89743A - Newbern

OCAMA [IDREDGE & FILL NY 89/4J /A }s C D
GENERAL PERMIT Previous permit _
Date previous permit issued
NIFINew ❑ 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. Li General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Authorized Agent k—c' 1) o
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Address
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Project Location (County):
City 1.
State ZIP
Street Address/State Road/Lot #(s)
( J i
n t,)
E ! t y
Phone # ( )
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Email__t
AA
Subdivision
City ('tr7C �7 iA
ZIP
Affected ❑ CW
[3EW ❑ PTA ❑ ES ❑ PTS
Ad" Wtr. Bod r V.,.r i [
1 y
&
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Y�CI na man unk
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AEC(s): ❑ OEA
❑ IHA ❑ UW ❑ SPIMA ❑ PWS
Closest Maj. Wtr. Body /�i � 'l � (' I'l Ck
C Lf
(((_
56(� Il rl
ORW: yes/no'
PIN A: yesCdli
Type of Project/Activity
-',/C:c-i'fUAL,rc.
Ty,•7?<L G. x<TC}/^fr4''r
i2t,{ I .-_
Shoreline Length
Access Length _
Pier (dock) lengtl
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
-
Bulkhead/ Riprap length
Avg distance offshore
,- - -
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
L_
Boat ramp
Boathouse/fToatliff� I % -71
,
Beach Bulldozing —
Other
SAV observed: yes no
i
Moratorium: n/a yes no
Site Photos: es
Riparian Waiver Attached: no
A building permit/zoning permit may be required by: _
Permit Conditions
f
OF STATUTES. CRC RULES
Agent or Applicant PRINTED Name
Signature **Please read compliance statement on back of permit**
11
Application Feels) Check #/Money Order
, ,l', (0..
(Scale: hJT )
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
(Please Initial)
Permit Officer's PRINTED Name
to --=.=-
Signature
Issuing Date 'Expiration Date

AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: t� y �F N C- vj g t-�t/�,4
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
'Z5 Z— I L>2$
13`GT'1"
Agent / Contractor
to act on my behalf, for the purpose of applying for andobtainingall CAMA permits
+
necessary for the following proposed development: u/Y Y 0 P (ei - f I 'Z `- ( 2
ErL 0fC�V, IC� Lx�'6 (
2x)2 1
at my property located at F 33-J �. c> N1G
in C1th2,q,1-uc(-- County.
-L7,qy1
l furthermore certify that l 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
Je-ii- 71PW PrYI
Print or Type Name
—�1i jr'"12t'
Title
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: �_� F F N yJ PO L. R (�
Address of Property: 3 3 t y lz�ir )-)S zeP) G PQ c 2- (qq
Mailing Address ofOwner] cal f��2�,1 tCrG2 RID&-E F(J i(1�(7���yZtiL 7qc/�
Owner's email: Owner's Phone#: %G Z — ZU-Z - 1 6 y
Agent's Name: 1 6ff) C-4ZT /v� ID(} ( j i Agent Phone#: Zj 2 ZUZ ? 03 2j
Agent's Email: C i t . (r.
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be completed by the Adjacent Propertv Owner)
I hereby certify that I own property adjacentto the above referenced property. The individual applying forthis
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.
V I DO NOT have objections to this proposal. _ I DO „ave objections to this proposal.
it 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
noted by Certified Mail.
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.)
100 wish to waive some/all of the 15' setback
-OR-
Signature of Adjacent Riparian Property Owner
I DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner:
TypedlPrinted name of ARPO:
!+1
Mailing Address of ARPO: (vC `% uwe-4,3 JSCO-clj
t yv
ARPO's email: CC 1�I L ;M4*j i (.ei+4ARPO's Phone#:
Date: Sf �7 _'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 NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: N t VJ R e R 4
Address of Property: 13 3 Vi US Ili[' C: 13 p �X t h �2 is
Mailing Address of Owner: t_)((�(� � i �!L.�cL A -7-7 q c/
�_— _ r� r
Owner's email: Owner's Phone#: % - 2
Agent's Name: &6 ) C_t�-Z Agent Phone#: j ,z -2 "7 U
Agent's Email:
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.
I DO NOT have objections to this proposal. __ I DO have objections to this proposal.
it 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 Mail.
WAIVER SECTION (Choose only one
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
-OR-
Signature of Adjacent Riparian Property 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: ! % ,,/) "&&,t;.-
Mailing Address of ARPO:
ARPO's email:.. �&, 4,rf ARPO's Phone#:
Date: *waiver is valid for up to one year from ARPO's Signature'
Revised August 2022

-12x12 DECK
10000 LB
BOATLI FT
6X40 PIER
{6
X6 LOWER
PLATFORM

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