89704A - Wright

tA ,(0MT1'&[1CAMA ❑ DREDGE & FILL
3 GENERAL PERMIT
F-INew ❑ Modification ❑ Complete Reissue [-]Partial Reissue
N9 89704 A B
Previous permit
Date previous permit issued
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: wwwdecinc gov/CAMArules
Applicant Name
City State _ ZIP
Phone #
Email
J 4..
Authorized Agent `I F��iY bl�rl-` Yam ( .I',._J(
Project Location (County):
Street Address/S[ate Road/Lot #(s)_ ,� `'-, '( I d t r_ ' -?
Subdivision ( OV"hyCt T")F'/tClk
City I l n l (c zip '� a 9)cq
Affected ❑CW DEW ❑PTA QES ❑PTS Adj. Wtr. Body, 'Q1j.ri -j-r� ) (i (na nJunk)
�...:
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body. , U f {- i I I ' r) (4l"6 F
ORW: yes/no PNA: yes/no
Type of Project/ Activity
N
Shoreline Length
Access Length /
Pier (dock) length t �>
1...
!
!
_
j
(-_..
't
Fixed Platform(s)
—
_
_...
( _
.
_
Floating Platform(s)� r
—��
I
I'—
-_
Finger piers)
Total Platform area t
Groin length/q
4-
-Bulkhead/ Riprap length - -}-
_—
I_-
-
'-
_
_
Avg distance offshore
1
—
i
--
.-
-
-
✓
_!.
?
—.
i1
L..._.
-
Breakwater/Sill -
L-'
'-
-
-
'
Max distance/length r
Basin, channel
Cubic yards
Boat ramp
i
-i-
Boathouse/Boatlift
Beach Bulldozing'
y
_
Other
�-
- .'f
-
-
-
_
i
I
--
2-
t
.—_+
-L4
—
.
-
✓
SAV observed yes no
Moratorium: t ri/a ; yes no
yes no Site Photos:
Riparian Waiver Attached:)
A building permit/zoning permit may be required by: ' ; f r rti I C-k=
Permit Conditions li �`.*_ -( i, �� f ` ❑ 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 THATAPPLY 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 Feels)
Check q/Money Order Issuing Date
Expiration

AGENT AUTHORIZATION FOR CAM/ PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address: L-3 r 0'-a. n 4 a.
Phone Number: Z�52�"- 322 6'7
Email Address: .-'
I certify that I have authorized l,� �� wit � � N Agent
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
at my property located at "L%I
in i' 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.
rnn' u, yNc wcu�c
Title
03,19 �o�/
Date
This certification is valid through

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner J6-"
Address of Property: ZZc3$ %� sN 12dr Cd+c1/�a ✓ r- .e�79a7
Mailing Address of Owner: a'3% ta� LB/aKCIM R4 644-@S�I t le 1 ✓) G .2-19 38
Owner's email: r!unn.�:o w lwr� 0 M)ocM+vAw owner's Phone#: 252- 333 - &y(o (o
Agent's Name: I hhA1 Agent Phone#: --S'Z --2X) 2-6
Agent's Email: ,f'Y ll-CaiNl
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
description or drawing with dimensions must be provided with this letter.
✓ hDO 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
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 Mall.
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 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 blanjc) T
Signature of Adjacent Riparian Property Owner: 0�Ia
Typed/Printed name of ARPO: SFQL-rin v, CDrheQIA--
Mailing Address ofARPO: �2//(� A/a-4)nr- (-rime_, Vd_ Bea -sin. ✓A- a,34Sk
ARPO's emai : n ARPO's Phone#: Z.K 7 - 6 / 9 - 78go
Date: / 0 - / R • .1 g *waiver is valid for up to one year from ARPO's Signature*
Revised August 2022

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL RETURN RECEIPT Rt nl tocTr . _ _
(Top portion to be completed by Owner or their agent)
Name of Property Owner: if3w 1 e,
Address of Property:
la� on l>ol. Canal Mailing Address Of Owner: Z3 F
Owner's email6_14,5wr', tt}�y ,
Owner's Phone#;y 3
Agent's Name: /�racj+ ��tt a �(ti
A Agent Phone#; 2$Z — Zp7 _ (097-6
gent's Email: (?to,.�L, /�„ �41� ., _ /_ �
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(bottom Portion to be completed ti
u scent pro a Own r
1 hereby certify that I own property adjacent to the above referenced property. The individual applying for this
descri lion or drawing permit has described to me, as shown on the attached drawing, the development they are proposing. g
with dimensions must be provided with this letter.
1 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
mailed to 401 S. Griffin St., Site. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection /f you have been
notified by Certified Mail.
understand that an p WAIVER SECTION (Chops__ _e on1� onai
y proposed pier, r, 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 revetment ), (If you wish to waive the setback, you must sign
the approp,late blank below.)
I DO wish to waive some/all of the 15' setback
-OR- Signature ofAd)acent Riparian Property Owner
I DO NOT Wish to waive the 15' setback requirement (initial the blank) of Y
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: _ C N R-(i, JL) I" NF,.L .SCi;n., 17r
Mailing Address of ARPO: % O d UKE-T C i d "6 M ILLY /11 I P�qL
ARPO'ssmall: CScH.urrr70 C"IIL(Q ARPO'sPhone#: 211 - 31'7- d17i-
Date: _ 2--7 Mq/L ?A 73 waiver is valid for up to one year from ARPO's Signature -
Revised August 2022

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