Wagner Property Management - 91412C

���`°"'u ❑CAMA ❑DREDGE & FILL N9 91412 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:
15A NCAC (" _1) 1 ' !' O 0 ❑ Rules attached. '❑ General Permit Rules available at the following link: ynvwdeq nc gov/CAMArules
Applicant Name'210 12A Ltal()({ Vi)�t 1rW 42tlr� 'I Lfrru'
Address r�bSrv✓FI �' 7
CityilrrA..Atu,,,1-. State AZIP !)
Phone#&P—) `��)) 2111�-
Email r�.jf V`C lam' I > n ar
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
city
Affected 2CW .E] EW _FJ'PTA ❑ ES ❑ PTS Adj. Wtr. Body Ili-�d I vr< ; 'xZ.P, �t_ (4tlman/unk)
II
AEC(s): ❑OEA ❑IHA ❑n UW ❑SPIMA ❑V PWS Closest Maj. Wtr. Body A)f''�.kl
ORW: yes/no) PNA: yes/ o
Type of Project/ Activity
Shoreline Length
Access Length(,
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
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
Moratorium: n/a yes
Site Photos: yes
Riparian Waiver Attached: yes
A building permit/zoning permit may be required by:
Permit
'i,' I".: Cln
(Scale:] 3� )
V ❑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
Permit Officer's PRINTED Name
I. ),
Signature -*Please read compliance statement on back of permit'
Application Feels) Check q/Money Order
Signature
Issuing Date
Expiration Date

�� °""+rt❑CAMA ❑DREDGE & FILL
3 GENERAL PERMIT
New ❑Modification ❑ Complete Reissue ❑ Partial Reissue
N9 91412
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:
I SA NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deo nc gov/CAMArules
Applicant Name
Authorized Agent �.t
t
F'"
Address
Project Location (County):
s
r... tiJ-*-+('
City
State ZIP
Street Address/State Road/Lot#(s)
Phone#(�)
"I
Email-
;r ('•
Subdivision
L'
City -^ti n„ ! \5 4
ZIP
Affected CW
EW , >❑-' PTA ❑ ES ❑ pT5
Adj. Wtr. Body 4 tA c-7 (^V!
(- ✓lC.f li �nayman/unk)
AEC(s): ❑OEA
❑IHA ❑UW ❑SPIMA ❑PWS
Closest Maj. Wtr. Body ��)Q,iti)p
t( �V
ORW: yes/no`.'
PNA: yesjno
V
Type of Project/ Activity
Shoreline Length "' 4y
(Scaler : 3) )
Access Length`,
Pier (dock) length ii X IP' OVIV C
Fixed Platform(s)
FloatingPlatform(s)�(�'y3%.s
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ar
Finger pier(s)
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Total Platform area -/� t
Groin length/q
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eel
Bulkhead/Riprap length
Avg distance offshore -
Breakwater/Sill
Maxdistance/length-
Basin, channel-
Cubicyards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
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Other71-1
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SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no4,,
Riparian Waiver Attached: yes no
IT
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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)
ram /�.' ..
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Agent or Applicant PRINTED Name ^--- Permit Officer'ws PRI TED Names---
Signature **Please read compliance statement on back of permit** Signature
Application Fee(s) Check Jt/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 RIZ(rior on -------
(Top portion to be corn
Name of Property Owner: 6v04'0 N-y
Address of Property.
Mailing Address of Owner:
Owner's email:
Agent's Name: 'PC If
Agent's Email: `�' r /
by owner or their agent)
c !_��f� ski y
Owner's Phone#
Agern Phone#
9J. —
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
ottom_Portion to ha
1 hereby certify that f own property adjacent to the above referenced Property. he individual applying for this
permit has described to me, as shown on the attached drawing, the development the
dascri tion or.draZi wlth.dimen§ions must be�rovided with this letter. y are Proposing. A
! DO NOT have objections to this proposal .._„__--- I Do have objections to this proposal
lf you have object/ens to what la being proposed, you mUsf nod%y the N.C. Division of Coastal
Management (DCMj 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 it you have been contacted
ed
Certified Mail.by
I understand that an WAIVER SECTION
groin must be set back a rain mUrn distance of ipier. dock b�from my arg pilings oatramp.
l nN riparian
access unless waived rybyrme
(this does not apply to bulkheads or riprap revetments). (If you wish to waive access setback, you must n)e
the appropriate, blank below,) sign
I DO wish to waive some/ail of the 15' setback
-OR- Signature olAdlac©nl Riparian Properly (?wrier
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Prupeiiy Owner / r J 1 . r r ' MAY 1 Q �o2.i C
Typed/Printed name of ARPO: _ -- CM"�fl�
CITY
Mailing Address of ARPO: r'
ARPO's email: cv�cv\\ , n, ---
ciRC-RPO's Phone#:
Date: S1 k —
D-�_____._ _ V'waiver is valid for up to one year from ARPO's Signature'
HCViSed July 2021

N.C, DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONANAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
{Top portion to be cypleted by owner or their agent)
t, �:, ," j ! / { Yc r bps r7 ri
Name of Property Owner. t,'.. ^'��, �'� 1 rt� �? � � L LLB(, f i c�.' f�
r.'
.Address of Property
Mailing Address of Owner.
tt r r r
Owner's amid: !' b'--' ' a <'S t^{)wner's Phone#:. r c
�
Agents Name £ (�j;_ Agent Phone#:�n7`�
Agr.ntsPmail --!. L` L' .mat (_:'( c
--n 'cy
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
i Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacent to tha 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
100 NOT have objections to this proposal. __u I DO have objections to this proposal.
—_-- _------------_ _ --------------------- --------
If you have obrections to what is being proposed, you must nodly 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' frorn 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)
Signature of Adjacent Riparian Properly Owner
Typed/Printed name of ARPO: N LA
Mailing Address of ARPO:
iQ���rv�p
44AY I U 1O73
ARPO's email: hn�tib�k._�_a��sy„e:l.cer ARPO's Phone#: a52. 7aS dtS S'
Date: _�/9�pZ� _'waiver is valid for up to one year from ARPO's Signature'
crry
Revised July 2021