89745A - Kennedy

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❑CAMA ❑ DREDGE & FILL N9 89745 Q� 'A )B C D '
Previous permit
GENERAL PERMIT Date previous permit issued
❑Modifiication ❑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 y,1 f i 12` o 0 ❑ Rules attached. General Permit Rules available at the following link: wwwdecinc y, ov/CAMArules
Applicant Name r Vy (' 11 ."5 F f' h Yl 1 1
c[ LA
Address I o �")� t A% rL'� r I �( if (><'E
City / IJ t) iit�Ui_'i�� State �.i ry '. ZIP
Phone#(�f'1) 'T ()�,— tiQ`s)%
Email 414 1 kr'1314ed- j2 Q l rf
Authorized Agent
,I
Project Location (County): C u, f'Y
i
Street Address/State Road/Lot #(s) � � � �> I I G
Subdivision
.i .i City ZIP
Affected ❑ CW DEW PTA ❑ ES ❑ pTS Adj. Wtr. Body (—T) V Y � (rhaa /man/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body C
ORW: yes/no ' PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length
Pier (dock) lengtl
Fixed Platform(s)
Floating Platforms)
Finger pier(s)
r
Total Platform area V
Groin length/# —
Bulkhead/ Riprap length
Avg distance offshore_
Max distance/ lengt
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 r
Permit Conditions
I�
(Scale: )
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 Permit Officer's PRINTED Name
Signature -*Please read compliance statement on back of permit" Signature
Application Feels) Check Jf/Money Order Issuing Date
Expiration Date

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: Chris Kennedy
Address of Property: 1097 Waterlily Rd., Coinjock, NC 27293
Mailing Address of Owner: 1097 Waterlily Rd., Coinjock, NC 27293
Owner's email: [e-mail] owner's Phone#: [phone]
Agent's Name:
Agent's Email:
Agent
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to qe completed by the Adlacent 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
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.G. unnsion or G055101
Management (I)CM) 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 representatNes 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 Whom my area of riparian acce s unless wai d by me
(this does not apply to bulkheads or riprap revetments). (If you �py�ish to waive a 7etb�ack, yo must sign
the appropriate blank below.) /, t ;fi` „{et Z+
I DO wish to waive some/all of the 16 setback
HIM
I do not wish to waive the 15' setback requirement (initial the
Signature of Adjacent Riparian Property Owner:
TypediPrinted name of ARPO: n unp v of iuq, a n„y
Mailing Address of ARPO:
ARPO's email.•^ r 6A L ARPO's Phone#: 3 ,t , 1- j
Date: J j 1 ' 6%��-L—*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 NOTIFICATION/WAIVER FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: Christopher J. Kennedy
Address of Property: 1097 Waterlily Rd., Coinjock, NC 27293
Mailing Address of Owner: 1097 Waterlily Rd., Coinjock, NC 27293
Owner's email: [e-mail]
Agent's Name:
Agent's Email:
Owner's Phone#: [phone]
Agent Phone#:
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 de;cfibed to me, as shown on the attached drawing, the development they are proposing. A
100 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 wilting 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) 2"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 some/all of the 15' setts q J / j / // f1
-OR- i future of Act k&nt Riparian Property Owner
�%
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Ov
Typed/Printed name of ARPO: Thomas
Mailing Address of ARPO: 113 Perkins Lane, Coinjock, NC 279233, L
ARPO's email _ __ ARPO's Phone#: a501 i 2 a LJ
Date: — __ 'waiver is valid for up to one year from ARPO's Signature`
Revised July 2021

Posts
vvv ••
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Proposed Dock ?
•
2 2,
Ck— I ino
Waterlily Rd.
1097 Waterlily Rd. m
Perkins Lane
Boat Lift
d
m1093 Waterlily Rd.

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