91435C - North Shore MHPK LLC

�o °"�'4 f1DAMA n DREDGE & FILL No. 91435 A B (� D
yo
GENERAL PERMIT Previous permit _
Date previous permit issued -
1 'New n 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:
aN. /Svc �
I5A NCAC �'� III Rulesattached. +' l General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant Name /Ju I' \S'('';1i- Oh Pk (C( Authorized Agent 7'c1. c,L'v'.e i
Address 3 01 -2s V '
- 1 Project Location(County): lot-tie'l
City t ac c C--- State NL -ZIP Zis S 12- Street Address/State Road/Lot#(s) ALv/4k SAol..A. .TD(i t'C-
Phone#(<> 13Zb - 2E(Ar-
Email , iv.h e oceo,AR AL . (-o.., Subdivision /Vo(41n S/1 ov= i'1HPL-
City • i/(vi'F'C ul,k ZIP 2RS I Z
Affected CW E ''PTA n ES ❑PTS Adj.Wtr.Body Q 0 , - S.'M-..4. (nat/man/unk)
AEC(s): ❑OEA ❑IHA ❑UW n SPIMA ❑PWS Closest Maj.Wtr.Body 30,--"E s v(
ORW:yes/no PNA:yes/no
Type of Project/Activity _t.. c t kIbvt C 1ODO ' 3) .ca. L L.v'S 4-.%:c'
(Scale:/V 1S )
Shoreline Length
Access Length
Pier(dock)length O' } d ,4� <5'`` ,Fixed Platform(s) —" l J�-F- ! I
• I
Floating Platform(s) �. tit g(IAA.) Gv`.--. I ,e,,,.,,-.tea 1f-
Finger pier(s) �----- • ��� v�"� J O 6 1 r
Total Platform area / .
Groin length/# 3�(4 I 30$ c 13
Bulkhead/Riprap length_/ - - - J :--� I �v) OZ t�.�(y
Avgdistance offshore '- l/Y/Z3 — ----..__
� 1_ iv t._._.__._�
Breakwater/Sill f
Max distance/length j" p�
Basin,channel `i, 00yo 7 j Cg,Z//li3\`■■
Cubic yards /t)pU yd 2p1 }VcE' 31�d3 ✓
Boat ramp �>r�18�Z� Y _.
Boathouse/Boatlift '�_
Beach Bulldozing ♦,6.. ? l
Other _---------' l 11(CV14tl14) - }_._...._.... _._.- — _ ..._.-_
t
SAV observed: yes no 1 -
Moratorium: n/a yes no
Site Photos: yes no . - -
Riparian Waiver Attached: yes no , i .
A building permit/zoning permit may be required by: ` ws.4'I(- let LL
F n TAR/PAM/NEUSE/BUFFER(circle one)
Permit Conditions ) \ja -V:16t,u6+/fiovc ,I I ab �'G re 1x.-e (ti'£ 1
1`4 vt.1 0.4- -f(io„, boo y€ '3 c'G wt,„1 i ct--416 jrrT.t- -(1 ❑ See note on back regarding River Basin rules
-.0 Y C Gt,,, - 3) 6 roc,. r-,Vri 511<,-PQ 6 ",
�� (� I' n See additional notes/conditions on back
-I lAc-vt -CYLA.(c l;,-?t 't 1
i 5 (t I i
I AM AWARE OF STATUTES,CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
14 Agent or Applicant PRINTED Name - Permit Officer's PRINTED Name ( ���••////
�� 'l/1 , ,i,--,--
Signature**Please read compliance statement on back of permit** Si nat e
11400 - COP5/2 � l��f2s/2 ,
Application Fee(s) Check#/Money Order Issu g Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit conditions. Any violation of these terms may
subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for
compliance. The applicant certifies by signing this permit that: 1) prior to undertaking any activities authorized by this
permit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the
local land use plan and all local ordinances, and 2) a written statement from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar- Pamlico River Basin Buffer Rules Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules
for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the
NC Division of Water Resources. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax: [phone] 252-946-6481
(Serves:Carteret,Craven—south of the Neuse River,Onslow Fax: [phone]
Counties) (Serves: Beaufort,Craven—north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District Wilmington District
401 S. Griffin St.Ste. 300 127 Cardinal Drive Ext.Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax:[phone]
(Serves: Bertie, Camden,Chowan, Currituck, Dare,Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

�30,�``'"` cfICAMA n DREDGE & FILL No 91435 A B CD
I1 GENERAL PERMIT Previous permit
Date previous permit issued �'
_,n New I I Modification ❑Complete Reissue n 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 n Rules attached. ❑ General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant Name Authorized Agent
Address Project Location(County):
City State ZIP Street Address/State Road/Lot#(s)
Phone#( )
Email Subdivision
City ZIP
Affected n CW 0 EW ❑PTA ❑ES n rrs Adj.Wtr.Body (nat/man/unk)
AEC(s): n OEA ❑IHA n UW ❑SPIMA n PWS Closest Maj.Wtr.Body
ORW:yes/no PNA:yes/no
Type of Project/Activity
(Scale: v ., )
Shoreline Length
Access Length
Pier(dock)length ROP, )f
Fixed Platforms) _— II
uinnaaia
i
C
Floating Platforms) � II/
it.:
Finger pier(s) I i r
Total Platform area ..
Groin length/# -�! t f ram'
f ► • r 1
Bulkhead/Riprap length .:
Avg distance offshore �—
Breakwater/Sill
Max distance/length j �1r
Basin,channel ' ill lif( ' I :1
I
Cubic yardsi (41 ill:
tq_?+ <`11111111
1
Boat ramp . I
i
Boathouse/Boatlift
Beach Bulldozing I I
Other Millillriagra
INIM
1111111111ENIMM I
SAV observed: yes no 1 ? j
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no ;. I i
permit/zoning1 t I A building permit may be required by: `.<
Permit Conditions , n TAR/PAM/NEUSE/BUFFER(circle one)
r ir,. ;( n See note on back regarding River Basin rules
nSee 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 r,,. r. Permit Officer's PRINTED Name
Signature**Please read compliance statement on back of permit** Signature J
/t 1 z l e77
Application Fee(s) Check#/Money Order Issuing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit conditions. Any violation of these terms may
subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for
compliance. The applicant certifies by signing this permit that: 1) prior to undertaking any activities authorized by this
permit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the
local land use plan and all local ordinances, and 2) a written statement from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar- Pamlico River Basin Buffer Rules Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules
for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the
NC Division of Water Resources. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax: [phone] 252-946-6481
(Serves: Carteret, Craven—south of the Neuse River, Onslow Fax: [phone]
Counties) (Serves: Beaufort, Craven—north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. Ste. 300 127 Cardinal Drive Ext.Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax:[phone]
(Serves: Bertie, Camden,Chowan, Currituck, Dare,Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 1 V 6 M\A,R `( , ►--.
Mailing Address:
Phone Number: Lj L- - LLp -
Email Address: \`.�� a ,.C.\ - .
I certify that I have authorized \ • f
Agent/Contracto
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: , ,,5-NA
at my property located at Q r S\-N a r Q-- 3 I
in cQ c"-1% c.r• Cc 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:
S a 3
Signat re 3 V
A . Q . 3
Print or Type lAime 1
( ; Title
_ VL I ' k / 2 _ 3 \
Date
3 � �
This certification is valid through I I j

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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. p )\C",.> `--' \-\\Q
Address of Property: t�r � Nr%4 e_- M\'1% LQ S 3 3 p`•-‘ , 3C)(,12
Mailing Address of Owner: 2 n-k N‘c-\ eX... AL, L11:1 L.
Owner's email: (�.r�n\ Owners Phone#: - 7L-4 ).- J 3Qi
--err
Agent's Name: \ rr Lc • .�.� Agent Phone#: 2.;[.. 1- - \ \DI- , 3 `y +
Agent's Email: .]ec ` \ \ LLL. q .\• `A
3 ��
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner) 3 \
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. 6-`3
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
malted to 400 Commerce Ave.,Morehead City,NC 28557.DCM representatives can also be contacted
at(252)80I1-2808. No response Is considered the same as no objection Ifyou 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).(tf 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 Property Owner:
Typed/Printed name of ARPO: \ �-� �^ S °r (IN
\ �, (�•
Mailing Address of ARPO: �1 \ � Ce C--4 JS a_vl ay \N J t art\a+��� "Q 1--r.}(.,__
L ,, ►L
ARPO's email: \OvJ�- ARPO's Phone*: L. J 1- -71. 3 - 71 1 4)
_ 11 �.G.co. err.
Date: la- \�- Z v L *waiver is valid for up to one year from ARPO's Signature`
Revised July 2021

•
U.S. Postal Service.'
o CERTIFIED MAIL= RECEIPT
Domestic Marl Only e
co for delivery mfonnation.visit our web,rte.rl vnrn uspn cone
tr. Atl�tntilE-.8$pcOr,$ 85i12'
43 Certified Mull Fee 34.15 t I 0684
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c ❑Adut Signature Regaled s $0.00
❑Adut Srenaturs Reetr;C.W De'lveryCI S �_
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Osta8 $1.11
06/16/2023
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N 'Street and Apt.No."O B(o x 727
cilYtate21P+da Atlantic Beach NC 28512
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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWANER 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: roc S�"c�< e� � .-J S �J r 3k-.\ 3 0<0
Mailing Address of Owner ,C 2 S0 v � "� �- Ue-z`� r)8 >,2 3 Owner's email: rN.A^ct...Owner's Phone#: Z- --72_,1/441 - 2-ci.skoS
Agent's Name: \ \:--- Agent Phone#:
Agent's Email: 6\1 ri A,3�`^. 2 Z —"`�-.o"\. cry ram' 3 J l
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner) S
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.
v 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(252)808-2808.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 skin
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)
--L
Signature of Adjacent Riparian Property Owner.. ��}�vI i,L
4L—Vcr:
Typed/Printed name of ARPO: l Pf\ L 1 C �gS 2
Mailing Address of ARPO: ? V Ni( 7)\�r1) 'eft �1 J`'-C 1 i C l
ARPO's email: ARPO's Phone#: ALAI -3 LP ` L'
Date: L, —3 C' - .3 'waiver is valid for up to one year from ARPO's Signature*
RECEIVED Revised July 2021
JUL 10,2023
DCM-AND CITY

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1

tit 'kr5CAMA DREDGE & FILL No 91435 A B I) D
1 GENERAL PERMIT Previous permit
l Date previous permit issued
n New ❑Modification n 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 V 't4. / °CJ Ill Rules attached. n General Permit Rules available at the following link:www.deq.ncgov/CAMArules
Applicant Name r Jo/ BSI^f2L A44 P ((..0 Authorized Agent ---Ti 14^ Ca.i' vine I
Address ' v t�8 hF 25 0 Project Location(County): l_
^
City A-�lr w'>c1 L Rpc,c L State /J C-- ZIP ZFS S I Z Street Address/State Road/Lot#(s) AJv/4k SL - ID'i IA- 4_
Phone#(2 2) -3Z4' - 2g(.0S'
Email e A^1- Q 0 CPC--y1foJLt . (oN ' Subdivision A/O( S hvK -MHf L.
City'1-/t t'4'1 L LC-‘ ZIP 2-2S1
Affected n CW 5.EW rA n ES n PTS Adj.Wtr.Body 5 c'�1.L .�,,'�^ (nat/man/unk)
AEC(s): n OEA n IHA n uw ❑SPIMA n PWS Closest Maj.Wtr.Body J 3 Sa -ovt
ORW:yes/no PNA:ye re
Type of Project/Activity 'ilri7 pU(x A- ' wAv 'W(vt- C -P XC&Uo\ lam. (4.: 3) .t)(VC) 1 c-�c -G v'S 47 k -
1i9S!It44 (Scale:N1_; )
Shoreline Length " /10 CO'
Access Length ------- _-_ '.-. I
► RE _... ! ...... � -
-i z
s� 1 t [
Pier(dock)length ' , r i "1 " ' -s , ,
Fixed Platform(s)
/— i 3 i ' - ' 1111
j
Floating Platforms) 111W21 1, MC=
1111
Finger pier(s) _
Total Platform area
Groin length/# r
Bulkhead/Riprap length )
Avg distance offshore L"
Breakwater/Sill IMIIIIIIIMMIMIIIIIIIIIIIIIIIMIIIIIIIIIIMIEIIIIIIIIIIIIMIIIMIIIIIMNNIMIIIIIIIIIIIIIIIIIIIIIII
Max distance/length
Basin,chan </(,c2O Yol
j
Cubic yards '/DOU yc( 1 j 2"'Iti ( I-
Boat ramp _�--` '_ '
Boathouse/Boatlift ,,__ T i I U. 1
Beach Bulldozing 0111=111111111 iii
Other
,imI
111111111111111111111111111110111
SAV observed: yes no
Moratorium: n/a yes no 1111
Site Photos: yes no —
Riparian Waiver Attached: yes no ' 11111111111111111111011011110111111111111111111=1111111111111111
A building permit/zoning permit may be required by: ,A n 4'IC.- C.�
Permit Conditions i �� -'s ' •t,,,,,4�V -' L.- CP If Ob (LyGvi f'/. f A/c((h^6-11 f, n TAR/PAM/NEUSE/BUFFER(circle one)
/ J-, (1,(_ 4-LtG.�. I Q00 y,(3 �/i v i€- A /A-( - -/d r r v'" n See note on back regarding River Basin rules
((__ n See additional notes/conditions on back
4Vtc-v, taytlt( 1 LfiS (y ) .
I AM AWARE OF STATUTES,CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
w 11
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name '=-__ _
Signature**Please read compliance statement on back of permit** Signatu,re
1 11 00 . L.% -21 9 (,./Y 3/-z /5//stz
Application Fee(s) Check#/Money Order Issu g Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit conditions. Any violation of these terms may
subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for
compliance. The applicant certifies by signing this permit that: 1) prior to undertaking any activities authorized by this
permit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the
local land use plan and all local ordinances, and 2) a written statement from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules
for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the
NC Division of Water Resources. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax: [phone] 252-946-6481
(Serves: Carteret,Craven—south of the Neuse River,Onslow Fax: [phone]
Counties) (Serves: Beaufort, Craven—north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District Wilmington District
401 S. Griffin St.Ste. 300 127 Cardinal Drive Ext.Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax:[phone]
(Serves: Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

,�o��`°"r� l ICAMA I I DREDGE & FILL No 91435 A B CD
0 = GENERAL PERMIT Previous permit
Date previous permit issued
New Modification I I Complete Reissue I I 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. n General Permit Rules available at the following link:www.deo.nc.gov/CAMArules
Applicant Name Authorized Agent
Address Project Location(County):
City State ZIP Street Address/State Road/Lot#(s)
Phone#( )
Email Subdivision
City ZIP
Affected CW n EW n PTA El ES ❑PTS Adj.Wtr.Body (nat/man/unk)
AEC(s): I I OEA n IHA n UW [I SPIMA n PWS Closest Maj.Wtr.Body
ORW:yes/no PNA:yes/no
Type of Project/Activity ,•. ,., k'' ': ' Lt. -P y r(t ,) , (:L if-INcN y. ( 1) ' v' ;
(Scale: . )
Shoreline Length
Access Length IIIM
Pier(dock)length
f- craimoir ( . —
Fixed Platform(s) 1
Floating Platform(s) =
1a
Finger pier(s) 1
I
Total Platform area
ll L) I i,w
Groin length/# allra '
Bulkhead/Riprap length 1 3 ,
Avg distance offshore __.----- - . ..... I__.__
Breakwater/Sill MIIIIIMINIMMINIMMININIMINIIIIIIIIIIIIIIMINIMINNIMMINNillINIIIII
Max distance/length
IIIIIIIIIIIIIIIIIIIIIIIMMIIMINIIIIIIIMMININIMIMINIMINIMINIIIII
Basin,channel
i-.'_ F s 1 II 1
Cubic yards 1
Boat ramp _ 1— EILI
Boathouse/Boatlift
Beach Bulldozing
Other -
SAV observed: yes no E
Moratorium: n/a yes no 1 1
Site Photos: yes no
Riparian Waiver Attached: yes no 1 1 1 IMMININIMININIIII_
A building permit/zoning permit may be required by: A.,.�C LA t
Permit Conditions t I n TAR/PAM/NEUSE/BUFFER(circle one)
`' 1, - n See note on back regarding River Basin rules
nSee 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 Fee(s) Check#/Money Order Issuing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit conditions. Any violation of these terms may
subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for
compliance. The applicant certifies by signing this permit that: 1) prior to undertaking any activities authorized by this
permit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the
local land use plan and all local ordinances, and 2) a written statement from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar- Pamlico River Basin Buffer Rules Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules
for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the
NC Division of Water Resources. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax: [phone] 252-946-6481
(Serves: Carteret,Craven—south of the Neuse River,Onslow Fax: [phone]
Counties) (Serves: Beaufort, Craven—north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. Ste. 300 127 Cardinal Drive Ext.Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
(Serves: Bertie,Camden, Chowan, Currituck, Dare,Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: A n M\ L.�--
Mailing Address: d v X 2-5 \,
4`-. LV.J 'tL
Phone Number: LS2.-12-Ls -
Email Address: \�.•�� �- �c c�� -.�,� . c a�—_
I certify that I have authorized .a
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 r\ 5" c-v C r .1 e.,
in C--a r-1% t r • V 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: V
303
Signal re
== . . �_.. �. ) � J 3cla
Print or Type Marne 3 —�
Title S a
3 \ LA
Date
3 \ �
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This certification is valid through
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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._ a 5\ ' fc1'c\ �--�-'
Address of Property: EN r."\J\--.. ems. M\-\ L kit 34 3, , V1 lQ I
Mailing Address of Owner: Q 2—SMA `►(.- 2-
Owner's email: .rY.� O c.v.,cam.., . .. Owners Phoned: 4 J L - 7 2.4 .1-e\A 3
Agent's Name: Agent Phone#: 2-`-\ 3 y ,
Agent's Email: ,5.1 r-S\`S-1 \ LL dye*._.\• LA
3
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 3 V J I
permit has described to me, as shown on the attached drawing, the development they are proposing. A
description or drawing,with dimensions, must beprovided with this letter. S 1 2
1/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(252)808-2808. No response Is considered the same as no objection If you have been notified by
Certified Mall.
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 skin
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 Property Owner:
Typed/Printed name of ARPO: 'C t-ar 5fio c-. 4"'J a` cn \
Mailing Address of ARPO: \ �a• C--R'tsC—`h,°r" `�J t `-t\ac.�. �--
_ \L
ARPO's email: Sq(-•b.1\t-.ov� ` ARPO's Phoned: L J --7ir..3 - 711 $
Cc..("' _.Ares►
Date: (4 - \ I L� 'waiver Is valid for up to one year from ARPO's Signature`
Revised July 2021

U.S. Postal Service "
CERTIFIED MAIL-' RECEIPT
in Don7PS11C Mail Only
coF or delivery information-visit our weborte:R tvtvtr OSps.COn)
v
Atlont lt;B�C�(r l!C 81ld2:-
co .ninedMall Fair
o-• $4.15 ' 0689�
s'
~ Extra Samba&Fees(ctavcbay add he
p titan Remo lnadoo*El Milan Rec•ipt(elsetonk) $ sssvv O.t
_ Postmark
nn Po
pElowiilledMI1Moulded Mew $ $QCJQ Hefe
o OMAR Maniere"pidied • $0.00
Desna&maturewn"nn°owwyCI f
rrti Postage $1.11 06/16/2023
N
^' aosl.a.an0 Fos 61
rl Sent To
Sii iiatdApt.1G6:;o7FD ro.
PO Box 727
M.-k_ ` Atlantic Beach NC 28512
PS�r, 3800.April 2U.5-....