89772A - Emmons

1► &**-,SGAMA ❑ DREDGE & FILL. �' N9 89772 n(�} a C o
GENERAL PERMIT Previous
Date previous permit issued
(� New []Modification []Complete Reissue (I Partial Reissue
U adtortard by the Suttee of �North Grdina, Depvor)" of ErtWrpww1w QLWity and the COMW Raeaurces Cpnmission to in x of ermrcxr,�enai concern pw3wrt to:
I SA NCAC _f'T
_. ,1 ' i arc) ❑ hAm Awhod. N Genoraf Perrmt Ruk- waWs a the fogoering 4nk Wert JCAMA
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ype of Project( Activity
>ler (dadt) Iengtn (2 .. ....-0t.:.t�'k•�.t.S
nixed PixiPrxm(s} rii-ttiq„r
'ioatin6 Plattorm(s) '^ � �C.•°""'�'
L
•roger pietjs}
`otal Platform arve
tntkhead/ Rrprap ferWth
tmakwater/S ___._....--
Aux dotante/length
Win, channel `._�'—' :.. • .{f f�',—�•�{
:obit yards .
W trump
3oethouse/ ___[4t M r _• ',�__,. ......
leach euRdorfng
Aher
AV observed: no ((''y�y,,"���"`,"�•�'r--��----••��
vioratorrum: na J 9- t1.
pp n c"'s.AYtM T
e photos: ss no t T ., .. _ l ..
Uparian Waiver Aroched. yis ...._...._.... ..___ _ _ 4_ .._ _.__...... .,.._.. ._:
i building permit/xoning permit may be required by: "� .. c g
1 (J y,t ,, ' _ `, ' TAWFAMMEUSFJ6UKKER (Cade me)
*"A Conditions .,.' 1. � yPtam*x�`tJ CAC, 4�m ��
___ ...._ ._.._.... ._ i *a t'7. 't[\diat,._. _ See note on back mparmR Rorer Ravn rules
srr.,"borwl notes/conditions on back
AM1 AWARE OF SPATUM CRC RULES AND tXOerot M THAT APMY TO THtS PROItg ANO RN!M q COMPUANCE STATEMENTI (P6case IniWij
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g�tjory*�Icant MNTP Name permit OW*rs pf INJEO Name
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nat'dai lase readcamPFiance anerneRt on back of pernnftA Signa�jsrre f
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®CAMA ❑ DREDGE & FILL
a GENERAL PERMIT K
,z
N° 89772
Previous permit
Date previous permit issued
Q B C D
®New ❑ 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:
15A NCAC -14 , 19el� ❑ Rules attached. ® General Permit Rules available at the following link: www.deq.nc goy/CAMArules
Applicant Name S 1-�%gcuN `& Kee JI4 t- myi 6Y15
Address Io� 111�and ?A,
City 56e�'{'� �.rf-AAXSpS�tate RC- ZIP aIgIto
Phone #(1"Za
Email sFe.mYNN1, Q amC)A'COm
Authorized
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City ZIP OG 1 -E T7
Affected ❑CW �EW ©PTA ❑— ❑PTS Adj. Wtr. Body /� ` / t tt:yl��an/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body 41bptig'ytr(2
ORW: yes no PNA: yes/0
Type of Project/ Activity S r X f f pre, k r la
OLr� to f x ( Z' (Scale:11=3
Shoreline Length
Access Length
o
Pier (dock) length a (ot � / `trq e
Fixed Platform(s)r4-��
r u
Floating Platform(s) �
SW t �ti
Finger pier(s) ram"--- 0ct`��.
t-
TotalPlatformarea `9�oBypl-
Groin length/k -�
Bulkhead/ Riprap length
Avg distance offshore_
Breakwater/Sill ��`
Max distance/ length "�
Basin, channel
Cubic yards
Boat ramp t 1
Boathouse/ oatli IQ 11 / Zr
Beach Bulldozing
Other
SAV observed: e3 no t'���
Moratorium: (/�+ yes no t"kxr�7
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
Permit Conditions I� NOv�. c:i=
Agent or Applicant PRINTED Name
N. W�Rn yr-•�'trY1
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
U ' K
Permit Offi 'c� INSED Name i
Signature **Please read compliance statement on back of permit** Signature
&/Zo/z 3 It 012 o%Z 3
Application Fee(s) Check ft/Money Order Issuing Date Expiration Date

❑LAMA ❑ DREDGE & FILL NU 89772 A B C D
}'.' Previous permit
. GENERAL PERMIT Date previous permit issued
0 New ❑ 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. 0 General Permit Rules available at the following link: wwwden nc gov/CAMArules
Applicant I
Address _
City
Phone #
Email
State ZIP
Affected ❑ CW ❑ E W ❑ PTA
AEC(s): ❑ OEA ❑ IHA ❑ UW
ORW: yes/nod PNA: yes/po,
Type of Project/ Activity
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pler(s) I
i
Total Platform area
Groin length/# -'
Bulkhead/Riprap length
Avg distance offshore _. r
Breakwater/Sill j jjltl
Max distance/ length "
Basin, channel -- --
Cubic yards
Boat ramp �
Boathouse/ y``oatllfti (�
Beach Bulldozing
Other
1=___
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 required by:
Permit Conditions
❑ ES ❑ PTs
❑SPIMA ❑PWS
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Adj. Wtr. Body
Closest Maj. Wtr. Body
(Scale: )
❑ 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 NOTIFICATION/WAIVER FORM EC I V E E
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner:
Address of Property:
Mailing Address of Owner: /Uol r5l6iv,6F so_� muds
Owner's email:5lfr'171NDn5 fi, `� 1u') f� "� Owner's Phone#: 7S 7 71 7"— ,�/�l
Agent's Name:
Agent's Email:
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
J U N 0 1 2023
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 15from 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 Owner:
Typed/Printed name of ARPO: JER R y 1Ayq SCE
Mailing Address of ARPO: 3512, b L V E fA &A Lr ^t C.1 f2 . \/A, r3xkc
rL c0• a3452
ARPO's email: JERXYL i ��Ts���i CM'A�ARPO's Phone#: 15"1-13� '� 1 1(
Date: ' n M k1 &o 3 *waiver is valid for up to one year from ARPO's Signature"
Revised August 2022

TIPS FOR ADJACENT RIPARIAN OWNER NOTIFICATION & WAIVER FORMS
CAMA Regulations require notice of proposed development to the Adjacent Riparian Property Owners (15A
NCAC 7J.0204(b)(5)). Proof of actual notice (a sign -off by the owner on this form) or certified mail return
receipts (showing delivery of notice) are needed.
The purpose of this notice is to make adjacent riparian property owners aware of the proposed development
so that they have an opportunity to provide comments (or potentially object to) the proposed development,
and to give DCM an opportunity to consider these comments/objections before a permit decision is made.
"Permission" of adjacent property owners is not necessarily required for DCM to issue a permit; however,
permission must be obtained for certain types of proposed developments if they fall within a 15' setback area
along the riparian access area of the adjacent property, as determined solely by DCM. It is in the applicant's
best interest to provide comprehensive and accurate notice so that any concerns or objections can be
resolved early in the permit review process. In addition, if the adjacent riparian property owner appeals the
permit decision, insufficient notice could be a basis for granting such an appeal.
Who is an Adjacent Riparian Property Owner?
What is Adjacent? (Note: DCM reads this broadly to ensure comment by potentially impacted neighbors)
• A property that shares a boundary line with the site of proposed development; AND
A property that fronts a natural or manmade waterbody that is connected to coastal waters and
can support some form of navigation, even a kayak or canoe, including a common canal system
or a manmade basin.
• Easement holders? Yes, if the easement could be impacted by the proposed development.
• Streets/Roads? Only if the streettroad could be impacted by the proposed development. This
might include street -ends which might be used for parking and beach access.
• Holders of recognized submerged lands claims/shellfish franchises.
What is Riparian?
Do the boundaries of the adjacent property legally intersect with the water at mean high tide? If there is a
question about whether an adjacent property is considered "riparian,' please reach out to DCM Staff -
especially on the oceanfront beach where there may be undeveloped parcels on the beach or in the water.
Who/What is a Property Owner?
Forprivate individuals (or families), send notice to the address listed on the tax card. If the property is owned
by an Inc. or LLC, please send notice to the person listed as the registered agent on the NC Secretary of
State's Corporations Look Up site: hftps://www.sosnc.clov/search/index/corp. For Condominiums or
neighborhoods with an owners' association (HOA/POA), send notice to the association (which is usually a
corporation, for which you send notice to its registered agent).
What is Notice, and how do I ensure it is received?
• You can meet with your adjacent property owner, provide a description or drawing of the
proposed development, and ask them to sign this form and return it to DCM; OR
• You can hand -deliver this form and a description or drawing, and ask your neighbor to return it to
DCM (consider providing them with a stamped envelope); OR
• You can mail this form by USPS Certified Mail, return receipt requested (the Green Card). If you
choose this option, you must provide either the signed & returned green card OR track the
certified mail package number on USPS.GOV's online tracking system, and provide the tracking
print-out as proof of delivery to DCM
If you have any questions about this process, please reach out to DCM Staff and DCM Legal Counsel
and we will work to answer your questions.
Revised August 2022

5-30-23
To: Cynthia Rountree / CAMA
401 S. Griffin St. Suite 300
Elizabeth City, NC 27909
From: Shean and Kerry Emmons
104 Island Rd
South Mills, NC 27976
757-717-8921 -Cell
[e-mail]
Proi.ectAddress: 507 Winslow Rd.
Hertford, NC 27944
Ms Rountree,
please see the attached information for your review and an enclosed check for $200.
Shean Emmons
JUN 0 1 2023
®CM -EC

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FOR4-1 r-% ' p 1
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY d D
(Top portion to be completed by owner or their agent) J U N 0 1 2023
Name of Property Owner:
0
Address of Property: _7U ! IiJI/`OI'6Oi./ I0' (X`• In=1rTut C /1 i r I
Mailing Address of Owner: ��O))u-) �'Sll%vt IZt'. Y�v 1"�`(�S+ a %� 7tJ
Owner's email:'565grVvV6 P ! AAeiA. Cdi-4 Own er's Phone#: 757- 7C7- Y'`
Agent's Name:
Agent's Email:
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I herebycertify that 1 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
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
M
I DO NOT wish to waive the 15' setback requirement (initial the blank)
Phone#: (2S 4=
1 J
Date: J I I q 123 *waiver is valid for up to one year from ARPO's Signature*
Revised August 2022

DECEIVED
JUN 0 1 2023
DCM-EC
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