89660A - Hughes

.4;d°1Wr 40CAMA ❑ DREDGE & FILL N� g�66U �� A B C D
lffff 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:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www deq nc gov/CAMA ides
Applicant Name _
Address
City
Phone # ( )
Email
State
ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision _
City
Affected ❑ CW ❑ E W ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (naUman/onk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Mal. Wtr. Body
ORW: yes/rioPNA: yes/no
Type of Project/ Activity
Shoreline I. math
(Scale:, )
Access Length
Pier (dock) length
Fixed Platform(s)
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Floating Platforms)
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Finger pler(s)
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iGroin
Total Platform area
i�1i1
length/#
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'■1
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Bulkhead/ Riprap length
Avg distance offshore
1
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A building permit/zoning permit may be required by: to <: IG n it
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
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature *-Please read compliance statement on back of permit•• Signature
(Please Initial)
Application Feels)
N/Money Order
Issuing Date
Expiration Date

RECEIVED
APR 18 2023
N.C. DMSION OF COASTAL MANAGEMENT D C I V I` E C
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
Address of Property: 7 I el�b t"ctrU �C • ` C1
Mailing Address of Owner. /11
Owner's email: Ownges Phone#: 2 •7 81 `
Agents Name: kc1q* AIVAI-rv14, tnC Agent Phan#?? a- 7 3l ` 013
� .r 1 r,
Agent's Email:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that 1 own property adjacent to the above referenceu 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.
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 401 S. Gnfin 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
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 16 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 somelali of the 15' setbaci( '�
Y• 11
' ignature of Adjacerit Riparian property Owner
-OR-
I do not wish to waive the 16 setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner.
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email: ARPO's Phone#.
Date: `waiver is valid for up to one yearfrom ARPO's Signature`

01
RECEIVED
APR 18 2023
N.C. DIVISION OF COASTAL MANAGEMENT IV -EC
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION)WAIVER FORIPC
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:
Mailing Address of (h
Owner's email:
:1 .COM Owner's Phone# 6b 3' 291. 'V FJ;
Agent's Name: L41411epi 11' OI " .'rn(L- Agent Phone#: d5.)- -3J t' (1510
Agent's Email: Iota, /nL'j"'���n'IGIJ, CGS
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adiacent Property Owner)
1 hereby certify that i own property adjacent to the above referenceu 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.
ff you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (OCAI) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Gd In 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
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 16 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 /
X'
ignature of Adjacent Riparian Property Owner
-0R-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner.
Typed/Printed name of ARPO: 12° Qal' L&a"A w,,
Mailing Address of ARPO: 1 35 lkXK-1S U F"9 92 k,JF-
ARPo's small: %J W b o b e 6MA 1 L , 6r 1ARPO's Phone#
Data: "waiver Is valid for up to one year from ARPO's Signature'

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