Shaw, Jeff - 91315C

❑DREDGE & FILL N9 91315 A B G D
GENERAL PERMIT Previous permit
t 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 ❑ Rules attached. M General Permit Rules available at the following link: wwwdecInc gov/CAMArules
Applicant Name _
Address
City '
Phone # (_ )
State
Authorized Agent --
Project Location (County):
Street Address/State Road/Lot #(s)
City
Affected ❑ CW NEW PTA ❑ ES ❑ PTS Adj. Wen Body (60man/unk)
AEC(s): ❑ IDEA ❑ IHA ❑ UW ❑ SPIMA ❑ PW5 Closest Mal. Wtr. Body
ORW: yes/60 PNA: yes/no)
Type of Project/ Activity
(Scale:. )
Shoreline Length
Access Length)
!
a y
5+(
-
u
�.
c
�I
i
Pier(dock) length
-f
Fixed Platform(s) )� r X
I 1
I
1
Floating Platform(s)"-'-
[14
Finger pier(s)
i
Total Platform
area
Groin lengthlength/it
it
Bulkhea / Riprap length
--I--
-
Avg distance offshore
Breakwater/Sill '-
-
-
--
-.—.
--
.-
.---
—
---+
Maxdistance/length
t
�
Basin, channel
Cubic yards - rl,c,
i
___. h;
/
aii
( 1
-�—_
--L.
�_..�
Boat ramp
Boathouse/ Boatlift
I
I
—
j--
-
-
Beach Bulldozing
Other
I
�
1
SAV observed: yes no
Moratorium: n/a yes no
--�---
-
_
-
'
—
Site Photos: yes no
Riparian Waiver Attached: yes no
I
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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
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
•i
Id
Signature "Please read compliance statement on back of permit"
Application Feels) Check N/Money Order
Signature
Issuing Date Expiration Date

��`°"w ©CAMA El DREDGE & FILL N9 91315 A B " D
` GENERAL PERMIT Previous permit ----.
Date previous permit issued ----'
Q 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 r' : , i "i 1 I . (JV ❑ Rules attached. M General Permit Rules available at the following link: wwvzdeq.nc.gov/CAMAruIes
Applicant Name
Address h /'
City f �..,I I .'7 State /V C . zip
Phone #
Email t, ',. „ /�1.� . 1 r r"t.
Authorized Agent .'___
Project Location (County):
Street Address/State Road/Lot #(s) —
Subdivision `
City I'i. <-i td r�✓T
n
Affected ❑ CW NEW ❑ PTA ❑ ES ❑ PTS Ad!. Wtr. Body / 1 •(a Yr, 4 ( Y : /1 (nal/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body 14 Li 0 *-/1 i i I
ORW: yes/ro PNA: yes/169i
Type of Project/ Activity
Shoreline Length Air/ , 1 56 r
",,r•r t.._
(Scale:/j/ 7_j )
Access Length
-
Pier (dock) length y X ✓i Utz
Fixed Platform(s) ): zJ •'; r
(
!
-
—
—
-"'— -'—
—I
—
—
Floating Platform(s)
-
Finger pier(s) l . I y
(
—
�—
—
—
z
r
\
Total Platform area
--
Groin length/#
Riprap length
__
1
_ylkheaa/
Avg distance offshore
''�
-
-
i---
L
Breakwater/Sill
Max distance/ length
i.
Basin, channel
i
Cubic yards�—
Boat ramp ___'.-L.
Boathouse/ Boatlik
i
6{
i
I
Beach Bulldozing
I'-""-
Other
—t_
—•
7
SAV observed: - yes no
Moratorium: n/a yes no
Site Photos: yes noi
(—
Riparian Waiver Attached: Les no
_
_1—
A building permit/zoning permit may be required by:
Permit Conditions '
E 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
Application Feels) Check ff/Money Order Issuing Date Expiration Date

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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: �j,L /
Mailing Address:
Phone Number: %/9 �'�8 — %
Email Address: Si�+¢wl¢Ke_j;OA) W-) eaA-)A"I , 6,0NN,
I certify that I have authorized /e{I
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Zq_T;>06)_- /ZX3z 1>e,)Z
v
at my property located at Of
in 6�,4✓.e4- County.
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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:
�ynakire
Print or Type Name
OW�1/-ev2.
Title �CF)vs
l�l 7,OZ3; AVIAY 7
Date
This certification is valid through l,l

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or NAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: c t Z- X- lR t/
Address of Property: O 8 % %NYlnAAI OedfJb .31�4e7- II L
Mailing Address of Owner:
Owner's email: Phone#:
Agent's Name:
Agent's Email:
Agent
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.
1 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 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' setbac�� ,o
-OR-
Signature((ooffAdjacent Riparian Property Owner -GE-_IVVED
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property
Typed/Printed name of ARPO: �/A,,;i:� Gi.�ia-ASU J
MAY 17 2023
DC1l,1_MWD CI7'y
Mailing Address ofARPO: 200 %4a,,1ZMA-J %z17 -3F�I
ARPO's email: P61?h+'%>Su..) Grp.,±. ARPO's Phone#:
Date: r1&2 4 --1 `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 NOTIFICATION/WAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent) n /__ I_
Name of Property Owner P_.c1A U[�IGI,y;Y71�/✓ 1� VlY► //r .01 d YK *" l
Address of Property: ZZZ f /li�LMak l �. � � / Ili ZqJ`^%f0
Mailing P
Owner's
Agent's Name:
Agent's Email.
Agent Pho
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 DO NOT have objections to this proposal. I DO have objections to this proposal.
It 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.)
I DO wish to waive some/all of the 15' setback
ER
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email:
Date:
ARPO's Phone#:
"waiver is valid for up to one year from ARPO's Signature'
/-lLZ3
MAY 17 2023
Revised May 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: ,kWPS I. 010t ta,<r� /V � �inn�t 34/d l-i�V"
Address of Property ZP
zZ f /t(,yYiYld n 94, 0�,�au fml,4 HC Zli
Mailing P
Owner's
Agent's Name:
Agent's Email:
Agent
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.
_U1.11 I DO NOT have objections to this proposal. I DO have objections to this proposal.
it you nave 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
-DR- RRCF►v€-r,
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email:
ARPO's Phone#:
MAY 17 �-
DCM.MHU)
Date: `waiver is valid for up to one year from ARPO's Signature'
Revised May 2021

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: dE Ff cY/AW
Mailing Address: aop% %%7N iaey' tea, 1 6.411 ieT we-- ZO5/4
Phone Number: q/C% ,! ¢p G3%
Email Address: S�r�wy}u�h'o.J G re�b►+l .caM
I certify that I have authorized JI�T S144 J v
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
�oI4&'1-e'V �resic►�...
at my property located at All ZQj s%�v
in CA+�Alj- County
1 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
cJ��lnh%
Print or Type Narne
�ulove�2-
Title
-I—'-1
Date
This Certification is valid through __�_I__I
PF-CFIV1f
f4AY 17 7P
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