86868A - Hazlett

,oA(0Mr1'❑CAMA El DREDGE & FILL NY 86868 Q ( A B C D
so., GENERAL PERMIT Previous permit
Date previous permit issued
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized Eby 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.d .nc.gov/CAMArules
Applicant Name
Address
City State ZIP
Phone # O -
Email
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s) _
Subdivision }
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body t (nat/man/unk)
AEC(s): ❑ IDEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Mal. Wen Body
ORW: yes/no PNA: yes/no.
Type of Project/ Activity
(Scale:: )
^_
I
Y
Access Length
,�
I
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Pier (dock) length
L
3
FixedPlatform(s)
IL _•.
j
._
_
-
�_
—
_
I_
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I
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I
Floating Platform(s)
Finger pier(s)
I _
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I
-1
I_
Total Platform area
Groin length/#
Bulkhead/Riprap length
Imot
-~r}
)-{.
Avg distance offshore
Breakwater/SillMax
distance/lengthBasin,
channel
Cubic Yards
Boat ramp
—%—
_
Boathouse/Boatlift
I
I
Beach Bulldozing
Other
SAV observed: yes no
Moratorium: n/a yes no
TI
i
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by: w,v„.4�-c.
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. (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#/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: Justin Hazlett & Danielle Hazlett
Address of Property:
101 Mallard Drive, Currituck, NC 27929
Mailing Address of Owner: 101 Mallard
Owner's email: [e-mail]
Agent's Name:
Agent's Email:
Currituck, NC 27929
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 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.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
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 abply 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: c
,t 7 mU
Mailing Address of ARPO: cJ , U - od
ARP a ail: C ARPO s Phone#: 21 41J
Date: J *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: Justin Hazlett & Danielle Hazlett
Address of Property: 101 Mallard Drive, Currituck, NC 27929
Mailing Address of Owner: 101 Mallard Drive, Currituck, NC 27929
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 be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacent to 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.
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
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
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
-0 R-
I DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: Gi yr v�
Typed/Printed name of ARPO: r u hi GLi h r
Mailing Address of ARPO: 4,01,0 e U)e-1 '�—. I t= )K k Aa311
ARPO'semail: PO'sPhone#:
Date: 4111 ;xo z-:S *waiver is valid for up to one year from ARPO's Signature*
Revised August 2022

Currituck Boat Lift & Marine Services, LLC
Existing Boat House
Set For Demo
1216111 6x6 Piles Replaced with
8" Butt 25' 2.5 CCA Marine Piles
�— Double 2x12 Roof Band
5/8 Galvanized Timber Bolts
Cl)
N
ti D k
Proposed 8k Hi -Tide Boat House Style Boat Lift
[OF ma.
Justin Hazlett
101 Mallard Dr
Bells Island
Currituck, NC
27929

121611
Square Piles = Bulkhead Piles
New 8" Round Piling Embedment is 8' or more
The 8" Butt Piles Will be Notched for The 2x12 Roof Band to Rest In and be Bolted to with 5/8 Galvanized Timber Bolts
The Boat Lift is to be Mounted on Top of the Double 2x12 Roof Band

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: Justin Hazlett & Danielle Hazlett
Address of Property: 101 Mallard Drive, Currituck, NC 27929
Mailing Address of Owner: 101 Mallard Drive, Currituck, NC 27929
Owner's email: [e-mail]
Agent's Name:
Agent's Email:
Owner's Phone#: [phone]
Agent
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adlacent Property 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
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
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 onel
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 blank)
Signature of Adjacent Riparian Property
Typed/Printed name of ARPO: ti`IYY�-�,2a� i�CX GI�V� f�r
Mailing Address ofARPO: to),QaC,+ ink 66,fr? L�t,wd-hXCY. �L 2:TQ29
ARPO'semail: a•%2i��QefCs fY1CAh(°AR O'sPhone#: u2 -W7 -RGZia '_Cit027
Date: 5, 1(Q -W: ' 'waiver is valid for up to one year from ARPO's Signature*
Revised August 2022

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