Campbell, Ken - 91327C

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❑X CAMA ❑ DREDGE & FILL N° 91327 A B aD
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:
15A NCAC 0 % N, I ''- ❑ Rules attached. ❑X General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Address
City s'. State 'I ZIP /,o
Phone #
Email
Authorized Agent i'. , •i U /-,
Project Location (County):
Street Address/State Road/Lot #(s).
Subdivision
City
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Affected ❑ CW ❑ E W ❑ PTA ❑ ES ❑ PTS Adj. Wen Body (dat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity - I ,, r, J
(Scale: )
Shoreline l meth 4 ,,,, 190
Access Length
Pier (dock) length
Fixed Platform(s)
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4
r
4
1
l
Floating Platform(s)
Finger pler(s) _
-
-
.7
Total Platform area
Groin length/M
�I_
—._.
ulkhea /Riprap length
Avg distance offshore
Breakwater/Sill --
Max distance/ length
Basin, channel -
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-
-
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Cubicyards
Boat ramp
Boathouse/Boatlik
Beach Bulldozing
Other
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SAV observed: yes no w
Moratorium: n/a yes no -�-f-
Site Photos: yes no -
Riparian Waiver Attached: yes no
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-
-
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- -
-
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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/conditeps � pack
/!
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"
Application Fee(s) Check q/Money Order
Signature
Issuing
Expiration Date

ao�P'Qomr�,N❑CAMA ❑ DREDGE & FILL No 91327 A B ® D
GENERAL PERMIT Previous permit
Date previous permit issued
F\J 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 LI " Ii - ❑ Rules attached. M General Permit Rules available at the following link: v.ww.deq.nc.gov/CAMArules
Applicant
City State il/ { zip •.r S �„
Phone # (_ )
Email
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision -
City i'r
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity / ,
(Scale: N ; )
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s). -
Floating Platform(s)
Finger piers) --
Total Platform area -
Groinlength/# IN
<�ulkhe /Riprap length i L -
Avg distance offshore --- j
Breakwater/Sill
Max distance/ length - _ —
Basin, channel
_I
Cubic yards
Boat ramp
Boathouse/ Boatlift --_
Beach Bulldozing
Other
SAV observed: yes no + t r
Moratorium: n/a yes no -- — ——
..I_ I J Site Photos: yes no
Riparian Waiver Attached: y� no
A building permit/zoning permit may be required by:
Permit Conditions C.• - �TARJPAM/NEUSE/BUFFER(circle one) -
I,b -- ❑ See note on back regarding River Basin rules
❑ See additional notes/conditlo5`1 of back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT (Please Initial)
i l i
Agent or Applicant PRINTED Name f-
Signature "Please read compliance statement on back of permit --
Application Feels) Check #/Money Order
Permit Officer's PRINTED Name
Signj'ture
Issuing Date Expiration Date /

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: J`crC l_O6M
Mailing Address: 1w :�PQ Coer- -
Phone Number:
Email Address:
I certify that I have authorized
WFW
Lc 215 -7 0
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: \r6A 9 l DLk(K kj.
at my property located at jo n
in LW 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:
Signature
Print or Type Name
Title
5 / 3'D l a�
Date
This certification is valid through 5_I_3D_lC�4 "�i?1 t
to aM•,7utpii`1

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: �� p/) arvl e b-e-ki
Address of Property: Seca D gs- o
Mailing Address of Owner:
Owner's email: LL, �llictQ'1 Lo < c, rr. tl>i Owner's Phone#:
Agent's Name: lc -Lm © `ot,� Agent Phone#: aS a -)AS - 3 --L�k l
Agent's Email: oloynC -1\ [? h)CA 1c vA . (,bvY\
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.
/ 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
malled 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.
r
No. /
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
-OR-
Signature of Adjacent Riparian 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: 04 , !/ ; � is0 )
r Mailing Address of ARPO: &1711
S ARPO's email � / c Jr / /ro ra=, `ARPO's Phone#: 7,S S3,, ry s r
Date: waiver Is valid for up to one year from ARPO's Signature` SUN O -
Rcvlacd May P02Y
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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner:
Address of Property:
Mailing Address of Owner:
Owner's email: V ca—pbAt A? eec.r con Owner's Phone#: -gag---Hg4
Agent's Name: Y-Y-V� Agent Phone# _dSa
Agent's Email: —tbrv� 1 I P hn"c , (, ("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.
VDU 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
Certiffed 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
r�P Signature of Adjacent Riparian Property Owner
�}' p -OR- Rk 1.
i 1 do not wish to waive the 15'setback requirement (initial the blank)
JUN
Signature of Adjacent Riparian Property Ownei. p�1 �CMJUN 01
-
Typed/Printed name ofARPO: _�V�(� 142AA CS) 0ptX VCM-MHDGilY
Mailing Address of ARPO:
ARPO's email: ARPO's Phone#:�� r Z0� ip
Date: 5 '3o 9 3 *waiver Is valid for up to one year from ARPO's Signature*
Revlsed May 2021

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