86864A-Taylor

"te"r", MCAMA U] DREDGE & FILL N9 86864 A B C D�
Previous permit
GENERAL PERMIT 3 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. General Permit Rules available at the following link: wwwdq4.nc.goy1CAMAru1es
Applicant Name ,
Address - • c
City State ZIP
Phone # ( )
Email : Y
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)_
Subdivision
City
Affected ❑ CW Q EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/bnk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale:,a), 1)
Access Length
ock) lenghmks) jl(� x
jI
Fixed
Floating Platforms)
Finger piers)
T
l
Total Platform area
Groin length/tt
f'} '
4 t'
'-'
(
)
Y1
I
Bulkhead/ Riprap length
—
—
—
Avg distance offshore
A
Breakwater/Sill
Max distance/length `},
Basin, channel_
t'-L.
�..+-•
D
,
i
--
—I
jf
/
_
Cubic yards
a,.
Boat rampif
Boathouse/ Boatlift
Beach Bulldozing
Other
e
IL
SAV observed: yes no
I�Z
�
(
G
Moratorium..'n/a. yes noSite Photos: yes no=
�—I
Ttf-,
rt
-
Rioarian Waiver Attached: yes no
__
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:
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A building permit/zoning permit may be required by:
Permit Conditions I ❑TAWPAM/NEUSE/BUFFER (circle one)
I.., ❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLYTO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial ..'4
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit" Signature
Application Fee(s) Check R/Money Order Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ?-C!! Tad (o✓
Mailing Address: 13 t't 17a b ��n OTC,, G'4l asa_a�.Q
Phone Number: 75"� — (n 1 ? 744
Email Address: act 60X
I certify that I have authorized �Z eA i'�(s $ COhsP ✓ia
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: I a it Aec-u UoL.1 %
►3--y Jkh.ekcl 4 14 K (b 19,-ev
at my property located at Z2157(r oc sCZn fP--eer l . 6111 oiod e, fl G
in 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.
Properly Owner Information:
ignature
`i: ) ar
Pr} t or Typb Narm,
A ey-
Title
Y I Z-/ I LJ'LZ
Date
This certification is valid through fL l l 2a a-3

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:
r � �
Address of Property: ZZ-S& OGPf ri meal� �7y [A�J ��f�i� c a , 7
Mailing Address of Owner. /c31i �k-6 do ��✓4-t CkebV44,W A60/ z4a-zz
Owner's email: 3d ,f -e 7-y® me etr't&l-- Owner's Phone#: 757" (fl /&7� ICli�
Agent's Name: / rc do f, I L:'l 4
Agent's Email:
Agent Phone#: 2J� ZO7 - '52-C
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
oermN has described to me, as shown on the attached drawing, the development they are proposing. A
I DO NOT have objections to this proposal. I DO have objections to this proposal.
If yliu have objections to what is being proposed, you must notify the mu. urvision or coasrai
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. 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 (Choose only one
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 sometail of the 15' setback
Signature of Adjacent Riparialn Property
1e
DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: fig c J:3
Mailing Address of ARPO: Q o R r) lA Div t�{ � 1
(0110
ARPO's email: l\� �A ,/ v1nc.t 0 Sj �,� �' ARPO's Phone#: 0110 Z 15 -3 (r 5 A
Date: _-waiver is valid for up to one year from ARPO's Signature'
Revised August 2022

3:49 T of A V
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USPS Tracking'
Tracking Number: o
70202450000231041
❑ Retum Receigl(naNcopy) $
❑ Felum Receipt �elerlronic) $— �•��-
❑Cert1WMall RaslnctetlRelwv $ srl.(16
❑ Adult Signature Re ulre $
[]Adult Signature ReeMctecl Uellwq $
F0 Copy �ko Add to Informed Delivery
Latest Update
Your item was delivered to an individual at the
address at 12:47 pm on October 17, 2022 in
ELKTON, MD 21921.
Get More Out of USPS Tracking:
M USPS Tracking Plus@
O Delivered
Delivered, Left with Individual
ELKTON. MD 21921
October 17, 2022, 12:47 pm
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10/11/2022

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