Feels) Check #/Money Order
Signature
Issuing Date Expiration Date

Styron, Heather M.
From: Kari Taylor <[e-mail]>
Sent: Tuesday, January 10, 2023 9:23 AM
To: Styron, Heather M.
Subject: [External] 210 Salter Path Road
Attachments: MAP SKETCH.pdf; Agent Auth.pdf; Certified mail - Knott & Munoz.pdf
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an
attachment to Report Soam.
Good morning Heather,
Please find the attached CAMA paperwork for 210 Salter Path Road, Pine Knoll Shores. Please let me
know if you have any questions or concerns.
Thank you,
Karl Taylor
Executive Vice President
C:252-571-7282
CARTERET MARINE
sltylets

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Kimberly Tutor
Mailing Address:
7521 Benchmark Road, Kenly NC 27542
Phone Number:
252-290-0566
Email Address: [e-mail]
I certify that I have authorized Carteret Marine Services LLC
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
Install of 5x30 floating dock,
relocation of existing boat lift, install of new bulkhead infornt of existing bulkhead.
at my property located at 210 Salter Path Road, Pine Knoll Shores, NC 28512
in Carteret
County.
I furthermore certify that 1 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:
b '�& )tL40
Signature
Print or Type Name
Title
/ U i ao�3
Date
This certification is valid through

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Styron, Heather M.
From: Kari Taylor <[e-mail]>
Sent: Monday, May 1, 2023 2:30 PM
To: Styron, Heather M.
Subject: Re: [External] 210 Salter Path Road
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the
Report Message button located on your Outlook menu bar on the Home tab.
Yes, everything you stated is correct. And all will be limited to the 17.5' from NHW. No, our equipment
has not yet made it back to that area yet. (The water has not been kind today, the wind is crazy!)
Thank you,
Kari Taylor
Executive Vice President
G:252-571-7282
CARTERET MARINE
SEIU!CES
On Mon, May 1, 2023 at 2:10 PM Styron, Heather M. <[e-mail]> wrote:
Are you still wanting what was originally permitted and are you now wanting to relocate the existing
boatlift and add another section of platform as shown on your drawing? If this is the case all work is
limited to a max of 17.5' from nhw (existing bulkhead). You are showing a 4' x16' platform and the
boatlift along the outside of this correct? I just want to make sure before I modify the permit. Have the
pilings I received a complaint for been located to the correct position?
Thanks!
Heather Styron

District Manager
Division of Coastal Management 400 Commerce Avenue Morehead City, 28557
252.515.5417 (0) 252.725.3903 (M)
Heather,[e-mail]
www.deo.nc.eov
Find a Field Rep (armis.com)
tiA
t)egartmMlt of E:nvtronmeotat
Email correspondence to and from this address is subject to the North
Carolina Public Records Law and may be disclosed to third parties.
From: Karl Taylor <[e-mail]>
Sent: Monday, May 1, 2023 12:45 PM
To: Styron, Heather M. <[e-mail]>
Subject: Re: [External] 210 Salter Path Road
3

CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with
the Report Message button located on your Outlook menu bar on the Home tab.
Hi Heather,
This client is wanting to extend the platform to the property line. Please see the attached drawing.
Please let me know if you have any questions.
Thank you,
Executive Vice President
C:252-571-7 282
CARTEREi MARINE
s l a v l�cls�r•�—
On Fri, Apr 28, 2023 at 1:55 PM Styron, Heather M. <heather.m.styronPncdenr.gov> wrote:
Thank you!
Heather Styron
District Manager

Division of Coastal Management 400 Commerce Avenue Morehead City, 28557
252.515.5417 (0) 252.725.3903 (M)
Heather.M.Styron @ncdenr.gov
www.de.g.nc.gov
Find a Field Rep (arcgis.com)
Email correspondence to and from this address is subject to the North
Carolina Public Records Law and may be disclosed to third parties.
From: Karl Taylor <[e-mail]>
Sent: Friday, April 28, 2023 9:02 AM
To: Styron, Heather M. <[e-mail]>
Subject: Re: [External] 210 Salter Path Road
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with
the Report Message button located on your Outlook menu bar on the Home tab.
4

Hi Heather,
We are not completed with the job. We had an emergency job we had to move our equipment too.
The pilings are not in the proper spot our plan of action is that once the equipment is no longer
needed for the urgent job to come back and place the pilings in the correct placement and complete
the job. I apologize about any inconvenience.
Thank you,
Karl Taylor
Executive Vice President
C:252-571-7282
Carteret Marine Services
CarteretMarine.com
CARTERET MARINE
SEBVIGES
r..
On Apr 28, 2023, at 8:22 AM, Styron, Heather M. <[e-mail]>
wrote:
Hey Kari,
I received a complaint for this job and the person who left the complaint is saying that
there are pilings being installed farther in the canal than should be allowed. Are you
finished with this or still working there? I am going to run by to take a look.

Thanks!
Heather Styron
District Manager
Division of Coastal Management 400 Commerce Avenue Morehead City, 28557
252.515.5417 (0) 252.725.3903 (M)
[e-mail]
www,deg.nc.gov
Find a Field Rep (arcgis.com)
.. -�D E 5
[taa�rtn+tnt ar Fiivirorvi�anta� q�uatr
Email correspondence to and from this address is .subject to the
Carolina Public Records Lair and may be disclosed to third parch
e

From: Styron, Heather M.
Sent: Tuesday, January 31, 2023 2:17 PM
To: Karl Taylor <[e-mail]>
Cc: SVC_DCM.MHC.Admins <[e-mail]>
Subject: RE: [External] 210 Salter Path Road
This is ready and at the front with the admin staff. The total fee is 600 dollars (check
or money order only).
Heather Styron
District Manager
Division of Coastal Management 400 Commerce Avenue Morehead City, 28557
252.515.5417 (0) 252.725.3903 (M)
[e-mail]
www.deg.nLgov
Find a Field Rep (arcgis.com)
'IN

I
Email correspondence to and from this address is subject to the
Carolina Public Records Law and may be disclosed to third parti,
From: Karl Taylor <[e-mail]>
Sent: Tuesday, January 10, 2023 9:23 AM
To: Styron, Heather M. <[e-mail]>
Subject: [External] 210 Salter Path Road
CAUTION: External email. Do not click links or open attachments unless you verify. Send all
suspicious email as an attachment to Report Spam.
Good morning Heather,
Please find the attached CAMA paperwork for 210 Salter Path Road, Pine Knoll Shores.
Please let me know if you have any questions or concerns.
Thank you,
Kari Taylor
Executive V3r-e President
;asrerlei#sa

11EBET MARINE

Styron, Heather M.
From:
Kari Taylor <[e-mail]>
Sent:
Monday, May 1, 2023 12:45 PM
To:
Styron, Heather M.
Subject:
Re: [External] 210 Salter Path Road
Attachments:
CAMA Permit - Tutor.pdf; Knott - Certified Mail.pdf; 15' setback waiver
210 Salter Path Rd.pdf; MAP SKETCH.pdf
CAUTION: External email.
Do not click links or open attachments unless verified. Report suspicious emails with the
Report Message button located on your Outlook menu bar on the Home tab.
Hi Heather,
This client is wanting to extend the platform to the property line. Please see the attached drawing.
Please let me know if you have any questions.
Thank you,
Kari Taylor
Executive Vice President
C:252-571-7282
t
TERIT MARINE
5IRVICt8
On Fri, Apr 28, 2023 at 1:55 PM Styron, Heather M. <[e-mail]> wrote:
Thank you!
Heather Styron
District Manager
Division of Coastal Management 400 Commerce Avenue Morehead City, 28557
252.515.5417(0)252.725.3903(M)

[e-mail]
www.deg.nc.goV
Find a Field Rep (arcclis.com)
Email correspondence to and from this address is subject to the North
Carolina Public Records Law and may be disclosed to third parties.
From: Karl Taylor <[e-mail]>
Sent: Friday, April 28, 2023 9:02 AM
To: Styron, Heather M. <[e-mail]>
Subject: Re: [External] 210 Salter Path Road
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with
the Report Message button located on your Outlook menu bar on the Home tab.
Hi Heather,
2

We are not completed with the job. We had an emergency job we had to move our equipment too. The
pilings are not in the proper spot our plan of action is that once the equipment is no longer needed for
the urgent job to come back and place the pilings in the correct placement and complete the job. I
apologize about any inconvenience.
Thank you,
Kari Taylor
Executive Vice President
C:252-571-7282
Carteret Marine Services
CarteretMarine.com
GARIEREI MARINE
On Apr 28, 2023, at 8:22 AM, Styron, Heather M. <[e-mail]>
wrote:
Hey Kari,
I received a complaint for this job and the person who left the complaint is saying that
there are pilings being installed farther in the canal than should be allowed. Are you
finished with this or still working there? I am going to run by to take a look.
Thanks!

Heather Styron
District Manager
Division of Coastal Management 400 Commerce Avenue Morehead City, 28557
252.515.5417 (0) 252.725.3903 (M)
Heather.M.Styron(@ncdenr.gov
www.dea.nc.gov
Find a Field Rep (arcgis.com)
f
C'="—
OD.
r
f1e y.,¢, Mpti pt of fuvftUAfl148SLif {}IY,INty
Email correspondence to and from this address is subject to the f
Carolina Public Records Law and may be disclosed to third partie
From: Styron, Heather M.
Sent: Tuesday, January 31, 2023 2:17 PM
To: Karl Taylor <[e-mail]>
4

Cc: SVC_DCM.MHC.Admins <[e-mail]>
Subject: RE: [External] 210 Salter Path Road
This is ready and at the front with the admin staff. The total fee is 600 dollars (check or
money order only).
Heather Styron
District Manager
Division of Coastal Management 400 Commerce Avenue Morehead City, 28557
252.515.5417 (0) 252.725.3903 (M)
[e-mail]
www.deg.nc.gov
Find a Field Rep (arcgis.com)
Ernail corresponder?ce- to and from this address is subject to the f
Carolina Public Records Law and may be disclosed to third partie
5

From: Karl Taylor <[e-mail]>
Sent: Tuesday, January 10, 2023 9:23 AM
To: Styron, Heather M. <[e-mail]>
Subject: [External] 210 Salter Path Road
CAUTION: External email. Do not click links or open attachments unless you verify. Send all
suspicious email as an attachment to Report Spam.
Good morning Heather,
Please find the attached CAMA paperwork for 210 Salter Path Road, Pine Knoll Shores.
Please let me know if you have any questions or concerns.
Thank you,
Kati Taylor
Executive Vice President
CARTERET MARINE
siRulcis

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: �> kaux, F K ,un �nr tlIt�.+(
Address of Property: a 10 �(� Qct+k IZJ n
- j' iri- Lr o I) S itu✓e S a SI i
Mailing Address of Owner: i Sa I \c nx,.oLf (G 2d �2x�. !JC d -iSga
u�1so^0.tv.uj¢rry,At. k6t�fJC�V`tM1.l,nle..+ta-t
Owners email: Owner's Phone#: ;S•t d90 t)SLo6
Agent's Name: Carteret Marine Services Agent Phone#:[phone]
Agent's Email [e-mail]
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
description or drawing, with dimensions. must be provided with this letter.
�I 00 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 some 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 15from 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 scan
the appropriate blank below.)
I DO wish to waive som all of tof t 6' setbaAD
-OR-
Signature of Adjacent R1para/I Property Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: P 0 I d u K Cj , Vvi , vt0 Z
Mailing Address of ARPO:.. �"' C�, �'f'L°('- A . 1 PK� 41c� Zg � 12,
ARPO'sce/m/ail: � c� u t o2 8 ^^ at (• ARPO's Phone#:
Date: / / 2 *waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

TIPS FOR ADJACENT RIPARIAN OWNER NOTIFICATION & WAIVER FORMS
CAMA Regulations require notice of proposed development to the Adjacent Riparian Property Owners (15A
NCAC 7J.0204(b)(5)). Proof of actual notice (a sign -off by the owner on this form) or certified mail return
receipts (showing deliveryof notice) are needed, or any other method which satisfies the Local Permit Officer
(LPO) that a good faith effort has been made to provide notice.
The purpose of this notice is to make adjacent riparian property owners aware of the proposed development
so that they have an opportunity to provide comments (or potentially object to) the proposed development,
and to give DCM or the LPO an opportunity to consider these comments/objections before a permit decision
is made. "Permission" of adjacent property owners is not necessarily required for DCM to issue a permit;
however, permission must be obtained for certain types of proposed developments if they fall within a 15'
setback area along the riparian access area of the adjacent property, as determined solely by DCM. It is in
the applicant's best interest to provide comprehensive and accurate notice so that any concerns or objections
can be resolved early in the permit review process. In addition, if the adjacent riparian property owner appeals
the permit decision, insufficient notice could be a basis for granting such an appeal.
Who Is an Adjacent Riparian Property Owner?
What Is Adjacent? (Note DCM reads this broadly to ensure comment by ootentially impacted neighbors)
• A property that shares a boundary line with the site of proposed development; AND
• A property that fronts a natural or manmade waterbody that is connected to coastal waters and
can support some form of navigation, even a kayak or canoe, including a common canal system
or a manmade basin.
• Easement holders? Yes, if the easement could be impacted by the proposed development.
• Streets/Roads? Only if the street/road could be Impacted by the proposed development. This
might include street -ends which might be used for parking and beach access.
• Holders of recognized submerged lands claims/shellfish franchises.
What is Riparian?
Do the boundaries of the adjacent property legally intersect with the water at mean high tide? if there is a
question about whether an adjacent property is considered "riparian," please reach out to DCM Staff -
especially on the oceanfront beach where there may be undeveloped parcels on the beach or in the water.
WholWhat is a Property Owner?
For private individuals (or families), send notice to the address listed on the tax card. If the property is owned
by an Inc. or LLC, please send notice to the person listed as the registered agent on the NC Secretary of
State's Corporations Look Up site: irtts_ty iosnc.govtaarchfindexlcc For Condominiums or
neighborhoods with an owners' association (HOA/POA), send notice to the association (which is usually a
corporation, for which you send notice to Its registered agent).
What is Notice, and how do I ensure it Is received?
• You can meet with your adjacent property owner, provide a description or drawing of the
proposed development, and ask them to sign this form and return it to DCM; OR
• You can hand -deliver this form and a description or drawing, and ask your neighbor to return it to
DCM (consider providing them with a stamped envelope); OR
• You can mail this form by USPS Certified Mail, return receipt requested (the Green Card). if you
choose this option, you must provide either the signed & returned green card OR track the
certified mail package number on USPS.GOV's online tracking system, and provide the tracking
print-out as proof of delivery to DCM
If you have any questions about this process, please reach out to DCM Staff and DCM Legal Counsel
and we will work to answer your questions.
Revised May 2021

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Oka ' LAMA E DREDGE & FILL N9 91117 A e �—
Previous permit _
ENERAL PERMIT Date previous per mitissuea --
L)�New ❑Modification F,Complete Reissue El Partial Reissue
As authorized by th Sta of arth Car Ina, De artm of Environmental Quality and the Coastal Resources Commission in an area of environmental concern Pursuant to:
ISA NCAC`R �ftulos attached. General Pormi[Rulos available at rhe�llowing lnk;rtfrriiles
Authorized Agent _ �_/ _y f_ ,�,_.E�j! W
Address _ ,1 Project location (County):., _
City _ $tat-4.>�-sC ZIP_. :lw-,Street Addreis/3tten /lot ) v._..._.
Phone # t - rhJ }_i(/r
ARected ❑tv✓ W PTA ES PTS Adj. WinBody _ (natlmanlunk)
ISPHNNIA
AEC(s): ROEA IHA uW PWS Closest Mai, Mr. Body
OW es o PNA: yes in
Type of Project/ Activity
Scaler / j
Shoreline Length
Access Length —
Pier (dock) length -
Fixed Platforms)
Floating Platform(s)o K!U
Finger pier(s)
r
Total Platform area _
Rip
Bulkhead Riofsshongth� —
Avg eriance oHshle fyKAr�
Breakwater/Sill
Max distance/ length —'
Basin, channel
Cubic yards
Boat ramp
�'STn I
Beach Bulldozing
Other '�iitAA/f
SAVatoriu ed: yes (noMomtorium� nJa yes o
Site Photos. yes o
Riparian Waiver Attached' yes o
A building pennit/mrpl; permit may be rrRt
I
11
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❑ TAR/PAKNEUSE/BUFFER (6rclo one)
❑ See note on back regarding River Basin rules
I AA 9 P ' ❑ See additional notes/conditions on back

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