86957A - Catalfamo

0U rV ❑CAMA ❑ DREDGE & FILL
GENERAL PERMIT
N1New ❑Modification ❑Complete Reissue ❑Partial Reissue
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:
I SA NCAC f ?, ❑ Rules attached. 0 General Permit Rules available at the following link: www.deo nc gov/CAMArules
Applicant Name Authorized ,agent J- s. i'I & r P. ,t
Address lr' Project Location (County):
City - State ZIP Street Address/State Road/Lot#(s) -fit U;..,
Phone # I—)
Email Subdivision f)k= 1. 4 _z;; (�.
City _.,._....-. ZIP 2'
Affected ❑CW ❑.EW QPTA ❑ES ❑PTS Adj. War. Body ;(nat/man/unk)
AEC(s): ❑OEA ❑IHA ❑uW ❑SPIMA ❑PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale:
Shoreline Length
0
up,
WIN
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�'
10-
1
No
Avg distance offshore
Max distance/ length
Basin, channel
Cubic yards Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Ither
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ME
■■ME
in
■
■!■■
0
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ONE
ME
on
Noll
;AV observed: yes
Vloratorium: n/a yes no
ifte Photos: yes no �4
yes no
■
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■■bra■���■m■■
A. f
noTdiparianWadverAttachecl:
OEM
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A building permit/zoning permit may be required by:
Permit
Lac Ar
❑ 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 PROJECTAND REVIEWED COMPLIANCE STATEMENT. (Pleaselnitial)
Agent or Applicant PRINTED Name
Signature **Please read compliance statement on back of permit*
4ACN G i_ 1e0 1
Application Feels) Check ft/Money Order
Permit Officer's PRINTED Name
Signature
Issuing Date
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ('t oL, C-41-� ,� AY-►'t b
Mailing Address: 1/0 �_4_
Phone Number:
Email Address: LQOya "; - cPi�+ G% f{-dL,CerA.
I certify that I have authorized LfiN 6' t//rJ rj - 0 S Ilj pin Q
Agent / Contractor t ��
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: (30,47— Li Pr-
at my property located at _)/D 7) (L C d R 2 i i JC)<'
i
in COX it i l i� County.
l 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.
Property Owner Information:
Signature
Whiff_. CA-ZAI-62Y'Y) U
Print or Type Name
bwrJ
Title
Cate
This certification is valid through I I
V D
MAR 0 7 2023
DC M- 7-C

MAR 0 7 2023
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIEDM8JL • RFTURN -�RGE PI 7 REQLE—! TFQ or WAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property owner, _� V rrCp N /_.!Cj._C1 7�/ �� �!) f✓
Address of Property: f I b TFf4r 1) (7- C u /1 t?) f7J �iv� a 7S z 1
Mang Address of O.vnor.
Owners email: fy'VOCetM6�/IOl.,C1Yr� owners nnenen: .5a-,�S6'O'7dS`
Agent's Name: (cIJ-- F_t,, , Ak)a �, rCi, Agent Phone#. S 7'—1
Agont's Email;
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be vymolotiW by the Adiaaent Properly Owner)
I hereby certify that 1 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. e
description or drawing, with dimensions must bo._prggjded wi(, s tell r.
__I__ I DO NOT have objections to this proposal, _ I DO have objections to this proposal,
l.JCM -Ec
n you nave oo/eepons to wnar is Doing proposed, you muse noury me nra.. u,vrarvr, ...
management (DCAI) in writing within 10 days of receipt of this notice, Correspondence should be
mailed to 401 S. Grifrin St., Ste. 900, Elizabeth City, NC, 219oo. DCM representatives can also be
contacted at(252) 254-2901- No response is considered the same as no objection Ifyou have been
notified by CarNffed Atalf.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pHkngs, twat ramp, breakwater, boathouse, lift, or
groln must be set bade a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revelments), (If you wish to waive the setback, you must sign
the appropriate blank below.) �{%
I DO wish to waive some/all of the 19 setback y j(
Signature of Adjacent Riparian Property Owner
-OR-
1 do not wish to waive the 15' solback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner.
Typed/Printed name of ARPO: F/i It}Q1'd SS�
Mailing Address of ARPO: `1(z� Z14h ArGW. �)3radt�. p FL 3+269
ARPO's smalll: U�9XIShd �e �.L01tiL ARPO's Phone#: 2,67-- DL-01+3+
Date: 11Z712,3 'welver 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: Pa UL. AimZ7 /V _1WC i CA M 6it/r b
Address of Property: 1/U TEAL G2 iu/1(!/TUCK, tyC 2%5�'J
Mailing Address of Owner:
/! 8
%rF_4L,,,
D& rU/e2/ tA/O o2%9
Owner's email: m—wocecell
dmtocoen
Owner's Phone#:'otS�-aS6�0�d S
Agent's Name: (",,S,V tla i np2 (A e EVY s)
Agent's Email:
Agent Phone#: 457 -' 6-7
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 drawino, with dimensions must be provided with this letter.
x 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 (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
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,)
1 DO wish to waive somelall of the 15' setback / i
Signature of Adjacent Riparian y Owne
•OR -
I do not wish to waive the 15' setback requirement (initial the blank)
MAR 0 7 2023
Signature of Adjacent Riparian Property Owner:
Typed/Printed name of ARPO: PAM L„ A LYK,r) 3 �� ` ,� (�'
Mailing Address ofARPO: ir7�4�.. ��- (^t/P<i'./ i�''j�. r11C �'��
ARPO's email: ARPO's Phono#:
Date: `waiver Is valid for up to one year from ARPO's Signature'
Revised July 2021

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