Town of Morehead City - 91403C

❑DREDGE & FILL N9 91403 A B, it D
3 GENERAL PERMIT 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:
I SA NCAC ' ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name ( I rirLl Authorized Agent /�
Address Project Location (County): L. G,,..I <-i . {"
City State ZIP StreetAddress/State Road/Lot #(s)
Phone # ( )
Affected ❑CW
AEC(s): ❑OEA
ORW: yes/no ,!
❑EW ❑PTA
❑IHA ❑UW
PNA:
❑ES ❑PTs
❑SPIMA ❑PWS
Subdivision
City t IrrK K"'CA
Adj. Wtr. Body i c'
Closest Maj. Wtr. Body
Type of Project/ Activity pbeor ,c ( R rc-, ex Q,kcnjo\ (`+ r,, -\
(Scaled r ill)
Shoreline I enoth
Access Length
i
Pier (dock)length-
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)_-
I
_
1
Total Platform area
��
Groin length/q
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/length
Basin;channel`i"
X—r
Cubic yards
II
-
--
r'
Boat ramp
Q
Boathouse/BoatliR
±6
I
2
I
x
Beach Bulldozing
Other
L�
SAV observed: yes no
-
Moratorium: n/a yes no - -
.-1-
L
V
�
-
�..
...
_
r.,
-
-
-
Site Photos: yes no
Riparian Waiver Attached: yes no I
A building permit/zoning permit maybe required by: Wy_W c
Permit Conditions t)A J Uf v.<-t.r: -I te,. /ppp,,dl
r , . M1r` t �4 / ❑ TAR/PAM/NEUSE/BUFFER (circle one)
A)Lbt/ ❑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
Officer's PRINTED Name
Signature **Please read compliance statement on back of perm{it**
Application Feels) Check #/Money Order
Signature
Issuing Date
Expiration Date

"DREDGE & FILL N9 91403 A B0 D
GENERAL PERMIT Previous permit — �
Date previous permit issued
i]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 J (l / V ❑ Rules attached. r u General Permit Rules available at the following link: www.deq.nagov/CAMArules
Applicant Name ,''% Authorized Agent
Address Project Location (County): (. b,"
City State ZIP `% 2�ti', ,p Street Address/State Road/Lot
r
Phone#(_)
Email - r Subdivision
City ZIP
Affected ❑ CW E] EW © PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
r
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body_�'-
:.w
ORW: yes(no PNA: yes/no .
Type of Project/ Activity
Shoreline Length,
Access Length _
Pier (dock) length
Fixed Platform(s).
Floating Platform(s)
Finger pler(s)
Total Platform area
Groin length/p
Bulkhead/ Riprap length r
Avg distance offshore 'I
Max distance/ l�e`n�gtl
Basin, channel ry 1
Cubic yards;
Boat ramp
Boathouse/ Boatlift.
Beach Bulldozing_
Other
SAV observed:
yes no
Moratorium: n/a
yes no
y
Site Photos:
yes no
TT
—
RiparianWaiverAttached:
(yes' no
l
A building permit/zoning permit may be required by:
Permit Conditions
THAT
Agent or Applicant PRINTED Name
(Scale:) : LtoI)
.,���
ON
.rom
EN
■N
.
�ii
■r
.OEM
r ❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
Permit Officer's PRINTED Name
ENT. (Please Initial) -
rn � (
Signature "Please read compliance statement on back of permit'* - Signature
i
Application Feels) Check p/Money Order Issuing Date Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONfWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to becompletedby owner or their agent)
Name of Property Owner: I i��Lr n D7 Mweoeacl 6_ N
Address of Property: 101 Shepo v-4 S I Lf ee�
Mailing Address of Owner: 0 Owes S+, WC N ( 2S'557
Owner's email: c("Iei.wi11KrhlSN) Owner's Phone#: Z52--77ty
VVI0w IVadCi Kinc . ovai
Agent's Name: Agent Phone#:
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom_ portion to be completed by the Adjacent Property Ownerl
I hereby certify that I own property adjacent to the above referenced property. The individual applying forthis
permit has described to me, as shown on the attached drawing, the development they are proposing. A
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
1 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 some/all of the 15' setback
Signature of AdjacefftKarian Property Owner
I do not wish to waive the 15' setback requirement (initial the blank)
0 0 11y0
Signature of Adjacent Riparian Property Owner: ( MHp G'.T%l
Typed/Printed name of ARPO: IRO belt Puri 'Foy 01L(YY pw, D �i F M
Mailing Address of ARPO:
(fv //of 6 /fl,&yw &wd
U/�d
��
%//Y Gam) C
ARPO's email: D /r/ /u
6�50p dwre - CDWI ARPO's Phone#:
r,�
< 5 Z '
%Z`c' 2`/32.
Date: MAX
'waiver is valid for up to one year
from ARPO's
Signature"
Revised May 2021

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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: rO W n C4 Nl o t E-hiaL C I'rY
Address of Property: 4`1-& 1061 ShepnF d Sr
Mailing Address of Owner: U (ilk PJ y l 619 S L O M U C I Ky- 2R'3S7
Owner'semaiC doYA,cP Wltlietm-;iV Owner's Phone#: 25Z- 2-&-to%Lfri
MoTe'v east e I ivJhr . c r�
Agent's Name: Agent Phone#:
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adacent 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
I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you ha4e 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.)
I 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
�1olFD
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: �St-M m S / Src
Mailing Address ofARPO: (�( F��s ��oo �•����(�/
ARPO'semail: ARPO'sPhone#: <�Sz 3yZ C>�bS AGM"
Date: 5 - g - 2 3
*waiver is valid for up to one year from ARPO's Signature*
Revised May 2021

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