Gravel, Dorothy - 90093C

00AiA ❑CAMA ❑ DREDGE & FILL N° 90093 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: wwwdeq nc Yov/CAMAides
Applicant Name
Address
City State ZIP
Phone # (_)
Email,,
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length
Pier (dock)length �1� ` Z
Fixed Platforms) .�--
Floating Platform(s) r— t
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Boat ramp
Boathouse/ Boatlift,
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no _t
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
Permit Conditions
Authorized ,agent
Project Location (County): 4
Street Address/State Road/Lot #(s)
Subdivision -
City
Adj. Wtr. Body
Closest Maj. Wtc Body
(Scale:jVl , )
❑ 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
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature "'Please read compliance statement on back of permit** Signature
(Please Initial)
Feels)
Check#/Money Order Issuing Date
Expiration Date

a`°"" JCAMA ❑DREDGE & FILL N° 90093 A B C D
a T 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 i i
❑ Rules attached. q-General Permit Rules available at the following link: wwwdea nc gov/CAMArules
Applicant Name
city
Phone # I(—)
Email
Authorized Agent
Project Location (County):
State ZIP I'1 Street Address/State Road/Lot #(s)
Affected ❑ CW ❑ EW ❑ PTA
AEC(s): ❑OEA ❑IHA ❑uW
ORW: yes/po PNA,yes/no
Type of Project/ Activity
Subdivision —
City / / ZIP 1,
❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
❑SPIMA ❑ PWS Closest Maj. Wtr. Body
Shoreline Length
Access Length f`
Pier (dock) length
4 J
Fixed Platform(s)-
I �
Floating Plafform(s) - i
i
Finger pier(s)r
Total Platform area
Groin length/N
Bulkhead/Riprap length-
Avgdistanceoffshore
distance/ lengthBasin,
channelCubic
ards Y
Boat rampBoathouse/
BoatliftBeach
J4-
BulldozingOther
SAV observed: yes no rF'----
Moratorium:Breakwater/SillMax
n/a yes noSite
Photos:yes noRiparian
Waiver Attached: yes; no
is
A buildingpermit/zoning permit maybe required by: •.-, _� o iF"(- (ram
Permit Conditions
(Scale: /,J7`,
❑ 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 Permit Officer's PRINTED Name
Signature **Please read compliance statement on back of permit** Signature i
Application Feels) Check N/Money Order Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: -Za reor tly /i C& 4 J L-
Mailing Address : 32o A0-y JAU, /,AJ
k&�tk '/IJ& a'76/s
Phone Number: �9/9/ L f - 6 3Q1
Email Address: poff,elJra✓C5'n"t,(' �H7
I certify that I have authorized (Mar/gr J- e 6,9AdEL
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at / `f/ 6 rA Cd-mf oa/p Rd yjtwoo �j+��
in t_-at ,fete 'ice 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.
Property Owner Information:
Signature
�oreorJrr f} GRR✓��
Print or Type Name
Fi OC✓ n2/
itle
l od3
Date
This certification is valid through I t

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 Dot-44 Gr(AVE1 / v
Address of Property: 1q1 IE4 C-Mr t gip /IK/�aor" _ ,A/6 c2 o 0
TT I.� T—/� '
Mailing Address of Owner 3 aO Bay+ LAne, RaAcr A� , At c, a 7615
Owners email p(b_�re 49L,,2J, c0M Owner's Phone#.1R4g7' SyI4
Agent's Name L✓ Gr�e,� Agent Phone#:"tI t'�7a1 i6
Agent's Email It) 1r6t� Vi�) @ NG�oV. Loi 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 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 DO NOT have objections to this proposal. I DO have objections to this proposal
N 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 nprap revetments). (If you wish to waive the setback, you must sign the
appropriate blank below )
I DO wish to waive some/all of the 15MAX.
scent Riparian Propery Owner—�
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property
TypediPrinted name of ARPO:
Mailing Address of ARPO:,g0 Rr' e. Roi yo��'N& a7596
ARPO'semail: /ar;-ar)mws(Rct'vlcr,_C4 ARPO'sPhone#:_III'3y�-yJ35
Date: y /a 03 'waiver is valid for up to one year from ARPO's Signature'
Revised May 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONlWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner &jrjyf� y C2 reh &
Address of Prol
Mailing Address
Owner's email
Agent's Name
Agent's Email
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be completed by the Adiacenl 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 DO NOT have objections to this proposal. I DO have objections to this proposal
If you have objections to what /s being proposed, you must notHy 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 )
1 DO wish to waive some/all of the 15' setback y_ ) / ,,\ l„ A.
-OR-
t2 D ^
Signaturreff Adjacent Riparian Property Owner I
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Ripanan Property Owner.
Typed/Printed name of ARPO:
Mailing Address of ARPO: i. ©. O..w �r� 1J C iSS 'jC7
ARPO's email:
ARPO's Phone#: d - 2l( ( - 7 "t ? 1
Date: —1 k "K 9- 3 •waiver is valid for up to one year from ARPO's Signature'
Revised May 2021

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