89749A - CASPInc -Knowles

DREDGE & FILL
GENERAL PERMIT
❑New ❑Modification []Complete Reissue ❑ Partial Reissue
NY 89749
Previous permit
Date previous permit issued
_� V
t A ,B C D
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 } N • ) �Ob ❑ Rules attached. ❑ General Permit Rules available at the following link: wwwdeq nc gov/CAMArvles
Applicant Name
Address
City State ZIP
Phone # (_ )
Email
r /i
Project Location (County): C L / ! �I ) -, I- I
Street Address/State Road/Lot #(s) ( I '^ ('A CI'1 '-; i"(. u1 1 v
Subdivision
City
Affected ❑CW yr;EW HPTA ❑ES ©PTS Adj. Wtr. Body // (gVman/unk)
AEC(s): F]OEA ❑IHA ❑UW $PIMA ❑PWS Closest Maj. Wtc Body
ORW: yes/,,Ao PNA: yes/no
Type of Project/ Activity
Shoreline Length IX
Access Length
T
�ev dock) length
Floating Platform(s)
F
In (5) ->) cy '
Total Platform area A
Groin length/N
head iprap length
Breakwater/Sill-
Max distance/ length
Basin, channel -
Cubic yards
Boat ramp
BoathousL/'Iftoatlifj 12... axe! i i
Beach Bulldozing -
Other
SAV observed:
yes nozyi,�
Moratorium: n/a
yes noSite
Photos:
yes no
J+;)
Riparian Waiver Attached:
yes no
A building permit/zoning permit may be required by: !_
Permit Conditions -
�e (Scale:j
❑ 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)
i
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature"Please read compliance statement on back of permit'" Signature !/:! )
Application Feels) Check q/Money Order Issuing Date I Expiration Date

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: _�,0h �Moyju,S
Mailing address: —31 q =L-Y nlcc u P4
i tiw.den iJC 2'7g71
Telephone Number:
I certify that 1 have authorized /p7 pc✓n.5 1g., �]I � Lyc��nvn f -(agenUcontractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of t t K h eaJ QbC �{
9
at my property located at /12 6 /^'xS+ d & Ablec(l vc
This certification is valid through Gb(0- 20 2Z9 (date).
(Property Owner Information)
Signature
Print or Type Name
Title, co. owner or trustee for property

Telephone Number
Email Address

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONfWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion Ito be completed by owner or their agent)
Name of Property owner. �i,Qnh_ It yi(hQ _ tt\F /_nk)W `6
GO
Address of Property: j�Ps Qlry0 "a Z fVtoyaCK AJC, 2'7953
Mailing Address of Owner: 3 (q TvY dt(_K. Rd ay cn N(, 2?9Z f
Owner's email: A)raR reel Owners Phone#: '7$ 1' �4 �' ce_i y 2
Agent's Name: 2 t)Ltin) j 1!P( 1*0^ Agent Phone#:&Z) y 2U`Z(OSS
Agent's Email: �%WLXA-b";r)0130U} IN-jle.Mr- ,
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be completed by the Adjacent Prooertv 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.
rf you have objections to what is being proposed, you must notify the M.C. Division of Coastal
Management (DC" 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 N you have been
notified by Certired Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lit, 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 dprap revetments). (if you wish to waive the setback, you must stun
the appropriate blank below.)
I DO wish to waive someiaii of the 15' setback Y
Si,gnaturok4LAfacent Ripariait 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:
Mailing Address of ARPO:
! q5g'
ARPO's email: �d.OSin�tX�t7fYl 5tr clftRPO's ?hone#:.i S? 40ct-r_ogpi
pate: djl � .waiver Is valid for up to one year from ARPO's Signature'
Revised July 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND QEIJVERY
(Top portion to be completed by own�e/r or their agent)
Name of Property Owner. j _ Oaa Mi('hoid- `fk 1 I^+()p Iat 6
Address of Property: �k2o cArn SktA Lae MAXack NCi 2- Ms8
Mailing Address of owner: (R �� fj,CK Rd (mow NG 2't9Zi
Owner's email:. h1ofth 6/i05' '�9Jlttr'%'tnrq Owner's Phone#: —751" fit% 1' $-I4 2.
Agent's Name: 9MMIS I Oklld DOME s(_!Dpi Y9 Agent Phone#:
Agent's Email: kl t
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be completed by the Adjacent Property Owner)
t 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 dimensionsmust be provided with this letter.
X I DO NOT have objections to this proposal. I DO have objections to this proposal.
H you have objections to what is being proposed, you must notify the N.C. DiylsIon of Coastal
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 (252) 2t34.3901. 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 sign
the appropriate blank below.)
I DO wish to waive sometall of the 15' setback
-0R-
Signature of Adjacent Riparian Properly 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: Daniel Gilbreath
Mailing Address of ARPO:
ARPO's email: V,
Date: 3/28/2023
1795 Tulls Creek Rd., Moyock NC 27958
ARPO's Phone#: [phone]
__`waiver is valid for up to one year from ARPO's Signature-

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