89709A - Evans

°t�0ja ®CANFAT"❑ DREDGE & FILL ��� ? 89709 0 B c D
AV
1- GENERAL PERMIT �oDspousp
Date previous permit Issued
®New ❑Modification El Complete Reissue ❑hrtial Reissue
As authorized by the Slate of Nadi Camilla, Lsepartment of Environmental Quality and the Coastal Remurces Cominizion in an area of emrfmnmentai concern pursuant to.
ISA NCAC 1406 ❑ F�rles attached. - General Permkfaules avaliabte aziDefolbxinglYsk: yrMNnS,go:tfC/sriM lee
city rAft ^ smile MG Zip :l TUL
Plmne # (252) _ W3 79!eS!
Email uretec{-VACQUYe.Cmw,
Affected ❑CW NEW ®Pm ❑ES ❑PrS
AEC(* ❑OFA ❑IfiA ❑UW ❑SPIMA ❑PWS
ORW: yeJ6> PNA: yeso
Tape of Project! Activity
Project Location (County): � /, _
StreetAddress/State Road/L.ot #(s)hP.�Ly 4o& Q eR%
4 C
Sabdivisiws "'—
cny F„�lQ,wVisn _i1P— 2`1Ft31
Adj. War. Body t(Sd�\�� �it, Ri %M,r en' -dunk)
Closest Na), Wtr. Body
Shoreline Length 7JCYr (SCelet( )
Access length �"` - � .• _
Pier (dock) length
Fixed Platform(s) A •-..- .__, ... .. _ ___ ,ice.".... ..
Floating Platform(s)
ringer piers)
Total Platform area
Groin fength/# li ---i ._...._.,_.._
Bulkhead/ RIjimp length ? --
Avgdlstanceoffshore ^ -. .....
Breakwater/Sill ^ Max distance/ length
Basin, channel --
Cubicyards
s
Roa[ramP
ecafhouse/Boat11R
Beads Bulldozing
Other
," u1
SAV observed: yes r ,x
Moratorium: yes npSite Photos: 4� 09
t
Riparian Waiver Attached: yes e -
A bultdingpermit/toning permit maybe required by: Ukiswo^ �Oti nt-s
PermR CorMidons.._..._._._.—....__.._...—
Permit
-
❑ TAWPAM/NEUS"LIFFER (circle one)
Sea note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please InWal)
Signature` -Please mad compliance statement on back of penh-- Signature
Feels)
_ ttcrZ 51y/ 3 91Y/2
Application Fees) Checkg/Money order Issuing Date Expiration Data

�`°"" ®CAMA El. DREDGE & FILL (% N 89709 a B C D
a GENERAL PERMIT I" Previous permit
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 7 N" 1400 ❑ Rules attached. Ld General Permit Rules available at the following link: wwwdeclnc gov/CAMArules
Applicant Name A Y1%am,4 Cyo.yvV's
Address _ hC4 T , nC'h 11 c .vry Rd •
city 'Eden�l-av� State MC zip ;L 7Q3 "L
Phone#(2�) 333-C651
Email ClC'2ke.C-kVAC-@(ive,CC^.
Authorized Agent
Project Location (County): C I\d (W�tCZyx /,
Street Address/State Road/Lot #(s) Ut"k ttaX7C �Y'C.el
2d. %,h-,tA 34q 'Kodcy R.ek CreRl,c 2o1
Subdivision
City _ En 11FAV Sh zip 2114 A Z
Affected ❑ eW ©EW © PTA ❑ ES ❑ PTS Adj. Wtr. Body C.�\6 W o, I , V*—, man/unk)
AEC(s): ❑OEA ❑IHA ❑UW SPIMA ❑PWS Closest Maj. Wtr. Body T"'J0rk- S5L rj
ORW: yet� PNA: yes,ADO
Type of Project/ Activity
Shoreline Length— 13by
Access Length r
0.
Pier (dock) length
Fixed. Platform(s)
Floating Platforms)
Finger piers)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
^
Max distance/length
^
Basin, channel
Cubic yards
Boat ramp
Boathouse/Boatlift
^
Beach Bulldozing
Other
I
SAV observed:^ yes
Moratorium: yes no af„Sp _.rD
Site Photos: <es no �y
Riparian Waiver Attached: yes 0
A building permit/zoning permit may be required by: C 1 "Wc,^ COL__^�
Permit Conditions
Agent or Applicant PRINTED Name
CONDITIONS THAT APPLY TO THIS PROJECT AND
Permit Officef's PPhNTEp Name
(Scale:NTJ )
TAR/PAM/NEUSE/BUFFER(circle one)
See note on back regarding River Basin rules
See additional notes/conditions on back
(Please Initial)
Signature "Please read compliance statement on back of permit" Signature v
'am• =' I7_07— 5/4/2.3 q/y/23
Application Feels) Check #/Money Order Issuing Date Expiration Date

❑CAMA ❑ DREDGE & FILL NU 89709 A B c D
3 GENERAL PERMIT Previous permit
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:
I SA NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq nc goy/CAMArules
Applicant Name _
Address
City
Phone # (_ )
State
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 ❑ UW ❑SPIMA ❑ PWS Closest Mal. Wtr. Body
ORW: yes/noPNA: yes/no
Type of Project/ Activity _
Shoreline Length.
Access Length
Pier (dock) length
Fixed Platform(s),
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/Jt
Bulkhead/ Ripmp length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed:
yes no
Moratorium: n/a
yes no
Site Photos:
yes no --
Riparian Waiver Attached:
yes no !...__
A building permit/zoning permit may be required
Permit Conditions
(Scale:i• )
❑ TARIPAM/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
Signature --Please read compliance statement on back of permit**
Application Fee(s) Check #/Money Order
Permit Officer's PRINTED Name
Signature
Issuing Date
Expiration Date

®-y
N.C, DIVISION OF COASTAL MANAGEMENT ` d
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
E�TjF I) ED MAIL_}2ETURN RECEIPT REQUESTED or NAND QELIYEBY +
(Top portion to be completed by owner or their agent) 0
Name of Property Owner.. _ y',— IAr"�
Address of Property: 3�1 LAC C {k 1 6l4m A-/ 2. i9- z&
Mailing Address of Owner. y!/ ,',,
Owner's omall: Leo Pe y4'. f ` rc �lwnees Phone#: '2E
Agent's Name:
Agent's Email:
Agent Phone#: .
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(BottM Domicil to be enmoletad by fha dI*ceng ProDerty QyMffj
I hereby certify that I own property adjacent to the above referenced property. The Individual applying for this
permit hits described to me, as shown on the attached drawing, the development they are proposing, A
descriplon or dmw4no with dimensions must be a ylded with this fader.
I DO NOT have objections to this proposal_ _ I DO have objections to this proposal.
Management (DCAQ In writing within 10-days of receipt of this notico, Comsspondenee should be
mailed to 401 S. Griffin St, Sta. 300, Elizabeth City, NC, 27909, DCM reprasentaWas can also be
contacted at [phone]. No response is considerod the same as no objection 1f you have been
notiffed by Cerntad Mat,
WAIVER SECTION ihQpga onN onet
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of I& from my area of riparian access unless waived by ma
(this does not cooly to bulkheads or riprae revetments. (if you wish to waive the setback, you must alas
the appropriate blank below.)
I DO wish to waive somolatl of the 15' solback
-OR-
Signature of Adjacent Riparian Properly Owner
100 NOT wish to waive the 15' setback requirement (Initial the blank)
Signature of Adjacent Riparian Property
Typed/Printed name of ARPO:
Mailing Address of ARPO: .5"n C, $ p' /' G es VC4 �32�
ARPO's am ail:�1m3AS60C r G;CHJARRPO's PhonON: -e"$
Date: -waiver is valid for up to one year from ARPO's Signatum*
Revised August 2022
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RECEIVED
APR 2 7 7023
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I` 100
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APR 2 7 2023
DCWD,

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