86865A-Hall

ICAMA X DREDGE & FILL
GENERAL PERMIT
] New ❑ Modification ❑ Complete Reissue []Partial Reissue
N° 86865
Previous permit
Date previous permit issued
6) B C D /
As authorized b�yt 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 (+` 1100 (IA. l ad O ❑ Rules attached. Uf l General Permit Rules available at the following link: wwwdeclnc yov/CAMArules
Applicant Name Or.clr � � il<. 6,. 14,c 11
Addressgn3 615 C- m 0_ 6. pae l
City 1�1k �a n state MA zip l9 1
Phone # [phone] b 1
Email ';-)W 1+kilk!5 '�'( �mw.,. L�
Authorized Agent I6et L( /V!t 6J11-t tyfh(4�c N
Project Location (County): tl,)r r.7 t.t`
Street Address/State Road/Lot #(s) a A SK OLCG
L.o 1- *to C'aLLjlr-i v-\ S�
Subdivision i\o r o \rc. 1.¢t. [ h
City Core, II,G zip a'"cl a. ,:T
Affected ❑ CW %EW PO PTA ES PTS Adj. Wtr. Body CL. �k 4- KnolT� Ts )nnl e,y (na an nk)
AEC(s): ❑ OEA 1-1IHA nuW nSPIMA El PWS Closest Maj. Wtr. Body L .. r. t-k 'Sa.� ✓` C
ORW: yes& PNA: yes
Type of Project/Activity Ntw r.1 Sh,��.�•� �w�Rt,i�r.,� 4w.L. X It,• Qr</
4' w x R' Ofle AOL'c 44k 1214 f 0 f An (Scale: jli:L.S, )
Shoreline Length t I0Cyr
Access Length
ie ock)length )b� K ti
F" latfo $ X 4'
Floating Platform(s)
Finger piers)
Total Platform area
.���
Groin length/#
ea iprap length )tl0 '
Avg distance offshore 1 `
Br
Max distance length a
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other _
IiJ\kL1__J IJ L^ yw\-
0.11. 11SuLA V.c.
(24 W 86w.,i A
ryJ'Y f�a f.kl i�J\Kh.as ct
I� I 6.4 pr<r t N
w
ll �0.1
`n 1�
~ti �
n�rti,r,�a IL;,cy` pr«
�'xti' Ll 'vP-lawn p�.iia♦M `�'
� v' + o.�1174.1 V-I\M,� ,n� L``J\`\Qn. I<f•41 L...i-\!
�
SAV observed yes yes e ,II 1 n�
Moratorium:,9n/a' no
Site Photos: C..�� no
Riparian Waiver Attached: yes ® n
A building permit/zoning permit may be required by:
Permit Conditions
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJI
,Agent` rA plican PRINTEpPldme
f Signature -'Please read compliance statement on back of permit"
4(y_� ofr) x -at.l e. 01tia%hx2;91J ataa i
Application Feels) us b y(y.. 4heck #/Money Order
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please Initial)
_ �I10 I-S 4110 /a-�
Issuing Date Expiration Date

VL
AMA ❑DREDGE& FILL NU 86865 A B C D
ENERAPERMIT Previous permit
Date previous permit issued
ew ❑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. 0 General Permit Rules available at the following link: www.deg.nc.gov/CAMArules
Applicant Name
Address
City
Phone # ( )
Email
State i " ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City=
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ U W ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Chnrclina l ength
(Scale: r,,
Access Length
Pier (dock) length iC
x
Sr`�—
Fixed Platform(s)
i
Floating Platform(s)
9f
Finger pier(s)
Total Platform area
Groin length/N
r—.-
—
r
yei
i
Bulkhead/Riprap length
it
Avg distance offshore
F-;-�iv�l
--
Breakwater/Sill
Max distance/ length
i—
�I
Basin, channel r'�
I
Cubic yards !11'''
Boat ram
,r
_77._
_—y,,
l
,�yW
-
Boathouse/ Boatlift
1
Beach Bulldozing Other
_
�
I
SAV observed yes no
1
Moratorium n/a yes no
.—
r
r —
i
Site
aPhotos:
rian Waiver Attached: yes no
1
—
r
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 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 q/Money Order Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: dau%4 4a((
Mailing Address: 1433 /Ts f1k Cltgpe I J?cl, ellG4pog
rind, 21921
Phone Number: qq3 — 3su — (a (G3
Email Address: nr u J4 aft 62® hrftm t (• enr✓t
I certify that I have authorized /3-eceek /a-,, k(1,04ck t rons{rcbbn
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: S %61( ae�c-- ( l :ncrr
IOti ��G d ( rns�all q)a
?i.oe
4 A
yak pl A> em
at my property located at
66eas, �ta��r
/f✓w<la (1C CZ927 ,
in C'V( -64 County.
l 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
Print Narne
Title
Date
This certification is valid through __ Z /_ao / Zo 23

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: J,00L'i'd AOLM
Address of Property: 2 LS6 DGee✓1 Pee'." I /0"o list tic a'7 `t 2.7
Mailing Address of Owner: t4?3 5!6 EiK ��a1. T?d n ► 41f 21921
Owner's email: ttv.1 lttatl S'T ®Woxl',1 • eo&ner's Phone#: 4446 - T76 ' G ! j- 3
Agent's Name: a%#Ack &1kNk-er.A1S Agent Phone#:
Agent's Email: M ^et l YAAkecJi &9 4/yt-J • cc -v%
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
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 norny me rv.c. urwsron or t.oastar
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 on
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
-OR-
I DO NOT wish to waive the 15' setback requirement (initial the blank)
r Signature of Adjacent Riparian Property �Owner: —r��• l/��'
Y" Typed/Printed name of ARPO:
X Mailing Address of ARPO: i 3 t hJk �k�ti �ctr t fGGI 4te,
X ARPO's email: 10 J 1 e-C2- 6� ,3X -, VARPO's Phone#: T ILL L ' )'l 7 T
Tel
Date: L� *waiver is valid for up to one year from ARPO's Signature*
Revised August 2022

■ Complete items 1, 2, and 3.
m Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
t. Article Addressed to:
�dwa'c� �1cllorwrt
+SZ'33 '�rivtces i0.n�t� Qd.
(p,fWita `(J dq&d^ Op
23'f,fOZ
1111111 1111111111111111111111111111111111
9590 9402 6930 1104 1157 53
7020 2450 0002 3104 1429
PS Form 38111 dDly 2020 PSN 7530-02-000-9053
Agent
e. Received by (PrintedNeme) 10.
17 u Yes
�t�lo
Service Type
❑ Pr Mty Mal Express®
Adult Signature
❑ Registered Mail-
--Adult signature Reetrktad Delivery
❑ Reabtersd Mail Reelected.
Codified Ma1W
G fiw Mal Resldctad Delvery
D ery
❑stgnatuumCanikmatan-
collect cn DNNary
❑ signature Wiienalion
Doltecton DeWary Restricted Deliery
Rastdcted DBlivery
'—.—'Man
IfieR&t�eUooYYer{'-
eN�
Dordssdu Return Receipt

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